To Drive or Not to Drive...

What should you do when driving becomes a problem?
 
Driving
    is a sign of independence to most people, but when your loved one
   starts to become a danger to himself or others, it is time to think
   about taking away his or her driving privileges. In early Alzheimer's
   a person's memory is affected, so it is very easy for a person to get
   lost or disoriented, making it difficult to get back home. Not only
   is this dangerous, it is also very frightening to the patient! He or
   she may also become confused or scared with all of the noise and
   commotion of the traffic going on around them as they drive. This
   could be the breeding ground of an accident. Here are some signs to
   watch for to determine if it's time to stop your loved one from
   driving:

Memory lapse that causes them to become lost or unable to locate
familiar places. Confusion or disorientation while driving.
Inablility or failure to heed and obey traffic signs and/or speed limits.
Inability to make good judgements in traffic situations.

So how do you go about telling your loved one that you can no longer
allow them to drive?

Here are a few things you can do that may help prevent them
   from driving:

Talk to them
    about their driving and the dangers they face, but don't become
    critical of them. Tell your loved one that you have to take the keys
    away for his or her safety. Make sure they know that you understand
    how they feel, and that you are there to support them.

Never leave the
    keys out where the loved one can find them. Be sure to have a good
    hiding place.

Make sure the
    patient does not have a duplicate set of keys to the car.

Make sure that
    the person knows he or she can depend on you to take them
whereever they want/need to go.

Often times, one
   must take more extreme measures to ensure their loved ones don't
   drive. In a lot of states, you may be able to report a driver with
   dementia to the state's Department of Motor Vehicles. In some states,
   it is required that the physician report cases of Alzheimer's to the
   DMV. You should check with your state's DMV for more
   information.

http://alzheimers.about.com/health/alzheimers/library/weekly/aa101800a.
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Driving Guidelines Issued for Alzheimer's Patients
WASHINGTON, June 26 (UPI) -- The American Academy of Neurology
says it
is time to crack down on drivers with Alzheimer's disease and is issuing
new practice guidelines that tell neurologists how to negotiate the
emotional issue of taking away a patient's car keys.       Writing in
the June 27 issue of Neurology, a special AAN committee says patients
with Alzheimer's Disease and a Clinical Dementia Rating (CDR) of 1 have
a "substantially increased accident rate" should not drive. For that
reason, the AAN wants physicians to tell both patients and patients'
families that the patient should no longer drive. These new guidelines
have widespread implications since the Alzheimer's Association says
there are 4 million Americans with AD and it estimates that the number
could increase to 14 million by 2050.       Dr. Richard M. Dubinsky,
lead author of the new guidelines says the AAN's quality standards
subcommittee bases the new guidelines on evidence culled from more
than
200 published studies.   "The evidence is clear: people with a CDR of
1or greater pose a significant traffic safety risk," Dubinsky says.
      Neurologists use the CDR to assess the degree of dementia, so a
CDR 1 rating refers to a person who has some difficulty remembering
recent events that interferes with everyday activities. For example,
this person will no longer be able to balance a checkbook or may stop a
complicated hobby such as woodworking. The person can take care of
normal activities such as showering but may need some prompting to
initiate the task.       Dubinsky, an associate professor and vice-chair
of the department of neurology, Kansas University Medical Center,
Kansas
City, says that persons with less severe disease, CDR 0.5, "are impaired
but may continue to drive if they are closely monitored." He says that
the guideline recommends that these patients have their driving skills
evaluated every 6 months. The guideline states, " patients with possible
AD with a severity of CDR 0.5 pose a significant traffic safety problem
when compared to other elder drivers."       He says that driving is a
very emotional issue because taking away driving privileges can
severely
limit mobility. "We have a big problem nationwide because we don't have
good public transportation and it can be quite difficult to live an
independent life without driving," says Dubinsky. Nonetheless, he says
that physicians need to step in and tell the patient that he or she can
not longer drive. Since the issue is so emotionally charged, "it's
better for the physician to "take the blame," he says.       A
spokesperson for the Alzheimer's Association says his group is glad that
the neurologists are issuing guidelines but says the new guidelines may
be too broad. In a prepared statement, AA says, "We support the
statement by the American Academy of Neurology that people with
milder
Alzheimer's disease should be discouraged from driving, but that the
final determination on that should be made with full involvement of the
individual with the disease, their caregiver and their health care
provider."       Dr. John C. Morris professor of neurology, Washington
University School of Medicine, says that "it is very appropriate for the
AAN to have some guidelines and I think these guidelines are very
reasonable. The problem is that guidelines do not apply to every
individual case." Morris says he served as a reviewer for the
guidelines.   Morris, a member of the AA board of directors, says,
"there are not many studies of people with defined Alzheimer's who have
actually been assessed on their ability to handle an automobile in every
day, real life situations."       The studies instead use surrogate
markers, which Morris says may not accurately reflect driving ability.
In his own work he has used driving instructors and other "driving
evaluators" to assess driving skills. As a result, he says, "there are
people with severity levels at CDR 1 who are safe drivers at least as
defined by the ability to driving on-the-road as evaluated by
professionals."       Morris says that a broad application of the new
guidelines could "result in some individuals who would have their
mobility restricted prematurely." For example California law "states
that AD is a reportable diagnosis so physicians are required to inform
the DMV. The DMV, in turn, revokes the patient's license. A patient can
appeal that decision, but frankly few do," says Morris.       But while
he is reluctant to take away keys too soon, Morris adds a final warning:
"These patients need to be regularly evaluated because eventually
everyone of them will be an unsafe driver." (C) 2000 UPI All Rights
Reserved.

