As we watch the statistics on the prevalence of dementia increase from year to year, we have to consider the impact this has on all facets of life.
One area that needs closer scrutiny is driving. Driving represents freedom and independence in a country where many goods and services are not within walking distance and mass transportation varies wildly from city to city and state to state.
It’s estimated that 5.4 million Americans of all ages have Alzheimer’s disease. As we age, the prevalence increases to one in nine persons age 65 and older and about one-third of all persons age 85 and older (
2016 Alzheimer’s Disease Fact & Figures).
Of the 46.2 million people age 65 and over living in the US, 35 million are licensed drivers (National Highway Traffic Safety Administration, 2011).
Due to our great dependence on automobiles in our society, our focus of care for persons with dementia needs to include driving status.
How dementia affects driving
Driving is a complex instrumental activity of daily living (IADL). The complex cognitive functions required for driving can be impaired in persons with dementia, even in the early stages due to the deterioration of the executive skills.
Executive function [PDF] involves making appropriate decisions, considering consequences, working memory, prioritizing, paying attention (and not being distracted), and focusing on important details.
Other cognitive functions that are affected as the disease progresses are judgment (knowledge of rules of the road), processing (reaction) time, problem solving (what to do when the unexpected happens), and visual perceptual skills (road sign recognition).
These types of cognitive impairment may occur in the
early stages of the disease.
The person in early stage dementia retains
procedural memory skills, such as applying the appropriate pressure on the gas and brake pedals and turning the wheel.
Photo: Photobuff/iStock
It is impaired
cognitive functions that lead to unsafe driving.
For example, a person with compromised ability to make good decisions or predict consequences may not consider:
- How they’re impacting the flow of traffic when they’re going slowly while merging onto a busy highway.
- How the vehicles behind them will be affected when they make a fast stop.
- Or how the safety of others in an intersection may be impacted by the person not obeying the traffic signals.
Unfortunately, in the news we hear stories of elder drivers hitting and either injuring or killing bicyclists and pedestrians or themselves, and damaging property from making critical errors while driving.
Studies and driving assessments of drivers with dementia have supported that driving errors that are strongly predictive of crashes include:
- Lane change with an unsafe gap
- Failure to stop completely at a stop sign
- Stopping over a stop bar
- Improper turning path
- Stopping for no reason
As the disease
progresses, drivers may start out driving and forget where they intend to go, not recognize or attend to their own familiar environment (neighborhood, streets, landmarks), and consequently become lost.
If their problem-solving abilities are intact enough for them to ask for directions, they may not be able to implement those directions due to impaired short-term memory and a decreased ability to think abstractly.
In the article
Drivers With Dementia and Outcomes of Becoming Lost While Driving, the authors found that out of 207 reports of lost drivers with dementia over a 10-year period, 70 drivers were never found. 32 drivers were found dead.
Challenges and tips for families
Losing the independence that driving provides can be very upsetting. Many times, persons with dementia lose insight into their driving abilities and are unable to understand that they’re at significant risk for injuries or accidents when driving.
This also becomes a challenge for families and care partners who want to preserve the person’s sense of dignity and protect the person’s safety and the safety of others.
If you have to take driving privileges away, here are some recommendations:
- Consider a driving assessment
- Ask the physician to write a “no driving” prescription
- Disable or remove the car
Be sure to provide safe, reliable alternative transportation and assure the person of your love and support.
When the decision to stop driving must be made, involving the person early in the process can reduce family members’ stress. And for the person with dementia, it’s important to validate their feelings and preserve their independence by ensuring that they have a safe and reliable way to get around.
Driving assessment resources
- Hospital-based programs, in both rehabilitation and acute-care hospitals
- University-affiliated programs, often with connections to a medical center
- State-operated facilities or programs established by the Department of Veterans Affairs
- Independent, community-based businesses
Many web-based resources are available too, including:
For professional care partners
As a member of a community concerned about the health and well-being of persons with dementia, you can assist your local community by sharing information about dementia and how the progression affects cognitive processes.
At Dementia Care Specialists, we teach the use of the Allen Cognitive Disabilities Model to discover a person’s remaining functional cognitive abilities while discovering impaired cognitive skills.
Using the Cognitive Disabilities Model can provide vital information to family and healthcare professionals as to when it’s time for the person to retire from driving. This is a time when information provided by healthcare professionals trained in the model can have a huge impact on the safety of persons driving with dementia and others on the road.
Offer your knowledge of the Cognitive Disabilities Model to persons with dementia, their families, care providers, other healthcare professionals, and public service agencies.
Your input could provide someone with transportation independence without compromising safety.
References
- Am J Occup Ther. 2010 Mar–Apr; 64(2):225-32. Drivers with dementia and outcomes of becoming lost while driving. Hunt LA, Brown AE, Gilman IP.
- 2016 Alzheimer’s Disease Facts and Figures, Alzheimer’s Association.
- alz.org/care The Alzheimer’s and Dementia Caregiver Center