Coping with Alzheimer's

When driving becomes an issue

The freedom to slide behind the wheel of a vehicle, turn the key and drive away symbolizes many things: independence, convenience and competence. So its understandable that most of us want to be able to drive as long as possible. Although advancing age may bring a decrease in vision and hearing and a slowing of reflexes, most people learn to compensate for such diminishing abilities. For example, an older person may decide to drive fewer miles, more slowly and not at night. Even though its never an easy choice, most people determine for themselves when its time to limit or stop driving.

When to stop

For a person with Alzheimer's disease, the decision to stop driving is often not voluntary. Just how long someone with Alzheimer's should be permitted to drive (if at all) is an issue that stirs the emotions of those with the disease, their caregivers and the general public. Although some states, such as California, require that people with Alzheimer's disease be reported by their physicians to the state health department and the department of motor vehicles, most states don't have such requirements.

Increased risk

The risk of being involved in a traffic accident increases with a drivers age. Even older adult drivers without Alzheimer's disease are more than twice as likely to be involved in fatal traffic accidents as are middle-age drivers. According to a study published in the December 1988 issue of the Annals of Neurology, per mile, people with Alzheimer's disease are 19 times more likely to have an accident than an older adult without the disease. Despite this increased risk, people with Alzheimer's on average drive 2.5 years after their diagnosis &em; even though they may have significant cognitive impairment and have been advised by a caregiver to stop.

Surveys indicate the general public prefers that physicians help keep unfit drivers off the road. However, health care professionals have conflicting opinions on the subject of when to take away the keys from people with Alzheimer's. Because the disease progresses differently in each person, its nearly impossible to generalize about when people with Alzheimer's lose their ability to safely handle a motor vehicle. What makes it even more imprecise is that some people in the early stages of the disease are still able to pass a driving test.

Psychological tests can help determine whether someone with Alzheimer's has the memory, perception and coordination needed to drive safely. But there are no definitive, quantifiable, standardized tests to pinpoint when driving should be discouraged or stopped. As a result, caregivers remain responsible for continually reassessing the driving abilities of a person with Alzheimer's. As the person becomes more impaired, the caregiver must balance loss of independence and dignity against the risk to self and others in making the decision.

When safety becomes an issue

Knowledge of the rules of the road, good judgment and adequate eyesight, hearing and coordination are all needed for safe driving. Some experts say that over the years, the ability to drive is so ingrained that it becomes somewhat "automatic." Driving skills seem to be well-preserved into old age in most people.

Most experts agree that even if a person has good coordination and reasonably sharp senses, when judgment is compromised, driving becomes unsafe. "Most people with Alzheimer's disease think they're safe and skillful drivers," says Dr. Jonathan M. Evans, a specialist in internal medicine and geriatrics at Mayo Clinic, Rochester, Minn. "What's interesting is that people with the disease forget that they can't remember how to make good judgments," Dr. Evans says. "They lack the insight to voluntarily stop driving."

Warning signs of unsafe driving

If you're the caregiver of someone with Alzheimer's, its up to you to assess that persons ability to drive. When any one of these signs is apparent, its time for the person to give up driving:

• Inability to locate familiar places
• Failure to observe and obey traffic signs and speed limits
• Poor or slow decision-making in traffic
  
• Anger, confusion or frustration while driving
  

"My concern is that real-life driving situations, even in familiar areas, are not predictable," says Dr. Evans. "People with Alzheimer's disease are unlikely to be able to judge or respond quickly. That means they may have difficulty reacting properly to a situation like a child crossing in front of them or a car stalled in traffic, even when it happens on a familiar stretch of road."

Dr. Evans adds that there may be no warning signs of deteriorating driving skills. He says the unpredictable course of the disease, with an inevitable decline in cognitive skills and judgment, are reason enough to advise all people with a diagnosis of Alzheimer's disease not to drive.

"My opinion is that you can either drive a day longer than you should and risk a tragedy, or you can stop a day early and avoid serious injury or death," Dr. Evans says. "As a physician, it's my responsibility to bring up this issue with the patient and family. This relieves the caregiver of that pressure."

One thing is certain. Eventually the physical limitations of the disease stop everyone with it from driving.

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