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Driving - Privilege or Right?
<< Page 1 - Page 3 >>
Is it time to
take the keys away?
PHASE ONE
Here are some steps to take as you evaluate whether it's
time to remove the driving privileges for the senior in your life.
1.) Contact the AARP to see if there are any local 55 Alive programs. If
so, enroll the person in these inexpensive classes. 2.) If there are no
local AARP classes, check with local community agencies for the aging
as
well as private driving schools to see what might be available. 3.)
Review the person's medical condition with their healthcare provider.
This includes discussions of the medications they are currently taking.
4.) Be sure that the person has a current eyeglass prescription. Eye
exams should be done on a regular basis as well as hearing screening.
5.) Go on several drives with the driver. Watch how they react to
complex traffic conditions. Do they drive too slow? (Rarely will they
drive too fast.) Are they missing yield or stop signs? Do they have
problems turning to see over their left shoulder? Do they use turn
signals? 6.) Check out the routes they normally drive. Are there
alternative routes that might be easier for them to navigate? PHASE
TWO
If you have determined that there are valid reasons to no longer let
this person drive, here are some other things to consider before taking
the final step. 1.) Make a list of all the places they drive to on a
regular basis: grocery store, doctor, church, pharmacy, clubs,
hairdresser/barber etc. Investigate the available alternatives for
transportation. 2.) Many communities are starting to address these
issues with specialized senior services. This can be as comprehensive as
special senior buses or as informal as lists of volunteer drivers. Check
with your local community agencies to see what might be available in
your area. 3.) If feasible, look into the possibility of moving the
loved one to a retirement community or an assisted-living situation
where there is little or no need to drive. Some of these retirement
centers provide transportation to common destinations. PHASE THREE
Once
you have determined that there is no other choice, you need to be aware
that your loved one may resist - mightily resist. By removing their
driving privilege you are taking away their independence and sense of
freedom. This is not only threatening, it can be humiliating and even
considered insulting. You will need to have your arguments well in hand.
You will need to be prepared to explain why there is no other choice as
well as how their transportation needs will be handled. You need to
present your case firmly but lovingly. After all, you are protecting
them so they will stay alive for a long, long time!

http://seniorliving.about.com/people/seniorliving/library/weekly/aa06170
0b.htm

Aging and driving - testing and licenses - what are your thoughts?
There should be no difference in testing as you age. (44)
20% Testing should be based on driving record regardless of age. (43)
20% Every driver over age 70 should be tested every two years. (39) 18%
Every driver over age 70 should be tested annually. (92) 42% No opinion.
(0) 0% 218 Total Votes

http://seniorliving.about.com/people/seniorliving/gi/polls/pollresults.h
tm

Safe Driving for Seniors
Internet URL(s)
http://www.americangeriatrics.org/education/forum/driving.shtml

American Geriatrics Society
http://www.americangeriatrics.org/
Description
This article addresses topics that seniors may want to consider in order
to determine their ability to continue driving a vehicle safely

Safe Driving For Seniors
by  Germaine Odenheimer, MD
Most of us have had at least one close call with another car, pedestrian
or object while driving, and many of us have had car accidents.  So how
do we know when these incidents signal that it is time to worry about
one's ability to drive safely?

Q. How old is too old to drive?
A. You can be a great driver or a lousy driver at any age.  In
              general, young, inexperienced drivers tend to have the
              worst driving records, and experienced middle-age drivers
              tend to be the safest drivers.  As early as 60, but more
frequently after the age of 75, driving skills tend to decline.  This is
              especially true of older drivers taking certain medications
and with conditions associated with the aging process, such as vision
problems, arthritis, diabetes, strokes, Parkinson's disease or
Alzheimer's disease.

Q. 
              What danger signs can I look for that may indicate my
              driving skills are declining?
A. 
              There are a number of warning signs to look for:

Running stop signs or red lights without realizing it
Stopping for green lights or when there is no indication
Near misses with vehicles, pedestrians or objects without
realizing it
Merging into another lane without looking
Going the wrong way against traffic
Getting lost in familiar areas
Stopping in the middle of intersections
Confusing the gas and the brake pedal

Q. 
              What can I do to improve my driving safety?
A. 
              Crash rates and serious crash-related injuries increase
              with advancing age, especially after the age of 75.  There
              are a number of things you can do to reduce your driving
              risk:

Avoid driving at night, in heavy traffic, and on unfamiliar roads;
Take driving classes from a driver educator or rehabilitation
specialist; Take a refresher lecture course offered by organizations
such as:
              the American Association of Retired Persons (AARP), the
              Automobile Association of America (AAA), and the National
              Safety Council (see contac
t information below).

