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Driving & Alzheimer
edswall
Posted: Thursday, February 2, 2017 2:07 PM
Joined: 2/2/2017
Posts: 2


I am posting this for a friend; however, I am not positive this is the right forum.

She has been diagnosed with Alzheimer although it is not yet advanced. She also lives in a rural area. A month or so ago she was driving into town with her daughter. She came to the highway from the access road she lives on and looked both right and left; seeing a car a ways off she judged she could pull out and did so. A moment or so latter she hears a large honk behind her. [A few caveats, I know that turnout and there is a sign posted someways down the main highway that there is a hidden drive; the speed limit around there is 50. Also, some people around there like to honk and to speed]. Well her daughter was quite upset and insisted taking her to a competent physician and between them - the physician and the daughter - they decided that she should no longer drive. This is a bit of an inconvenience in a rural area to say the least. She actually is a quite careful driver.

Since something like this is not a particularly unique occurrence (and, in fact, from my perspective the other driver was considerably more dubious). It has happened to me and I often need to take into consideration other drivers who underestimate. I also, of course, don't wish to see her injured (and I am sure that is the view of this doctor and her daughter). However, I also wonder if this was an entirely appropriate response from her physician and, more importantly, I wonder how she would go about finding out.


The_Sun_Still_Rises
Posted: Thursday, February 2, 2017 4:34 PM
Joined: 7/24/2015
Posts: 3030


This actually a very HIGHLY debated topic....mostly debated by those who do NOT have a dementia dx. 

Many who have dementia diagnoses DO still drive perfectly safely...up in stage 5 and 6. 

But every person with a dementia diagnosis will vary widely in their symptoms, abilities, and area of the brain being ravaged.  So I believe that it important look at each individual person on a case by case basis rather than make an all encompassing ruling for everyone. 

YES...in all likelihood what happened you friend was the OTHER driver's fault.  From what you describe, it CERTAINLY sound like that me. 

You also have understand that currently we have a view of dementia and a dementia care model in the USA....that advises caregivers get power of attorney (right control and direct medical care) RIGHT AWAY...and advises them take over IMMEDIATELY and take driving privileges.   This is so hurtful many people diagnosed with dementia, that it causes a huge breakdown in their relationship their loved one...trust is broken.  Since you friend obviously was complaining about it you....you can see what I mean.  That relationship breakdown affects how well caregiving going go in future, so it worthy of considering how best promote a good relationship between person diagnosed dementia and caregivers. 

Driving a hard thing give up, esp in a rural area when there are no other choices...because it is MORE than just driving that is lost...it comes with a whole host of other things that are lost as well, that caregivers rarely take in account....and, because the person with dementia is often less able communicate their needs in a way another can understand....it often means, other needs will never again be met in that person's life.  Like the need socialize....a caregiver often willing take mom or dad grocery shopping (or bring them groceries), but few willing take them their book club, knitting circle, and the umpteen other things they might be involved with.  So giving up driving, for many, means losing friends.  They also might be doing volunteer things...so giving up driving means giving up being valued and productive contributor the world...and means letting down those they helping.  It means giving up feeling good about being able handle you own grocery shopping.   Also, it means giving up being able go out and get a cup of coffee, or driving see sunset, or going out lunch when you WANT do.  This is a basic freedom that others enjoy that we asked give up.  Those in Dementia Rights Movement are very articulate about this...and I think it was Richard Taylor who talk about all the other things that are lost when we give up driving. 

We all will lose the ability drive at some point.  And, I firmly believe dings and scrapes on a car is FAR more late than the point driving should be let go.  But I check for things like, how one handles unexpected things....like construction....can they easily re-group and navigate around construction.  How do they handle unexpected things, like when someone suddenly break in front them...how their reaction time.  Can they still handle the car when slipping on ice??  Are they noticing speed limit.   Can they have a conversation with you and drive well...that a BIG one.  

We all will lose our ability drive safely at one point....although it is still often taken from people far more early than it need be in many cases.  People told fear us...so they do...and that would be part of the STIGMA that comes with a dementia diagnosis.

All the people with dementia that I know that still drive and utmost concerned the safety others.  It the same for stove use.  IF we know what our diagnosis is, if we are well informed of what it does us and how it progresses, we tend be VERY careful....as in EXTRA EXTRA careful doing dangerous things, like using stove and driving. 

Which bring me the next wondering...does she know she has dementia, and does she FULLY understand what that means and the extra care she needs to take?? 

