Driving With Early Alzheimer's

It's OK, experts say, but caregivers must decide when to take the keys away

SUNDAY, Nov. 25, 2001 (HealthDayNews) -- A family member has just been diagnosed with early Alzheimer's disease. The next logical step is to take away his car keys, right?

Not necessarily, according to Alzheimer's experts. They say the decision to revoke someone's driving privileges is a complex one that requires weighing the mental skills of the individual and the safety needs of others.

"A diagnosis of Alzheimer's doesn't mean the patient [should] stop driving," says Stephen McConnell, vice president of public policy for the Washington, D.C.-based Alzheimer's Association. "But when a person poses a certain risk [to himself and the community], driving privileges should be withheld."

Maureen Mohyde is director of corporate gerontology at The Hartford Financial Services Group, Inc., whose company sells insurance to many people over 50 years old.

She says, "Most people make their own decisions [to stop driving] and make them wisely, but others lose the ability to make that self-assessment."

Those who can't act in their own best interest can sometimes be very disruptive, Mohyde says, like the man who refused his daughter's request to stop driving by telling her, " 'You're not a man if you can't drive.' "

Mohyde says that because many more people are now receiving early diagnoses for Alzheimer's, when the illness causes only minor impairment, these people can continue to work -- and drive. But this can worry their families.

The Hartford began getting more and more calls in recent years from families asking the company to cancel a client's car insurance without her permission, Mohyde says.

"We couldn't take away their insurance," she says. "But we realized that people were struggling with the decision."

The firm's response was the publication of a booklet designed to help caregivers make the right decision about when an Alzheimer's patient should stop driving. Called "At the Crossroads," the booklet offers practical advice to families wrestling with the tough decision.

Key to a smooth transition is planning ahead as much as possible.

"You do have to begin to plan for the time when he or she has to stop," Mohyde says.

She urges families to talk ahead of time with the patient about what driving means besides just transportation; often daily chores provide important social connections. It's also important to make alternative transportation plans for the day a driver has to surrender his keys. If a family member won't be free to drive the patient, you still have time to find someone who can.

The booklet also includes a form for both patient and caregiver to fill out and sign. It says that when the time comes, the patient will agree to the caregiver's decision to stop driving. Although this form has no legal worth, it seems to help caregivers, Mohyde says.

"When the time comes for the driving to stop, the caregivers do feel less guilty when they all have signed the form," she says.

The booklet suggests that caregivers monitor the patient's driving and make careful notes of any mistakes that could indicate a loss of judgment. Things to look for include simple mistakes like incorrect signaling, or trouble navigating turns. More serious warning signs are hitting curbs, driving at inappropriate speeds, or getting lost in familiar places.

"You look at first for things that aren't necessarily dangerous, but for a pattern of losing skills, like always signaling incorrectly," Mohyde says.

McConnell adds that "physicians and the health profession should also participate in helping families with this decision, although some doctors are uncomfortable about violating the privacy between doctor and patient."

"Driving is one of the most difficult ethical, legal and really personal issues that families confront with an Alzheimer's patient," he says.

Adds Mohyde, "There is no single way to do this."

What to Do: To learn the 10 warning signs of Alzheimer's disease, visit this Alzheimer's Association Web site. And this association site looks at the link between Alzheimer's and heredity.

SOURCES: Interviews with Maureen Mohyde, director of corporate gerontology, The Hartford Financial Services Group, Inc.; Stephen McConnell, vice president, public policy, Alzheimer's Association, Washington, D.C.
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