Q. 
              Who can help me decide if my driving skills are declining?
A. 
              Rehabilitation Centers (e.g., Vocational Rehabilitation
              Centers, Veterans Administration Centers) are often the
              best place to obtain driving evaluations.   Driving
              schools may help, but keep in
              mind that they are not trained to recognize or diagnose
              medical conditions.  State licensing agencies also offer
              driving evaluations.

Q. 
              What can I expect from my doctor in determining whether I
              am a safe driver?
A. 
              First and foremost, it is very important that your doctor
              cares about you and is willing to listen carefully to your
              concerns about your driving ability.  Once you have dis
cussed the issue, you
              can expect your doctor to conduct a thorough medical and
              medication review.  You can also expect him/her to test
              your vision and memory.   Finally, your doctor may be able to
supply a referral  for education/refresher
classes and driving evaluation.

Q. 
              Where can I go for more information?
A. 
              More information on driver assessment, driver education
and transportation
              options in your community can be obtained
through organizations
              such as: AARP at (202) 434-2277;
Alzheimer's Association at (800)
              272-3900. Website:
<http://www.alz.org>;
              American Optometric Association at
(314) 991-4100. Local aging centers
              and agencies are another
good resource.

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Reporting Drivers with Dementia
By the DMV
Dementia And Driving
Dementia is an organic brain disorder characterized by impaired memory
and judgment.
Many mental skills such as judgment and perception are necessary to
drive safely and may be diminished due to dementia. Dementia is a broad
category that includes disorders such as Alzheimer's disease,
Multi-Infarct Dementia, AIDS Dementia Complex, Posttraumatic
Dementia,
dementia from medication, intoxication, infections, depression, and
brain tumors. Reporting A Relative Or Friend If you know of someone
that
may have dementia and is exhibiting unsafe driving skills, you may
report that individual to your local DMV. The person will be scheduled
for a reexamination of his or her driving knowledge and skills. Making A
Decision To Report A Person With Dementia It is not an easy decision
to
report a relative or friend to DMV. But if you have concerns that the
person's driving skills have declined, your report may help save that
person's life or the lives of others. How Do I Report? You may write a
letter to your local DMV identifying the driver in question and your
reason for reporting the person. You may prefer to obtain a copy of a
DMV form entitled Report of Driver with Dementia. This form gives the
reporter guidance in providing information about the person that will be
most useful to the department. Whichever method of reporting you
choose,
it is important that you sign your name. Confidentiality You may request
that your name not be revealed to the person you are reporting and DMV
will keep your name confidential. We understand that reporting a
relative or close friend is a sensitive issue. We do not want to
jeopardize your relationship with that person, but we do want to ensure
that an unsafe driver is removed from the road. Vehicle Code
[[section]]1808.5 ensures that all records received by DMV relating to
the physical or mental condition of any person are confidential and not
open to public inspection. What Does DMV Do When It Receives A
Report On
A Driver With Dementia? DMV will send the reported person a notice
that
he or she has been scheduled for a reexamination. We will also send that
person a Driver Medical Evaluation form that must be completed by the
person's treating physician. If the person does not appear for the
scheduled appointment or have the medical form completed, his or her
driving privilege will be suspended. What Happens At The
Reexamination?
The person will be given a written test on the rules of the road and
will be interviewed by a Driver Safety hearing officer. The hearing
officer will review the person's medical form and ask the person many
questions. Some of the questions will focus on the person's memory. If
the person does well on the written test and at the interview, he or she
will be scheduled for a driving test. If the person does not do well on
the written test or at the interview, and it is evident that the mental
skills for safe driving are impaired, the driving privilege will be
suspended. It is suggested that the person be accompanied by another
driver in case a suspension is imposed immediately. Driving Test A
person with mild dementia is given a special driving test that takes 30
to 45 minutes. The examiner will be looking for the person's ability to
concentrate, recall multiple instructions, execute them safely, and
possibly find a location that should be familiar to the person (church,
doctor, pharmacy, home, store, etc.). The examiner will be watching for
signs of mental confusion, perceptual misjudgment, and/or impulsive
actions or reactions to normal driving situations. If the person does
well on the driving test, he or she will be permitted to continue
driving. However, DMV will continue to reexamine this person on a
regular basis. Dementia is generally a progressive disorder, therefore,
the driver will be rescheduled for a reexamination every 6 to 12 months.
This allows DMV to monitor any deterioration of the person's condition.
DMV's Mission A major goal and responsibility of DMV is to enhance
highway safety by increasing the competency of drivers. While the
driving competency of persons affected by dementia may be
compromised,
DMV recognizes that the independence and mobility provided by the
ability to drive is an important factor in the quality of life for most
Californians. All factors are considered, including medical information
and the person's ability or inability to demonstrate compensation for
the condition. A decision will be made, regarding the driving privilege,
only after a fair and comprehensive evaluation of all information and
evidence is made. (c) copyright1996 Alzheimer's Outreach
http://alzheimers.zarcrom.com

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