If not, you have understand that for a whole host of reasons, many people choose NOT tell their loved one about their diagnosis or how bad it can be.  And, you should likely support her caregivers in the way they are choosing handle it, if they the ones that going be doing brunt of care....as it becomes a very hard job for them.  It could be that you are right, that it early take driving away from her and that the daughter was just looking for an excuse....but she do have everyone's best interests in mind and she could know things that you don't about mom.

No one have the ONE answer for what do....caregivers are often in the dark just trying do what they feel is best.  Maybe you can sympathize and let her know what a great driver you think she is, while you help you friend understand how much it would hurt her if she ever hurt anyone while driving...and how much her family love her even if they don't understand.  And maybe help her come up with a plan how stay active in her life and activities....that maybe you can share with her daughter....what kinds of things are MOST important for her stay involved in. 

I hope this help.

<3


Iris L.
Posted: Thursday, February 2, 2017 4:51 PM
Joined: 12/15/2011
Posts: 14699


Welcome, edswall.  Safety is a priority in living with dementia.  The PWD (person with dementia) may not always realize the level of her driving skills.  Is there a pattern of poor driving?  There are places that can objectively evaluate driving skills.  Look for an occupational therapy department at a hospital that offers rehabilitation services.



I must also add, here is something that often happens.  The PWD complains that their caregiver is keeping them from doing what they want to do, or what they have always done.  The PWD is not aware of their changes.  This is due to a feature of dementia called anosognosia.  The PWD thinks everything is the same.  The friend comes along to "rescue" the PWD from the controlling caregiver.  You can see how this can become a huge problem.   



Consider that someone might step up and offer to drive your friend where she needs to go.  Also, now is the time to consider if her current living situation is the best for her.  She might need to live closer to town.  There are a lot of questions to consider when dementia is the diagnosis.



You are in the middle between two people dealing with dementia from different perspectives.  A lot of decisions need to be made.  What you can do is read a lot, and attempt to support both of them.  Please keep reading this board and the caregiver boards.  


Iris L.



 


jfkoc
Posted: Thursday, February 2, 2017 4:54 PM
Joined: 12/4/2011
Posts: 13733


Very often the discussion about driving centers around getting lost. There are three other important considerations. Depth perception, processing information and reflexes. 

Impaired driving not only is a safety issue it is also a liability issue and yes, we caregivers worry about it a lot.


Mimi S.
Posted: Thursday, February 2, 2017 5:58 PM
Joined: 11/29/2011
Posts: 6061


Was this the first incident?  Does person take longer than expected running errands?

Unexpected/unexplained dents, scrathcs on car?

Would you allow your grand children to ride in the car while she drives?
Some PWD I would feel fine while they are driving.  Some undiagnosed I won't get in the car with.

jfkoc
Posted: Thursday, February 2, 2017 7:18 PM
Joined: 12/4/2011
Posts: 13733


Agree with Mimi. having a diagnosis of cognitive does not mean you are impaired. If/when it effects driving is it a problem.

I won't drive with my daughter-li-law.


edswall
Posted: Friday, February 3, 2017 7:46 PM
Joined: 2/2/2017
Posts: 2


Thanks for all the great replies. I will make them available, suitably edited, to my friend.

My friend is quite intelligent and I have the utmost respect for her wisdom and insight.  Her memory is not as good as it used to be (she had forgotten something minor like exactly where I lived) and she is, perhaps, a little more frustrated about things. She is also quite aware of her diagnosis and is quite respectful of her caregiver (presently her eldest daughter) and any physicians she has visited for care or advice. In a sense, she is resigned to her present circumstances and trying to make the best of them. However, when I asked her whether she had asked for something like a second opinion, she admitted - ruefully - that she had not and that, in a sense, had felt pressured to acquiesce. 

To my knowledge she probably has a better driving record than I do and I am reasonably cautious. However, I don't know the details of her office visit although I have the impression that it was 'decided that it was better if she stopped driving.'

One of my reasons for positing to this forum was to ask if others had found themselves in similar circumstances and what appropriate (and respectful) options might be open to her.


The_Sun_Still_Rises
Posted: Friday, February 3, 2017 9:20 PM
Joined: 7/24/2015
Posts: 3030


We have little recourse when we dx'd dementia...it often feel like our rights personhood fell away with the stroke of a doctor's pen.   

I have Alz, and I still a good driver with no accidents, dings, near misses or anything like that.  I am still responsive changes, can still handle ice and slippery weather, and still have lightening fast reflexes.  I am also cautious, knowledgeable about my dx, and have a long list of signs I always on the look out for when stop driving.  And, my workers all comfortable with me driving. 

