August 9, 2023 – Four years ago, Pamela Smith, a 76-year-old retiree from Orlando, Florida, was concerned about her husband’s driving.
Dick Smith was recently diagnosed with mild cognitive impairment and is within the early stages of Alzheimer's disease, Pamela said.
“I noticed that he was wandering around the road and when I pointed it out to him, he corrected himself. We had his eyes checked – we thought it might be a visual impairment – but his eyes were fine.”
A number of times Dick almost hit a concrete median on the highway. Once he didn't know the way to get out of a small car parking zone. “The worst was when he pulled away from a red light and turned right into the flow of traffic, not giving nearly enough room for the cars coming fast. I just held my breath and waited for a possible accident.”
Just as Pamela was about to talk over with her husband about handing over the keys – a conversation that was causing her great concern – Dick himself realized that it was now not secure for him to drive.
“The last straw was when I pulled off our freeway and merged into traffic and my judgment of the speed of the traffic was so poor that my heart actually skipped a beat or two,” said Dick Smith, 80, a retired health care employee.
“I was mature enough to realize that I would rather make sure we were all alive and safe and nobody got killed. That's why I knew I had to give up driving,” he said. “I've always loved driving, especially long distances, so it was very painful. It still hurts.”
A typical problem
Fortunately, Dick was self-aware enough to acknowledge that he could now not drive safely. But unfortunately, many individuals proceed to drive despite cognitive impairments, latest research shows.
The researchers studied 635 individuals with a median age of 77. The group included Mexican Americans and non-Hispanic whites. All had shown signs of cognitive impairment (lack of pondering ability) based on a test called the Montreal Cognitive Assessment.
61.4% of the people participating within the study were lively drivers and a few third of their caregivers had concerns in regards to the safety of their drivers.
Start the conversation early
Monica Moreno, senior director of care and support on the Alzheimer's Association, said it's vital to acknowledge that everybody experiences Alzheimer's disease otherwise.
“We would never say that all to live with any type of cognitive impairment should automatically lead to driving,” she said. “It is a very individual experience and a decision that the family must make together with the person living with the disease, and it is unique and special to each situation.”
Lead study author Lewis Morgenstern, MD, professor of neurology, epidemiology, emergency medicine and neurosurgery at the University of Michigan, agreed, noting that some people with early mild cognitive impairment “can probably still drive safely and that driving allows them to maintain their independence and their role in society.”
However, families should remain vigilant because “it is inevitable that as Alzheimer's disease progresses – and it is a progressive disease – at some point the person will no longer be able to drive safely,” Moreno said.
According to Moreno, telling a loved one that they can no longer drive is “one of the most difficult decisions the family has to make at this time, because driving is an essential part of a person's independence,” she said. “It keeps them socially involved and able to socialize with others – friends, family members, and so on.”
When we think about “taking away their keys or asking them to give up their keys, we think about the impact on the person who is also experiencing other losses at the same time, and that is huge,” says Moreno, who also leads the Alzheimer's Association's National Early Stage Advisory Group – a group of people with early-stage Alzheimer's who work on advocacy and education about what it feels like to go through the process of Alzheimer's disease.
Moreno encourages families to talk about driving right after the diagnosis. Hopefully, during these initial conversations, the person will agree to accept the feedback that driving has become unsafe at this point.
Morgenstern and his co-authors found that it can be helpful to provide a living will if the person is still able to do so.
Similar to living wills for end-of-life care, living wills are an “agreement between an individual and a trusted person to have discussions about giving up driving” and to permit the motive force to designate one other person to make driving-related decisions for them in the longer term.
Approaching the conversation
The Alzheimer's Association website has a bit on dementia and driving. It also has videos with conversation scenarios to assist people address the subject.
In addition, there may be a 24-hour hotline operated by medical professionals that individuals can call.
“You can talk over with a care counselor who can provide help to develop a plan to begin the conversation,” Moreno advised. “And then after you have got the conversation, you may check with the counselor what went well and what didn't. So you're working with an authority who can guide you thru the entire process.”
If the person is not ready to give up driving
If the person with dementia does not agree or does not realize that they can no longer drive safely, and you or another caregiver are unable to persuade them, perhaps other family members can step in and try to do it.
Morgenstern advises caregivers to talk with the person's primary care physician about safety issues related to cognitive impairment, including issues related to driving and home safety.
Consider taking a practical driving test, attending a driving school or even occupational therapy, he said.
The Alzheimer's Association offers information on how to get a family member evaluated. It may be more effective if the person hears the difficult news from a professional outside the family.
If a person's disease has progressed to the point where driving is dangerous for them but they don't want to accept it, families may need to control access to the car keys, Moreno said. Some families render the car unusable by removing the battery or leaving the wires unplugged, so the car won't start if the person finds the keys and tries to drive away.
“We know that later, because the disease progresses, even the sight of the family automobile within the driveway can trigger an individual's desire to drive,” Moreno said. “I've spoken to families who parked the automobile across the corner and even sold it after they now not needed it so it wouldn't trigger a memory within the person with dementia.”
She stressed the importance of discussing driving early, while the person is still able to do so. “That way, if the person refuses handy over the automobile keys when the time comes, you may know that you just are honoring their wishes and that can assist reduce feelings of guilt.”
Making the transition
Moreno pointed out that in the modern world, services like Uber and Lyft allow people to continue to be independent and get rides to activities and places they enjoy, so they are not isolated.
Pamela Smith was “nervous at first” because Dick had criticized her driving. “That made me very tense and it was an unlucky situation,” she said. “We needed to have several discussions about it.”
Now he keeps his head down and looks at his cell phone or does crossword puzzles. “I don't want to wreck our marriage with my criticism,” he explained.
He advises people to be “mature and sensible” and decide to stop driving before something bad happens.
“I used to be afraid we’d lose our savings, our insurance, our automobile, our lives, or hurt or kill another person, and that didn't make sense to me. Even in my impaired state, I believe I made a very good decision, and the children were amazed that I did all of it alone.”