Driving: Ideas For Helping a Loved One to Stop
Driving is a privilege that adults enjoy for most of their lives, and it really represents for us a sense of autonomy and mastery over our environment. Permanently surrendering this privilege is seen by most as a real threat to our status in the family, in the community and in society. Pair this threat to dignity with an overall loss of independence and you have set the stage for a real battle. Older adults in particular find this transition to be immensely traumatic, as they have likely seen peers already experiencing such losses. Facing a sense of mortality is never easy, and it is natural to want to hold onto as much independence as possible.
The key to successfully convincing a disabled person to give up certain risky activities is as simple as using logical reasoning to explain how the risks outweigh the benefits. Unfortunately, people living with dementia are not often able to respond to logical reasoning. In fact, it is their overwhelming lack of logical reasoning that causes them to make such poor judgments about issues related to health and safety. This is the result of the disease, and they cannot “decide” to be more rational. Brain damage prevents them from having this ability for the most part. To worsen matters, individuals with dementia also have poor short-term memory—limiting their ability to recall recent events that would support the need for change. Maybe there was a minor fender bender, or perhaps it was not possible to find the store or the way home on a recent trip. These examples would be wonderful fodder for a discussion about a lifestyle change, provided the person could remember the incident.
So what can the family do to help a loved one make this transition? First try to explain the risks and see if a discussion is possible. Suggest that it is important to prevent the first accident, rather than await the first signs of a problem. The first incident could be the one that kills your loved one, or some family that happens to be a victim of that accident. This is a scare tactic that is difficult to use, but could be effective. It uses the basic “insurance” concept of making some small manageable changes now in order to lessen the impact of a damaging event later. People purchase insurance because small payments over the years prevent total financial devastation in the face of a medical or natural disaster. We tend to make health decisions about diet and exercise in the hope of staving off illness and infirmity. Similarly, by giving up some independence now, such as driving, it is possible to avoid a debilitating crisis that will require a total loss of independence, or even loss of life.
If an individual with Alzheimer’s disease is comfortably engaged in the discussion, but simply disagrees that such a drastic change is needed, at least try to agree on some new limitations to the driving routine that will cut down on risk, and agree to reassess this issue every month. For example, Dad can still drive, but no other family members will be willing to risk their lives in the car with him, he can only drive in the daytime, and he has to take a working cell phone with him in case he gets lost or has an accident. Such a compromise might also drive home the severity of the situation and help future discussions. The reason for an agreement about reassessing is that you will lay the ground work for talking about this issue again having already listed some signs of a problem that would require a change—such as getting lost or scraping the car against another vehicle. This approach may only be appropriate for someone in the very early stages of dementia.
A discussion of this nature may not be possible. If confusion and memory loss are too severe, you cannot rely on such a conversation to instigate a change. The person might forget the agreement after the fact, or might have a catastrophic emotional reaction to even discussing the issue. In these cases a more creative approach is needed. Consider bypassing the need to convince the person to stop driving, and focus your energy on simply stopping the risky behavior. This might include asking the doctor for a “prescription” note that advises the patient that driving is no longer possible and must be stopped. Doctors are seen by many as having some authority. Similarly, many cities offer a driving assessment program that is either administered by, or run in cooperation with, police departments and motor vehicles departments. Such programs will take away a license if the participant is too impaired to pass the assessment. Inquire about such programs by calling your local Area Agency on Aging, police department, and motor vehicles bureau.
In severe situations it is important to consider some other ideas, including: hiding or removing keys to the car, dismantling certain features of the car engine system so it is inoperable, and removing the car entirely. These interventions are quite forceful and strict, but are sometimes needed in cases where the individual with Alzheimer’s disease is determined to continue to drive despite the best efforts of the caregivers to thwart the behavior. This aggressive type of intervention might be used when the individual with dementia is creating severe risk by driving. When confusion and general functional impairment are so severe, it is simply not safe to be allowed to operate a vehicle. However, judging the severity of risk might be a challenge, and you might consider seeking a consultation from a doctor, a driving program or an Alzheimer’s agency in your community.
Published On: June 15, 2007