July 20, 2010
The ability to drive is a crucial factor in helping older adults feel a sense of dignity and independence. But what happens when a diagnosis of Alzheimer's enters the picture?
While some people with early Alzheimer's disease can continue to drive, even for extended periods, special precautions or limitations may be required. And as Alzheimer's progresses, driving becomes increasingly unsafe, with a greater risk for accidents that can prove fatal.
The American Academy of Neurology, a leading professional group of physicians who deal with Alzheimer's and other brain and nervous system ailments, has updated their guidelines to help caregivers, patients and doctors determine when people with Alzheimer's should stop driving. The guidelines recommend that doctors work closely with patients and family members of people with Alzheimer's disease in order to identify those at high risk of unsafe driving.
Dr. Donald J. Iverson of the Humboldt Neurological Medical Group in Eureka, Calif., who helped develop the guidelines, stressed that "it’s important for doctors to discuss this with patients and caregivers soon after the diagnosis, since restricted driving will affect the patient’s quality of life and may lead to other health concerns such as depression." He also notes that the decision to ban driving is a complex one and may require input from an Alzheimer's specialist.
"While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive," Dr. Iverson said. "But while some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving."
Family members should also trust their instincts, the guidelines note. Research has shown that caregivers who rate a patient’s driving as “marginal” or “unsafe” were often proven correct when the patient took an on-road driving test. On the other hand, people with Alzheimer's who thought their own driving was “safe” were not necessarily accurate in their own assessments.
Warning signs that family members should look for that may indicate driving is no longer safe include:
- Recent accidents or collisions.
- Recent traffic tickets or violations.
- Driving less, or avoiding driving at night or in the rain – although people who continue to drive under these circumstances may also be at risk.
- Aggressive or impulsive behaviors – behind the wheel or not.
It's also important that patients and caregivers know their state laws. In some states, doctors are required to report any medical conditions that may impact their ability to drive safely, including Alzheimer's disease.
In addition, since driving ability often declines fairly rapidly among patients with Alzheimer’s, regular follow-up assessments are warranted. The American Academy of Neurology recommends a reassessment every six months for people diagnosed with very mild dementia who continue to drive.
Driving safely is an issue for any older driver. Per mile driven, the accident rate is nine times higher for those 85 and older, compared to younger drivers in their late 20s through their 70s. If someone has failing cognition due to early Alzheimer's or other forms of mental decline, the likelihood of a car crash is much greater.
Yet imposing driving restrictions can be hard for anyone to accept. Driving affords older people a coveted sense of independence and connection to the wider community at large. Taking away a license can be devastating to self-esteem and make life more difficult for seniors and family members both.
Alzheimer's disease is of particular concern, because patients may be unaware of their progressive mental decline and the threats they pose on the road. Unlike someone who has a condition like failing eyesight or arthritis who cuts down on his or her own driving voluntarily, a patient with Alzheimer's may stay behind the wheel longer and drastically misjudge the ability to continue driving.
In the case of Alzheimer's, it often falls on caregivers to assess the driver and enforce a driving ban. It is vitally important that family members look for any signs of mental decline in loved ones and discuss concerns with a doctor.
D. J. Bronson, M.D.; G. S. Gronseth, M.D.; M. A. Reger, Ph.D.; et al: "Practice Parameter Update: Evaluation and Management of Driving Risk in Dementia: Report of the Quality Standards Subcommittee of the American Academy of Neurology." Neurology, Volume 74:1-1, April, 2010. American Academy of Neurology, Annual Meeting, Toronto, April 12, 2010.