What About Driving?

Driving safety is a challenging topic and rarely all-or-none in the beginning stages.  Caregivers or family members often wonder when their loved one is no longer safe to drive and may struggle with the decision to “take away the keys.”  Once the disease affects thinking, reaction time, and visual skills, the safety of your loved one and all the bystanders on the roads must take priority.

Ideally, when a neurodegenerative condition like Alzheimer’s disease is caught early, the person with cognitive changes can be a part of the conversation.  It may be helpful to talk about the topic, despite the discomfort it may bring.  I often ask, “How will you know when you are no longer safe to drive? What will it take for you to come to the decision that you should no longer drive? How can we plan for this in the future?”  This helps the individual prepare for the decision to stop driving, before they become unsafe.  In fact, early in the disease process, individuals may start to limit their driving to daytime hours, avoid major highways, and only drive short distances on familiar routes.  In this scenario, the individual may make the decision on their own that it is not worth the risk of getting into an accident and stop driving before the cognitive changes actually interfere with driving ability.

But, the above scenario is the ideal situation and let’s face it…many caregivers find that their loved one may refuse to hang up their keys.  Giving up driving decreases the individual’s independence and places greater demands on family members to provide or coordinate transportation.

 Family members often express the following thoughts and fears:

·        Is mom safe to drive?

·        If she stops driving, how will she do her shopping? It will isolate her.

·        How will he/she get around?  Now I will need to make time to provide regular transportation.

·        It’s only a quick drive to the supermarket down the road for scratch offs, he will be so upset without this routine.

·        Will he become angry and belligerent?  Or depressed an anxious?

·        Will he listen to me? I’ve never had to tell my parent what he/she can or cannot do.

Family members agonize over how long to allow their loved one to drive following a dementia diagnosis.  What is the line in the sand that determines he/she is no longer safe behind the wheel?  In reality, a person is safe to drive until the day they suddenly aren’t, but no one knows when that day will be. If you wait for the day when they are a danger behind the wheel, you may be faced with a tragedy. There is no predicting which day he/she will go through the red light, or will get lost, or worse, turn into oncoming traffic on the highway. The decision to take away the car keys must take place before your loved one is a danger to themselves or others.

 Family members often ask, “How do I tell the person with dementia that they cannot drive anymore?” Honesty works in some families and the patient may feel sad or angry, but they accept it and stop driving. Other families don’t find that it goes quite so smoothly. In these cases, the following strategies may be helpful:

 ·        Enlist the assistance of the patient’s doctor.  Each doctor can help in a different way:

o   Ophthalmologist:  Check their eye sight. If there has been a decline in vision, they might have to surrender their driver’s license.

o   Primary care physician or neurologist: Call the office before the next check up and let them know you want their help telling the patient they are no longer safe to drive.  Ask for a script that says the patient is not safe to drive. You can display it on the fridge as a reminder.

o   Neuropsychology: a neuropsychological evaluation can measure the patient’s thinking skills and help determine if they are safe to drive.  A neuropsychologist can explain to the patient why they are not safe to drive.

·        Consider a driving evaluation to determine safety on the road. 

If the patient refuses to accept what the doctor has said, the doctor can write a report which you can submit to the Motor Vehicle Administration informing them of the patient’s incapacity. I have also met family members who took away the car keys or discretely disabled the vehicle.

There is no doubt, this is one of the hardest tasks for the family caregiver, but you cannot compromise on safety. The guilt you will experience if your loved one hurts themselves or someone else would be even more difficult to bear.  You do not need to go through this alone.  Reach out to a professional to get guidance and develop a plan that will work for you and your loved one.

Interventions for Agitation

Dementia is commonly broken down into three stages, with each stage bringing it’s own set of challenges.  The Early Stage comes with the diagnosis and feelings of grief as the patient and family come to understand that the future will be very different from what they had planned and hoped for.  The Middle Stage brings a variety of new behaviors, and the need for increased safety vigilance.  The End Stage requires more physical care.

This blog entry will focus on Interventions for Coping with Increased Agitation.  Not every person who receives a dementia diagnosis will experience agitation or Sundowning Behaviors, but these behaviors are common.  As the ability to think logically decreases, the patient’s judgment and problem solving skills also diminish.  The patient may lose the ability to express thoughts and feelings, they can feel confused, anxious or frightened.  They can become easily overwhelmed with too much stimulation, noise or activity.  They can become frustrated when unable to make their needs known.

Communication Tips:

• Communicate clearly and in simple sentences while making eye contact.  

• Use yes/no questions if your loved one is unable to complete sentences.  

• Try using a Communication Book if your loved one has difficulty with word finding.  (A Communication Book is a book filled with pictures to help identify needs.)

Grounding Techniques:

• Using words and tone of voice to help orient and allow the patient to feel more secure, such as “You are safe, I’m here with you, it’s OK.” "Breathe."

Redirection Strategies:

• Use music

• Engage in an unrelated topic of conversation to pull the patient’s mind away from the situation/thoughts/conversation that is troubling him/her

• Watch soothing videos of nature, funny animals, birds, fish

• Engage with a pet or even a realistic stuffed animal 

• Bring the patient to a room with decreased stimulation, dim the lights, etc

Anticipate Problem Situations:

• Modify the schedule if she/he is appearing troubled or agitated

• Be flexible

• Plan around her/his better times of the day

Notice Physiological Needs:

• Is he/she too hot or too cold?

• Is he/she over tired?

• Is he/she hungry?

• Is he/she constipated, or experiencing UTI symptoms?

Medication Options:

Sundowning is common and is often a restlessness/agitation that frequently occurs any time after 3:00 PM.  The above interventions may not reduce symptoms.

Talk to the patient’s doctor and ask about medications for sundowning symptoms.  The doctor may prescribe a medication for daily use or for use only when needed (PRN).  Keep a log of all PRN doses, and stay in contact with the MD if you begin to administer medications regularly, or if they are not helping.  

You are not alone in this.  If you are struggling, reach out to a family member or friend, or seek guidance from a professional.  Help is available.

As discussed in my Caregiver Blog, there are two basic ways to hire a private caregiver, either use a Home Health Aide agency, or hire a private individual through word of mouth, etc. Once you decide what it is that you are looking for, there are a variety of questions you will want to ask in order to make an informed decision.

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