14 Jan 2007
Dear Mary,
How do I know when it is time for my father to stop driving? He was diagnosed with early Alzheimer’s disease in August and spent most of his adult life behind the wheel as a delivery person. He has always prided himself on knowing the rules of the road and I worry that taking away driving privileges will cause him great emotional harm. Most of the time my stepmother rides with him and directs the way but other times he is out on the street alone. He has become confused before while walking and had trouble finding his way back home. I would appreciate any tips you might have.
Dear Reader,
Generally speaking, caregivers and Alzheimer’s disease affected persons overestimate abilities - and the same holds true for driving. The process of driving requires sequential thinking, concentration, good judgment, and the ability to plan ahead and anticipate problems. Alzheimer’s disease gradually diminishes ability in all these realms making the person a danger to himself and others on the road. The ability to do things in order gradually diminishes and agnosia (the inability to recognize things) renders the person incapable of recognizing street signs and traffic lights. Spatial visual problems interfere with judging distance and confusion over gas and brake pedal can occur. Warning signs that say it is time to stop driving include: unexplained dents, bumps, and dings on the car; incorrect signaling and confusion about turning left or right; speeding or driving too slowly; drifting into other lanes; ignoring stop signs and traffic lights; and getting lost.
Now, the real question is how do you get him to stop driving? You can report him to the Maryland MVA Medical Advisory Board (410-768-7511) who will send you a packet to be completed by his physician. Most physicians’ offices have this information on hand and will do initial testing and send the results to the board. In some cases the person refuses to accept (or forgets) that he can no longer drive and more drastic measures must be taken. They include: disabling the car; hiding the keys; or better yet, removing the car from sight and telling him it is out for repair. You can keep using this excuse until the thought eventually passes. It is important to have alternative means of transportation available to prevent isolation and depression.
Dear Mary,
I had a disturbing experience that I would like to warn other caregivers about. I was transporting my father to an appointment when he opened the car door at a stop light and got out right in the middle of traffic! He has dementia and apparently he thought that since we stopped, it was time to get out. Fortunately, he was not hurt but it took some convincing to get him back in the car. Now I lock all the doors before I put the car in drive.
Dear Reader,
Thank you for the warning and thank goodness he was not hurt. I think of caring for someone with dementia as an adventure and one should always be ready for the unexpected.
Cars with automatic locks are very convenient, but some allow front seat passengers to exit by pulling on the handle. The safest car is one with a master lock that secures all doors from opening until released by the driver. Another hazard is automatic windows which pose a threat for escape or injury. Here, again, a master lock allows the driver to disable individual control. Everyone should check their cars for these safety features. I checked mine and was surprised that it did not have a master safety door lock only a window lock.
Mary C. Fridley RN, BC
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