Elder Journal - Older Drivers & Dementia

By Paul Takayanagi
Older Drivers and Dementia: Their Car Keys or Your Peace of Mind

There are currently approximately 36 million older adults (persons over 65 years old) in the United States with about five million of these persons 85 years and older. The current generation of older Americans are among the first to have been born and raised in the era of the automobile. Most Americans today cannot remember a time when there were not cars, highway systems and all of the cultural aspects our mobile society provides us. When a person ages, there are sometimes challenging issues around driving that arise. One of the primary issues is a diminished level of driving skill due to sensory deficits like vision and hearing. Many older persons also have decreased movement in their neck and shoulder areas that diminish their peripheral vision and can be one of the primary causes of accidents with older drivers.

The American Automobile Association (AAA) is one of the primary resources for older driver issues. Their regional offices can provide training for individual older drivers to keep their driving skills optimum and they offer many other resources. Their primary program is called Mature Operator courses and are designed especially for drivers 55 years of age and older. They have specially trained instructors that understand the effects of age on driving and how to correct for some of these. Contact your local AAA office for more information (resources provided below).

General aging issues like diminished vision and hearing are one thing but when dementia begins to strike an older person this complicates driving issues greatly. One of the challenges every family faces when they have a loved one suspected of developing dementia is when to persuade her or him to give up driving a car. The ability to drive is more than just a utilitarian activity in our culture, it is a way of life. Once an American qualifies for and receives a driver�s license, it becomes a lifetime responsibility. The car has become a primary symbol for American life and our lives revolve around and can be literally dependent on the ability to drive and be mobile. It�s mobility that is really at the heart of the issue for older drivers. Without the ability to drive, older people can become isolated and dependent on others to do even the most commonplace chores and activities like grocery shopping, going to doctor and dentist appointments and to social events. When dementia strikes, these activities are even more compromised.

Here are two real life examples of older driver and dementia issues:

Emily is a 60 year old retired schoolteacher. Her mother, Agnes, is 82 years old and began to display signs of memory loss in early 2001. Agnes has had numerous �fender bender� accidents. Initially, she could negotiate these incidents by herself, contacting insurance companies and garages for repairs. Recently, however, Agnes had a minor accident that resulted in a large dent in the passenger side of the car. When Emily questioned her about it, Agnes could not remember anything about the accident. This, quite understandably, alarmed Emily and she has begun to realize that her mother is not capable of driving anymore. She has asked her mother not to drive but this has proved futile so far. Emily lives about a twenty minute drive from her mother. Agnes says she doesn�t want to bother her daughter for a ride every time she needs one. Emily is thinking of contacting the Department of Motor Vehicles and reporting her mother as an unsafe driver but feels reluctant to do so. She would rather that her mother just �come to her senses� as she puts it and not drive.

The primary issue is when exactly a person with dementia should stop driving. The Alzheimer�s Association has expressed concern that if a person must give up driving upon diagnosis that this will prevent people from accessing diagnostic and health care in the early stages of dementia. Even physicians are sometimes reluctant to advise a family to take away the car keys of a loved one with mild memory loss if there have been no accidents or other challenging driving incidents like becoming lost. The driving ability of a person in these situations needs to be monitored well and handled delicately.

Frank is a 75 year old retired engineer who was diagnosed with mild cognitive impairment four years ago. He is still highly functional and is also physically quite healthy. At over six feet tall and 190 pounds, he towers over his wife, Ann, who is just barely five feet tall. Ann couldn�t keep Frank from driving even if she wanted to do so. Their relationship is complicated by the fact that in their forty year marriage, Frank has always done the majority of the driving. While Ann can drive she has always been more comfortable with allowing Frank to do the driving. She feels that as long as she is with Frank when they are in the car that it�s okay for him to drive. Recently, Ann decided that she would go away for the weekend with their daughter for some much needed respite from caring for Frank. Her absence, however, meant leaving Frank alone in the house. To prevent Frank from driving alone, she had their son, John, take the tires off the car and put it up on blocks in the garage. She felt this would keep Frank out of the car. But when she returned on Monday afternoon, to her surprise, she found Frank had been able to persuade a friend to take him to a tire store where he purchased a set of tires and then put them on the car himself. He had been driving since Sunday afternoon. Ann asked her physician to get involved because as she says �Frank always listens to him.� His physician talked to Frank about the safety issues involved with operating a car and persuaded him to allow Ann to do more of the driving. While Frank hasn�t relinquished driving completely, he is more accepting of the notion of not driving anymore.

The fact that dementia is being diagnosed earlier, on average, than it has been before now is only complicating the driving issue. When persons were diagnosed in the more moderate and later stages of dementia, their functional and dysfunctional abilities were more clearly discerned. Many of these persons had already relinquished their car keys on their own or because they physically could not drive. But people in the very early stages of dementia are often quite functional, aware of themselves and have most of their abilities, like driving and other activities of daily living, fully intact. Families will have to watch their loved one with mild memory loss closely to discern when problems with driving are developing. If you believe that your loved one with memory loss shouldn�t be driving then communicating your concerns as soon and as clearly as possible is important. Then you will be on your way to having peace of mind over the driving responsibilities of your older loved one.

For more information on older driver issues, go to the American Automobile Association web site at www.aaa.com. For information on reporting challenged drivers, contact your local Department of Motor Vehicles.

10/03

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