Driving

Driving1To most of us driving is almost a god-given right: we see driving as the source of our independence, our freedom, the way to get to anywhere we choose to go. To tell someone that they can no longer drive is difficult.

Signs of Unsafe Driving

Determining when someone can no longer safely drive requires careful observation by family and caregivers. The following list provides warning signs that it’s time to stop driving:

  • Forgetting how to locate familiar places
  • Failing to observe traffic signs
  • Making slow or poor decisions in traffic
  • Driving at an inappropriate speed
  • Becoming angry or confused while driving
  • Hitting curbs
  • Using poor lane control
  • Making errors at intersections
  • Confusing the brake and gas pedals
  • Returning from a routine drive later than usual
  • Forgetting the destination you are driving to during the trip

Driving evaluation

At the earliest stages, a person with Alzheimer’s disease may begin to have difficulty with complex tasks such as driving. Although family and caregivers can watch for signs of unsafe driving, a proactive strategy would be to get a comprehensive driving evaluation by an occupational therapy driving rehabilitation specialist.

The evaluation provides a more objective understanding of the current impact of the disease on driving capacity and results in a plan of options. The goal is always to retain the highest level of independence and mobility in the community. Initial recommendations may include strategies to reduce driving risk during the early part of the disease.

Knowing When to Take the Car Keys Away

Making the decision that a person with Alzheimer’s is no longer safe to drive is difficult, and it needs to be communicated carefully and sensitively. Even though the person may be upset by the loss of independence, safety must be the first priority.

Look for clues that safe driving is no longer possible, including getting lost in familiar places, driving too fast or too slow, disregarding traffic signs, or getting angry or confused.

Be sensitive to the person’s feelings about losing the ability to drive, but be firm in your request that he or she no longer do so. Be consistent — don’t let the person drive on “good days” but forbid it on “bad days.”

Ask the doctor to help. The person may view the doctor as an “authority” and be willing to stop driving. The doctor can write a “prescription” to “stop driving,” and also can contact the Department of Motor Vehicles and request that the person be re-evaluated.

If necessary, take the car keys. If having keys is important to the person, substitute a different set of keys.

If all else fails, disable the car or move it to a location where the person cannot see it or gain access to it.

Another issue about Alzheimer’s patients and driving is the mere fact that if they are still driving, that means they have the ability “wander.”  Wandering is a very big problem of Alzheimer’s disease, and we provide more information about the ramifications of wandering in our “Wandering” section.

The fact that the patient is still driving means at some point he or she may drive away and forget how to get back home.

Having the Conversation

Losing the independence driving provides can be upsetting. It is important to acknowledge a person’s feelings and preserve his or her dignity and independence, while ensuring the person’s safety and the safety of others.

Starting the conversation

Initiate a dialogue to express your concerns. Stress the positive and offer alternatives.

Address resistance while reaffirming your unconditional love and support.

Appeal to the person’s sense of responsibility.

Reinforce medical diagnoses and directives. Ask a physician to write a letter stating that the person must not drive. Or ask a physician to write a prescription that says, “No driving.” You can then use the letter or prescription to reinforce the conversation.

Consider an evaluation by an objective third party.

Understand that this may be the first of many conversations about driving.

When the conversation does not go well

Some people give up driving easily, but for others this transition can be very difficult. Be prepared for the person to become angry with you, especially because memory and insight issues are part of Alzheimer’s.

Be patient and firm. Demonstrate understanding and empathy.

Acknowledge the pain of this change and appeal to the person’s desire to act responsibly.

Ask a respected family authority figure or your attorney to reinforce the message about not driving.

If the conversation does not go well, do not blame yourself; the disease can impair insight and judgment, making it difficult for people to understand that their driving is no longer safe. Also, the disease can cause mood and personality changes that make reactions more pronounced.

As a last resort, take away the car keys, disable the car or remove the car completely. When you do any of these things, be sure to provide safe and reliable alternative transportation.

Planning ahead

For people in the early stages of Alzheimer’s, it is never too soon to plan ahead for how you will get around when you can no longer drive. Putting a plan in place can be an empowering way to make your voice heard.

Tips for planning ahead

Remember that each situation is unique. What works for one person may be different from what works for another.

Involve family and close friends in the plan.

Confront resistance. Empathize with those who are uncomfortable having the conversation and stress the importance of preparing for the future.

Develop an agreement for all to share that includes practical safety steps, such as a periodic driving assessment, a GPS monitoring system for the car or the patient, and alternate transportation options.

Emotional issues

Since driving is associated with maturity, independence, and power in our culture, it makes sense that giving it up can trigger deep fear — and resistance. For most people, relinquishing the car keys will mean:

  • Loss of control and autonomy
  • Increase in dependency
  • Loss of ability to participate in activities they enjoy
  • Increased social isolation
  • Loss of the link to their past that driving provides

These aren’t irrational fears but very real concerns for seniors who can no longer drive. It’s important to try to put yourself in their place and imagine how you would manage if, for example, you couldn’t use your car for the next week. How would you buy groceries, visit friends, get to your doctors’ appointments? Now imagine being told that you could never drive again. Understanding your loved one’s experience will help you support him or her in making this difficult transition and aid you in helping to tap into resources that will make giving up driving easier.

Practical issues

Giving up the car keys is likely to create formidable practical problems — for everyone involved — concerning:

  • Housing. Is their current home practical and safe without a car, or will they have to move?
  • Shopping. Can they walk to the grocery store, or are there alternative forms of transportation available?
  • Physicians and other caregivers. Will they be able to get to their healthcare appointments without a car?
  • Community. How will they see friends, engage in activities, and pursue other interests? Do they have friends nearby?
  • Transportation options. What are the public transportation options available to them? Is senior transportation available in their community? Are there relatives, neighbors, or friends who could drive them to the store or to doctors’ appointments, at a reasonable cost?

Anticipate the practical problems that giving up driving is likely to involve, and you and others who care for them will be better able to take concrete steps to address any issues.

Transportation options

Driving is not the only transportation option available. There are many options people can explore that will allow them to continue to travel independently and remain in control of their mobility.

Transfer driving responsibilities to others. Arrange for family members and friends to provide transportation.

Arrange a taxi service.

Reduce the need to drive by having prescription medicines, groceries, or meals delivered.

The Alzheimer’s Research Association would like to thank the National Institute on Aging and the Alzheimer’s Association for the information contained in this section.