Dementia and Driving Don't Mix
After one such episode, one of Susan's sisters exercised a durable power of
attorney and had Walter admitted "to a secure Alzheimer's unit. ... Our
whole family has been in upheaval," says Susan. She says that she is glad
the AAN is issuing guidelines so that "other families may be
Dubinsky adds that some states require physicians to inform the departments
of motor vehicles about the need to prohibit driving. In California, for
example, Alzheimer's disease is a diagnosis that must be reported to the DMV,
which automatically revokes the patient's license. Patients are, however,
allowed an appeal.
In addition to issuing the new guidelines, the AAN says that research is
still needed to determine if there are a subsets of patients with Alzheimer's
with moderate dementia who can drive safely, or who can drive safely with
enforceable restrictions," such as non-highway driving or driving within a
limited geographic area.
While the Alzheimer's Association agrees that people with milder Alzheimer's
disease should be discouraged from driving, it released a prepared statement in
response to the guidelines, saying "the final determination is one that
should be made with full involvement of the individual with the disease, their
caregiver, and their health care provider."
"It is very appropriate for the AAN to have some guidelines, and I think
these guidelines are very reasonable," says Morris, who on the Alzheimer's
Association board of directors. "The problem is that guidelines do not
apply to every individual case."
"There are not many studies of people with defined Alzheimer's who have
actually been assessed on their ability to handle an automobile in every day,
real life situations," he adds. In his own work he has used driving
instructors and other "driving evaluators" to assess driving skills. As
a result, he says, there are people with mild dementia who are considered safe
drivers by professionals who have evaluated their actual driving.
Morris says that a broad application of the new guidelines could "result
in some individuals who would have their mobility restricted prematurely."
He urges taking an individualized approach for patients whose families or
caregivers are not reporting driving problems. He says that driving evaluations
can usually be "arranged through occupational therapy departments."
Allen has her own suggestions for coping. She says when it comes to getting
loved ones with Alzheimer's disease to stop driving, there are some important
things to remember. Cars equal freedom, and the desire to drive is deeply
connected to a good lifestyle. See how much of the patient's lifestyle you can
keep intact by researching the public transportation available in your
community, she says. Some towns offer discounts to seniors, and under the
Americans With Disabilities Act, Alzheimer's patients may be entitled to some
type of transportation, she says. Also, groups like the American Red Cross
offer regular trips to the grocery store in a van with a certified driver.