Many elders have an understanding of the changes they are experiencing with age and they begin imposing restrictions on their driving. Due to medical conditions, problems with vision, hearing and mobility, many drivers limit their driving to daylight hours, good weather conditions, avoid rush hour traffic and often use the same routes so they are comfortable with their surroundings.
But what about the person who has lost the ability to assess his own driving abilities? A lack of insight regarding cognitive and functional deficits often leads the driver to continue driving beyond the point he is competent to do so.
Alzheimer’s disease and other dementia diagnoses present many changes and losses to individuals in addition to memory loss:
- DISORIENTATION—An Alzheimer’s patient can easily become lost or confused by his surroundings and might have no understanding of how he got where he is.
- DECREASED INSIGHT AND JUDGMENT—Without the ability to reason and make decisions, the diver often becomes involved in unsafe situations that result in accidents. Driving too close, too fast for conditions, inappropriate lane changes and confusion at intersections are just some examples of this danger.
- PROBLEMS WITH LANGUAGE—Words, signs and traffic lights are all symbols which must be interpreted by the driver. The inability to instantly understand a command often leads to a crisis and injuries.
- CHANGES IN MOOD AND BEHAVIOR—Increased stress from the stimulation of driving is very likely to produce not only confusion but perhaps anger, frustration, fear or aggressive behavior toward other drivers. “Road Rage” behaviors are highly unpredictable when the driver has Alzheimer’s disease or another dementia diagnosis.
Studies of aging drivers who have dementia show the difference in perception of their skills. In a control group of individuals who are of advanced age but with no signs or symptoms of dementia, those drivers revealed accurate assessments of their abilities to drive. Some were overly critical of their driving skills and had imposed restrictions on their own driving. The comments of those drivers were in contrast with the assurances from the drivers who had dementia, who stated there was no loss of skill that caused a concern for safety.
The person who has dementia has very poor insight not only into his loss of cognitive skills, but he also shows little recognition of overall decline in his performance. Past instances of poor driving or even previous accidents are not recalled. The affected driver expresses confidence in his skills and resists comments of family members who offer to drive him as needed.
One of the greatest conflicts for the family caregiver—whether a wife, husband or adult child—involves the ability of the person who has dementia to continue to drive.
What can the family caregiver and community do about unsafe drivers who still drive o our highways and streets?
A study by the National Highway Traffic Safety Administration found that many family members of impaired drivers want authority figures, such as doctors, to help convince their loved ones to stop driving. Some doctors do write orders “Do Not Drive” and give those to the impaired drivers. However, many physicians do not report an impaired driver to their state offices due to liability risk. It is up the family members to take action to stop an impaired person from driving.
The Physician’s Guide to Assessing and Counseling Older Drivers is available through the American Medical Association’s Web site. This guide was created in 2002 to address this serious but frustrating issue and to help medical professionals accurately assess an aging patient’s ability to drive. But, in Arkansas, there is no mandatory reporting regulation stating that licensed professionals are required to report unsafe drivers to the Department of Motor Vehicles.
Discuss dangers with the driver, family members and health care professionals. Enlist all support and advice possible from the community to address the person’s need to stop driving.
If these actions do not prevent the person from driving, consider contacting the Arkansas Driver Services Division driver control department at (501) 682-1631. A family member can write a letter to the driver control office at P. O. Box 1272, Room 1070, Little Rock, AR 72203. Request an ability to drive hearing. Include the name of driver, driver’s license number, date of birth, address and phone number along with copies of medical records, traffic citations or other evidence of unsafe driving. The office will issue a letter to the individual requesting their presence at a hearing. At the hearing, the individual must prove that he is physically and mentally competent to drive. Family members can submit letters reporting performance impairment. This process can take several weeks.
Driving is a highly stressful an emotional issue for families of a person who has a diagnosis of cognitive impairment. It is important to have support from the physician and the community.