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by Jill Lorentz

Jill Lorentz www.summitresiliencetraining.com • info@summitresiliencetraining.com

When is it No Longer Safe for the Person with Dementia to Drive by Jill Lorentz Driving is a sensitive issue, we need to be respectful to everyone’s feelings. For the Person with Dementia it is a loss of independence and their lifelong mode of transportation. For the family and friends, it is a scary issue of safety and liability. Dementia and Driving When an individual is diagnosed with dementia, one of the first concerns that families and caregivers face is whether or not that person should drive. A diagnosis of dementia may not mean that a person can no longer drive safely. In the early stages of dementia, some— though not all—individuals may still possess skills necessary for safe driving. Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time. This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving. Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting. Some individuals, recognizing the risks, will limit or stop driving on their own. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk. Because the progression of dementia varies from person to person, it is difficult to know at what point an individual can no longer drive safely. This fact sheet provides guidelines to help caregivers and persons with dementia decide when and how to limit or stop driving.

Deciding When to Stop As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Individuals with moderate or severe dementia should not drive.

Observe Behavioral Signs You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. When is it No Longer Safe for the Person with Dementia to Drive by Jill Lorentz Following are some signs that a person no longer has the necessary skills to drive safely. He or she: • Has become less coordinated. • Has difficulty judging distance and space. • Gets lost or feels disoriented in familiar places. • Has difficulty engaging in multiple tasks. • Has increased memory loss, especially for recent events. • Is less alert to things happening around him or her. • Has mood swings, confusion, irritability. • Needs prompting for personal care. • Has difficulty processing information. • Has difficulty with decision-making and problem solving.

It is important to compare present behavior with behavior before the onset of dementia. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. Share and discuss your observations with other family members, friends, and health care providers.

Arrange for an Independent Driving Evaluation The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles (DMV).

Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.

Continue to Monitor Driving If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly in a short period of time. The objective of monitoring is to detect a problem before it becomes a crisis. If there are any doubts about safety, the person with dementia should not be driving.

It is often helpful to keep a written log of each incident of poor driving behavior. Following are some of the common warning signs. • Drives too slowly. • Stops in traffic for no reason or ignores traffic signs. • Becomes lost on a familiar route. • Lacks good judgment. • Has difficulty with turns, lane changes, or highway exits. • Drifts into other lanes of traffic or drives on the wrong side of the street. • Signals incorrectly or does not signal. • Has difficult seeing pedestrians, objects, or other vehicles. • Falls asleep while driving or gets drowsy. • Parks inappropriately. • Gets ticketed for traffic violations. • Is increasingly nervous or irritated when driving. • Has accidents, near misses, or “fender benders.”

Discuss any concerns you have with the individual, family members, and health care providers. All involved will need to weigh potential risks and decide when the individual needs to stop.

Ask Individual to Co-pilot You can also estimate an individual’s potential for a traffic accident by taking the person along as a passenger and asking him or her to co-pilot. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. If he or she has difficulty or becomes frustrated easily, it may be time for another independent driving evaluation.

Involve Person in Discussions Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. Encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive. Support groups provide a good venue for both the caregivers and the individual to talk about their feelings and get advice from others in a similar situation. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.

If the individual is reluctant to talk about driving, ask the individual’s physician or care manager to bring up the subject of driving during health care visits. A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning.

Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will need to find the solutions that work best in their situation.

Limit Driving Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin gradually to modify their driving. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. Making the transition from driver to passenger over time can help ease the adjustment. Encourage individuals to try some of the following examples: • Drive only on familiar roads and avoid long distances. • Avoid heavy traffic and heavily traveled roads. • Avoid driving at night and in bad weather.

Reduce the Need to Drive Individuals able to maintain an active life often adjust better to the loss of driving  privileges. Following are some ways to reduce the need to drive: • Have groceries, meals, and prescriptions delivered to the home. • Arrange for a barber or hairdresser to make home visits. • Invite friends and family over for regular visits. • Arrange for family and friends to take the individual on social outings.

Make Arrangements for Alternative Transportation It will be important to make alternative transportation arrangements so that the individual’s mobility and activity level are not unduly restricted. Commonly used transportation options are: • Family and Friends. Family members, friends, and neighbors can offer to drive       the individual to social engagements and appointments. Consider making a   list with the names, phone numbers, and times of availability of those willing   to provide transportation.

Public Transportation. For individuals in the early stage of dementia, public   transportation may be a good alternative to driving. It works best for those who    are already familiar with the public transportation system in their area. Persons in    the later stages of dementia may not be able to figure out routes and schedules. • Taxis. For individuals in the early to middle stages of dementia who do not have    behavior problems, taxis can be a good option if someone meets the individual at    both ends of the taxi ride. You may be able to set up a payment account with the    taxi company so that the individual with dementia does not have to handle money. • Senior and Special Needs Transportation Services. The Yellow Pages of many    telephone books have a special section in the front with the names and addresses of   various service organizations. Look under transportation or community services   for the names of agencies that provide transportation for special needs. • Eldercare Locator (www.eldercare.gov), a nationwide directory assistance   service designed to help older persons and caregivers locate local support   resources, including transportation, for aging Americans.

When Persuasion Fails Ideally, an individual will limit or stop driving on his or her own. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. While it is important to maintain respect for the individual’s feelings, you must put safety first.

As a last resort, you may have to prevent his or her access to a car. Some methods to do that include: • Hiding the car keys. • Replacing the car keys with a set that won’t start the car. • Disabling or selling the car. • Moving the car out of sight. Caregiver Support Balancing safety with respect for an individual’s desire to drive can be difficult and emotionally trying. Enlist the support of other family, friends, caregiver support groups, and health professionals when making and implementing difficult decisions about driving. For further information and support, contact the service organizations under “Resources” at the end of this fact sheet.

For Colorado Residents: Go online www.drivesmartcolorado.com , Colorado Guide for Aging Driver’s, if you need more assistance: DriveAble is a great option, it takes away subjectivity/based on science. It is computerized testing which gives objective data. Looking for discerning info btw Bad habits vs poor decision making, reaction time and depth perception. This is a respectful way to deal with situations and  & take emotion out of it. You must have a diagnosis and referral. Not mandatory reporting agency, but does report back to physician and filed. In some cases release signed to send DMV results. PWD has recourse to ask DMV for follow up testing. Caveat/ if it is in file that you are a safety risk driver & accident occurs, insurance will likely not cover you and deny claim. Family is responsible.  KP, Medicare; cost between copay and full coverage to private pay. Several locations in Colorado. Widely required in six countries and 40 states.

Jill Lorentz www.summitresiliencetraining.com • info@summitresiliencetraining.com