Post by norbert1 on Aug 3, 2006 10:27:27 GMT -5
Early in the disease, the doctor should discuss this issue, and get the person to agree to driving restrictions and when driving will have to stop. A person with a MMSE of 20-25 may be able to drive safely in their neigborhood (and staying off freeways) but only a formal driving evaluation will tell if they are still a safe driver. During this period, it is important for the family to regularly monitor the person's driving ability. A person who needs any kind of assistance or cueing for personal care or dressing is unlikely to be a safe driver.
Later in the disease, they lose all insight into their disability or inability to drive safely. If you are dealing with driving at this stage, then you have to make sure the key the person has does not start the car.
In my case, I addressed my Aunt's demands to drive to the doctor. He pulled his stool right up in front of her and told her that if she wanted to drive, she would have to have a drivers evaluation at a drivers rehabilitation program. She never chose to have the evaluation but she continued to ask about driving. I could always remind her what the doctor said and that she had not yet decided to have the evaluation.
Having someone else to take the blame - priceless.
Stop the driving as gently and indirectly as possible. If done in a way that results in open, direct confrontation, the aftermath of this emotional issue can make all aspects of caregiving much more difficult.
If you decide to disable a car, put a note at the point where it was disabled explaining why. (People with Alzheimers have called mechanics to look at disabled cars!) With newer cars, there are fuses and relays for fuel pumps and injectors. Removing one of these means that the car will not run.
Altering the persons key is more appropriate if it is the family car. Keep working keys well hidden or locked up.
More information ---
Driving, Alzheimers Assoc. Policy statement
www.alz.org/national/documents/statements_driving.pdf
Driving – short fact sheet
www.alz.org/living_with_alzheimers_driving.asp
www.alz.org/national/documents/topicsheet_driving.pdf
Alzheimers: when to stop driving
www.mayoclinic.com/health/alzheimers/HO00046
Driving and Dementia – factsheet from Family caregiving alliance.
www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=432
A practicle guide to Alzheimers, dementia, and driving (from Hartford insurance) This information was produced after a major study of the issue.
www.thehartford.com/alzheimers/
brochure – At the Crossroads: A guide to Alzheimers disease, Driving, and Dementia
www.thehartford.com/alzheimers/brochure.html
---- Evaluating Driving Safety ------
I have been reading a great deal on this subject. The problem is that there is no in-office test that accurately predicts whether a person is a safe driver.
People with MMSE of 20-25 are generally the range where driving safety must be evaluated.
Most agree the most accurate way to access driving safety is with an in-car driver evaluation. Certain office testing can rule out people from driving, but of those remaining, only an in-car test can demonstrate safety.
In office testing—
tests of cognition, reaction time
motor function
vision
over the age of 85 (a risk factor in itself)
interview of the family for –
- voluntary reduction of driving
- observed driving difficulties – crashes, dents, citations, getting lost.
- family concerns about driving.
Two tests that have the highest correlation to driving difficulties:
- Clock drawing tests – show visual processing difficulties
- paper and pencil “Trail making test” part B – tests task and attention switching.
A few articles report that the judgement of an experienced neurologist is fairly accurate as a predictor of inability to drive safely, but was not as selective as the actual in-car evaluation. Realisticly, to judge the person's driving ability without an in-car evaluation, the doctor will use information from his evaluation and information supplied by the family about driving practices.
Dementia characteristics that pose a risk to driving.
- problems with visual processing (perceiving visuospatial relationships)
- physical slowing (psychomotor speed)
- performing multiple tasks – coping with unfamiliar situations.
- problems with reasoning and decision making
- lack of insight of their illness and consequences
- development of problematic behavior – hallucinations, poor reasoning, argumentativeness, aggression, hostility.
At a certain point, for a person to continue driving, it is important for the person to begin restricting amount of driving (to familiar areas and not on freeways) and for family to be routinely involved in supervising the driving – (an alternative may be routine evaluations.)
(for those with access to a medical library) - A good overview of this subject is in Journal of the American Academy of Nurse Practitioners, Vol 17 Issue 10, October 2005 pg. 393-402
Later in the disease, they lose all insight into their disability or inability to drive safely. If you are dealing with driving at this stage, then you have to make sure the key the person has does not start the car.
In my case, I addressed my Aunt's demands to drive to the doctor. He pulled his stool right up in front of her and told her that if she wanted to drive, she would have to have a drivers evaluation at a drivers rehabilitation program. She never chose to have the evaluation but she continued to ask about driving. I could always remind her what the doctor said and that she had not yet decided to have the evaluation.
Having someone else to take the blame - priceless.
Stop the driving as gently and indirectly as possible. If done in a way that results in open, direct confrontation, the aftermath of this emotional issue can make all aspects of caregiving much more difficult.
If you decide to disable a car, put a note at the point where it was disabled explaining why. (People with Alzheimers have called mechanics to look at disabled cars!) With newer cars, there are fuses and relays for fuel pumps and injectors. Removing one of these means that the car will not run.
Altering the persons key is more appropriate if it is the family car. Keep working keys well hidden or locked up.
More information ---
Driving, Alzheimers Assoc. Policy statement
www.alz.org/national/documents/statements_driving.pdf
Driving – short fact sheet
www.alz.org/living_with_alzheimers_driving.asp
www.alz.org/national/documents/topicsheet_driving.pdf
Alzheimers: when to stop driving
www.mayoclinic.com/health/alzheimers/HO00046
Driving and Dementia – factsheet from Family caregiving alliance.
www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=432
A practicle guide to Alzheimers, dementia, and driving (from Hartford insurance) This information was produced after a major study of the issue.
www.thehartford.com/alzheimers/
brochure – At the Crossroads: A guide to Alzheimers disease, Driving, and Dementia
www.thehartford.com/alzheimers/brochure.html
---- Evaluating Driving Safety ------
I have been reading a great deal on this subject. The problem is that there is no in-office test that accurately predicts whether a person is a safe driver.
People with MMSE of 20-25 are generally the range where driving safety must be evaluated.
Most agree the most accurate way to access driving safety is with an in-car driver evaluation. Certain office testing can rule out people from driving, but of those remaining, only an in-car test can demonstrate safety.
In office testing—
tests of cognition, reaction time
motor function
vision
over the age of 85 (a risk factor in itself)
interview of the family for –
- voluntary reduction of driving
- observed driving difficulties – crashes, dents, citations, getting lost.
- family concerns about driving.
Two tests that have the highest correlation to driving difficulties:
- Clock drawing tests – show visual processing difficulties
- paper and pencil “Trail making test” part B – tests task and attention switching.
A few articles report that the judgement of an experienced neurologist is fairly accurate as a predictor of inability to drive safely, but was not as selective as the actual in-car evaluation. Realisticly, to judge the person's driving ability without an in-car evaluation, the doctor will use information from his evaluation and information supplied by the family about driving practices.
Dementia characteristics that pose a risk to driving.
- problems with visual processing (perceiving visuospatial relationships)
- physical slowing (psychomotor speed)
- performing multiple tasks – coping with unfamiliar situations.
- problems with reasoning and decision making
- lack of insight of their illness and consequences
- development of problematic behavior – hallucinations, poor reasoning, argumentativeness, aggression, hostility.
At a certain point, for a person to continue driving, it is important for the person to begin restricting amount of driving (to familiar areas and not on freeways) and for family to be routinely involved in supervising the driving – (an alternative may be routine evaluations.)
(for those with access to a medical library) - A good overview of this subject is in Journal of the American Academy of Nurse Practitioners, Vol 17 Issue 10, October 2005 pg. 393-402
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : )