Driving with Alzheimer’s Disease
By Barbara (Bobbi) Kolonay RN, BSN, MS, CCM
Elder drivers are more likely to get into multiple vehicle accidents than younger drivers and suffer more serious injuries. As we age, our ability to drive safely can be limited by many factors, including visual decline, loss of hearing, mental functioning, limited mobility, and medication side effects. Frequently family members recognize the older adults limitations before they do and it is important that the adult children and family members carefully monitor the situation and driving limitations. The below information should help you determine whether you should take steps to encourage the senior to stop driving.
- Hearing Loss: Over one-half of older adults over the age of 65 have some type of hearing impairment and this increases with age. Loss of hearing happens gradually and the older person may not realize they are not hearing well. Older adults that are hearing impaired can be inattentive to their surroundings, and are not hearing important cues when they are driving. The first sign of hearing loss is one’s ability to higher pitched sounds, such as a horn, a car turn signal and emergency siren.
- Limited Mobility: Numerous diseases including but not limited to arthritis, Parkinson’s disease, diabetes and heart disease can affect ones ability to drive safely. One needs to be able to grip a steering wheel, move ones feet from the gas to the break, and look completely over your shoulder. A full range of motion is critical on the road. Additionally, most older adults drive sedans that are the most difficult to get in and out of and control on the road.
- Medications: Certain medications, as well as combinations of medications, can increase driving risk. Analgesics (pain relievers), antihistamines, antiarrhythmics (irregular heart beat), and antihypertensive drugs all have the potential to affect driving ability. The main factors in collisions involving older drivers are slow response, not seeing a sign, car, or pedestrian, and interaction with other drivers. Medications can make a driver more susceptible to any of these factors – and those over age 65 take an average of nine medications daily, including prescription, over-the-counter and herbal.
- Mental Functioning: By the age of 85 close to 50% of older adults have some type of dementia. Those with dementia are 5 times as likely to be in a accident than their noncognitive impaired aged-matched individuals. Dementia can be defined as “an acquired persistent impairment of intellectual function with compromise in at least three of the following spheres of mental activity: language, memory, visual-spatial skills, emotion or personality and cognition. Impairments in the above areas may cause delayed reaction to sudden or confusing situations on the road or in dealing with complex, confusing intersections.
- Memory can be divided into short-term and long-term. Decreased mental functioning is initially seen in the short-term memory. Older adults call upon their long term memory to recall such skills as how to start a car, driving a familiar route from point A to point B, and where the stop signs are along the route. On the other hand, you call upon your short-term memory while driving in unfamiliar territory, confronting a detour, or finding your car in a parking lot. This requires holding on to short-term information, which can be difficult in the early stages of dementia. Visual-spatial skills include a component of memory as well as depth perception; the ability to judge distance and speed, the ability to stay in ones lane, along with the concept of sense of direction. Cognitive impaired individuals also are at particular risk for accidents while making left turns across traffic, a maneuver that requires one to quickly process large amounts of rapidly changing spatial information. Those with early stage dementia lack insight to realize they are driving poorly. It is these individuals who need to stop driving that have the least personal awareness that they are incapable drivers.
Warning Signs Of Unsafe Driving
- Unexplained dents, dings and scratches on the car. These can be a sign of more serious accidents waiting to happen
- Car paint on mailboxes, sides of garage door, curbs, etc.
- Failing to use turn signals or keeping the signal on without turning
- Abruptly changing lanes, breaking or acceleration
- Trouble reading signs or navigating directions
- Range-of- motion issues – looking over the shoulder, holding on to the steering wheel, moving the feet or hands
- Increased nervousness with driving, fear while driving, or feeling of exhaustion after driving
- Other drivers honking; oblivious to the frustration of other drivers, not understanding why they are honking
- Reluctance of other to be in the car with the senior driver
- Getting lost more often
- Slow reaction to changes in the driving environment
Steps To Take If You Are Concerned About The Safety Of A Senior Driver
Most older drivers when intelligently engaged on the issue will lessen, self-monitor or stop driving when it is time to do so–but some may require more persuasion than others. (see my article on Anosognosia). It is important to keep in mind that resistance has a positive side. It indicates that an older driver is determined to be self-reliant, and wishes to demonstrate their ability to run their own lives. In few instances, however, an older driver will refuse to stop or alter driving practices even when they are becoming dangerous. Below is a list of recommendations to consider when dealing with a reluctant individual:
- Improve existing skills by taking a refresher course offered by AARP or their insurance company
- Go to the state Department of Transportation (DOT) for testing
- Appeal to an authority figure such as the older adults family physician
- Get an independent evaluation from a healthcare provider. Most rehabilitation facilities have occupational therapists that conduct driving testing for those believed to be impaired. You will need a physician order for this testing.
- Focus on the money they will save by using public transportation, car-pooling, or taxi services. You want to look at the cost of gas, insurance, car payments and repairs when calculating the cost of a car.
- Explore ways to reduce driving, such as making purchases through catalogues or on-line. There are many services available now that offer home delivery of groceries also.
- There are numerous alternative transportation systems for older adults through your local area on aging. Some may offer reduced taxi service, reduced van services, and free public transportation.
- Offer rides and find others who can offer rides. Ask family members to commit to one day a week to drive their parents/relative. Make sure to have a plan in place before removing one of theri most importance representation of independence.
- If family isn’t available, consider hiring outside caretakers to drive your loved one to places like the doctors office, grocery store, or mall. Chances are if they are having problems with driving, they may also be having problems navigating the confusion of these areas and these individuals can help.
- In the worst-case scenario, take away the keys, disable the car, or remove the car from the premises.
Most adults view their car as a powerful source of independence and mobility that they do not want to loose. But as we age changes can take place that make this source of independence potentially dangerous for the older adult and those on the road. It is important to recognize those factors that limit an older adults ability to drive safely and minimize them before an accident occurs. Family members and friends may be the first to be aware of these limitations, so it is important to listen to them voice concern for the older adults safety and assist with finding alternatives to maintain that sense of independence.