Difficult Conversations: Driving
Nothing is more sacred to most Americans than their personal independence. In many communities, however, public transportation is not widely available, so independence requires being able to drive. If your loved one is still driving now, at some point due to progression of Alzheimer’s disease their intellectual ability may not be powerful enough to keep them safe while driving. In addition, they may have other medical conditions contributing. Among the conditions that could cause concern about a person’s ability to continue driving are problems with eyesight and coordination, other neurologic illness such as Parkinson’s, and stroke. Medications and alcohol may also affect driving, and drug interactions can multiply impairment.
Keep in mind that driving is both a physical and intellectual activity. Imagine making a left-hand turn. You must move the steering wheel while adjusting the brake and gas pedal. Those are physical activities that make the car move. At the same time the driver must also judge the distance of the oncoming car, recognize what the traffic lights mean, and plan the timing of turning on the turn signal. There is a Lot going on.
A particularly challenging aspect of this issue is there is no clear consensus on when someone should stop driving. Clearly the goal should be risk avoidance for the patient as well as broader society. Some patients are willing to stop, but others are adamant that they are still good drivers.
It tends to be better to look at objective evidence of your loved one’s driving skills. This can be done via conversations with family members who have driven with your loved one. There are often driving assessments you can obtain from a driver’s education school or rehabilitation center.
Here are some indicators of impaired driving from Alzheimer’s disease:
getting lost in familiar places
failing to observe and obey traffic signs and speed limits
poor or slow decision making in traffic
trouble navigating turns or judging distance
not anticipating actions of other drivers
drifting across lanes
getting confused at exits
stopping before reaching an intersection
parking inappropriately
hitting or driving over curbs
anger, confusion or frustration while driving
scrapes on car, garage, or mailbox
car accidents or near misses
needing instructions from passengers
In Florida anyone can report an impaired driver via the Report a Driver Form available on the Department of Highway Safety and Motor Vehicles website. You may prefer to call 1-850-617-3814 (not a toll-free number). Any person is authorized to report an unsafe driver confidentially, with protection from civil and criminal actions. Complaints are investigated and retesting at a driver license office may be required. Elders are contacted via letter as the complaint is investigated.
Having to give up a driver’s license represents a great loss of freedom and mobility and can be difficult emotionally, as it is symbolic of loss of control over one’s life. As one older person described it, “It’s the hardest thing to have to give up your license, because then you’re grounded.” The elder may become socially isolated through a loss of friends and activities. Referral to community resources for transportation may be helpful. Ride-sharing apps can also provide needed transportation. The service “GoGo Grandparent” helps with scheduling and verification of arrival and pick up. Please be aware that these services may have eligibility guidelines, mileage limits, and call-ahead policies. To the person having to give up their driver’s license, using transportation programs cannot erase the pain of having lost the freedom to drive anywhere, anytime. Counseling your loved one to help get over the loss may be needed.