However, this is such a hotly debated highly emotionally laden issue because there are those who want us lose our privileges upon diagnosis, even though we could still have 2 decades before we have progressed the point of needing stop drive.   It is so debated and emotionally laden, that many with dementia dx's will not disclose others that they still drive.  Indeed, many with a dementia dx still work and do not disclose their diagnosis at work for fear of losing their job.  It is not that these people are unaware of the issues.  It is that with earlier and earlier diagnosis, we now have a whole generation of people with dementia that will still be competent, productive, and well able do things for many years....before the late stage images that we have been fed by the media. 

There are very few images in the media of those who are dx'd dementia and are still very able and still living life the fullest.  This is, unfortunately, often prematurely taken from us and skills taken over before we would otherwise lose them resulting in learned helplessness.  And, indeed, what is your friend going do...she needs her family take care of her as she gets worse, but it is still hard on a person when they are not listened or taken seriously or like they maybe still know what they are talking about. 

We still do not have a dementia care model in the USA that embraces the person's personhood.  What I mean by that, is the person's need for personal growth, for joy, and for meaning in their life, or contribute meaningfully the world, and be valued by the world around them. 

You seem naturally want give her these things as her friend...which is just so amazing and heartwarming I can not even begin tell you.  I sense it breaks your heart not be able fight for her right stay driving.  Many us who have dementia feel the same way.  Not everyone. 

I keep working in direction of try create a dementia care model that works for everyone....one that embraces our personhood and allows people see us like you see your friend, as still people.  We are still in here.  We may lose ability do tasks, we may lose ability communicate as well, we may have trouble walking, we may forget names and dates, but we still in here. 

I am so glad for her have your friendship, it means a lot have someone who understands you and validates how you feel.

<3


alz+
Posted: Thursday, February 16, 2017 9:09 AM
Joined: 9/12/2013
Posts: 3009


vision exam needed.

many times our visual processing becomes damaged and we would not know if someone did not diagnose it through exam.

My vision changed so I lost peripheral vision (tunnel vision) and it appears things are closer than they are. I could not judge distance anymore.My eyes are fine, it is int he brain processing.

good for oyu looking out for someone in need.


mcarley
Posted: Thursday, February 16, 2017 7:22 PM
Joined: 5/16/2016
Posts: 92


Another thing to keep in mind:  let's say the accident happened and it appeared to be the other driver's fault.  But, the other driver disputes this and in the course of discovery, finds out about a dementia diagnosis.  Immediately, this puts your friend in a very difficult position and she could be found liable.  

The loss of a driver's license is huge; in much of the US, public transit isn't good enough and it's a loss of independence.  But, we do have to keep in mind that this is also about safety.  Your friend may not be as good at recognizing her limitations as she thinks and her past driving record isn't much of an indicator as it would otherwise be.  It might be advisable to suggest a DMV test (our doctor requested it and even got the paperwork going).  If your friend passes, then maybe she can still drive for a while.  Even in that case though, it's important to plan for when she can no longer drive.  That day is coming even if it's not here yet. 


TheSteven
Posted: Wednesday, February 22, 2017 9:37 PM
Joined: 10/11/2014
Posts: 162


Hi edswall,

In many states your friend can get herself tested for driving.  It will help everyone involved to know whether or not her reaction and thinking times are good enough to drive.  If she passes the test and gets into an accident then the other driver cannot say that it is due to her diagnosis since she passed a recent exam.  Everybody even those without mental impairment can get into an accident and their licenses are not taken away.

The testing involves two parts, at least mine did in Massachusetts.  The first part is an electronic one questions and answers and then a simulator type of machine with wheel and pedals to make sure you don't hit pedestrians and can slow down for red lights and such.  This is done at an office like a Spaulding Rehab type place.

If she passes that she next takes a road test at a special place that teaches remedial and/or advanced driving courses.  Both of my kids took a skid school driving class there.  The test lasts about 30-45 minutes and is more difficult than those they give to kids getting their license the first time.  They test to make sure you can remember directions and navigate signs.  If someone gave your friend directions to take a right at the third traffic light and take Rt 140 North for example they need to do so without forgetting the directions and make sure they take the correct exit.  They also need to merge onto traffic safely, drive in neighborhoods safely obeying the speed limits just like a newly licensed person of course.

Normally, your friend would have to get retested annually.  Since I stopped my ALZ progression and reversed many of my symptoms and have been downgraded to MCI the neurologist said I no longer need to take the exams any more. 

Removal of my amalgams improved my condition. See http://amalgam.org/education/scientific-evidenceresearch/results-removal-amalgam-fillings/ or

http://www.fda.gov/ohrms/dockets/dailys/02/Sep02/091602/80027dde.pdf

I have more links to this type of information about this in my July 4, 2015 blog entry at http://thestevenalztreatment.blogspot.com


 


PaulsWife
Posted: Wednesday, March 1, 2017 6:34 AM
Joined: 3/1/2017
Posts: 7


How do you feel about driving assessment programs? DH has early Alzheimer's and the neuropsychologists have recommended it twice.  I hadn't driven with him for a while but did recently and it was scary.  Didn't see 2 red lights and tried to turn into the wrong side of a two lane road even though there were many signs and cars coming out.  

How can I help him agree to this (he agreed that day but has forgotten)?  


Mimi S.
Posted: Wednesday, March 1, 2017 8:33 AM
Joined: 11/29/2011
Posts: 6061


Hi Paul's Wife,

You don't need the test,You know he should not be behind the wheel.

You must call the DMV in your state and report him.  I some states he may be told who reported him. And it still must be done.

When I reported  aunt it didn't long for her to figure out who did it. I lost te family home she had given me in her will. It still needed to be done.


Iris L.
Posted: Wednesday, March 1, 2017 1:57 PM
Joined: 12/15/2011
Posts: 14699


Right away, disable the car in some way.  Disconnect the battery cables.  Hide the keys.  Put them in a locked box.  Tow the car.  Tell him the car is at the mechanic's and needs a part that has to come from out of town.  The part never arrives.


If you visit the Spouse/Partner board, there are many discussions on driving.


You will never get him to agree.  He has anosognosia.  Anosognosia is a characteristic of the dementias that keeps the patient from being aware that he has demenai.  He truly believes he is fine and that his driving is fine.  You will have to learn work-arounds to get things done.  The members will have good suggestions on work-arounds.  If you read this article on anosognosia, you will learn more about ansognosia.

 

http://alzonline.phhp.ufl.edu/en/reading/Anosognosia.pdf 


Iris L.


JLarkin
Posted: Wednesday, November 1, 2017 9:10 AM
Joined: 9/20/2017
Posts: 6


Hi to all. I was diagnosed with early stage ALZ 2 years ago. One of the 1st thing my primary care MD did was to make sure that I had an individual, in-car driver assessment by a certified tester, and also to take the AAA Safe Driving Class. I was driving well at the time. No tickets or accident in many years. But he urged this for defensive reasons saying that I was more likely to be sued without my insurance compan's protection. I easily passed and the test results are on filed with my car insurance coompany. Same thing with the Safe Driver Class. I also passed that and results are on file. Plus I learned a lot about how to avoid serious injury in the event of a crash (don't use cell phone or even have it on a seat where it could fly into me if I stopped suddenly). No loose objects at all in the car. Hold on to the steering wheel lower: 9pm-3am rather than the traditional 10pm-2am. Plus my insurance premium was reduced 10% once I filed the certificates.   Lately, there are "bad days" on which I know I shouldn't drived, so I don't. I walk, or tak the bus, or Uber/Lyft, or rely on my most frequent chauffer, my wife,  I hope you're doing OK today. Happy November!
Mimi S.
Posted: Wednesday, November 1, 2017 9:37 AM
Joined: 11/29/2011
Posts: 6061


Welcome to our world Jlarkin. We're so glad you found us. Do stay with us.

I like the steps you took about driving.  However, you have a progressive disease. How long would those papers on file be valid.

Some of us are very aware of our capabilities but this may change. Do you have someone else ewho can ride withyo now and then to give a second opinion as far as your driving ability?


JLarkin
Posted: Friday, November 3, 2017 1:59 PM
Joined: 9/20/2017
Posts: 6


Hi, Mimi. Yes, I all too well that that, regardless of the certificates, I have bad days and good days, and at any given time, I could be held liable for an accident based on evidence contributed to by the diagnosis/disease.  I know I have a special responsibility to seek help when needed, and to be ultra-honest about my capabilities on a given day. I'm fortunate that I have family and friends able and graciously open to helping me with rides. Shortly after I posted my not, I needed to go to church for a service. My wife dropped me off, and I asked another member of the church who lived nearby to bring me home, and she was happy to do it. I agree that know our boundaries is critical. I also recognize that there will come a time, perhaps sooner than I would like, when I won't have the judgment ability to safely make that call. My wife has agreed to take the "lead" position in making the call, and I have agreed to abide by it, whenever it occurs. I'll cope, with the help of others, public transport, Lyft/Uber, and foot power. I really appreciate your note.
llee08032
Posted: Monday, November 6, 2017 6:59 AM
Joined: 5/20/2014
Posts: 3972


Welcome, JLarkin. Nice hearing from you. The young onset board is more active. Please join us there if you like. You have a great attitude and seem to be taking all this in stride. Happy to hear you have lot's of support and opportunities to get around on days when your not up to driving.
 
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