According to The Journal of the American Medical Association, drivers with dementia have at least twice the risk of car crashes compared with those who don't have dementia. Yet just six states -- Oregon, California, Nevada, Delaware, Pennsylvania and New Jersey – require doctors to report when a patient is found to be mentally impaired. Therefore, the issue of when to stop driving is largely left up to people with Alzheimer's and their caregivers.
Studies indicate that most people opt out of driving on their own, says Robert Passmore, senior director of personal lines at the Property Casualty Insurance Association of America, a trade group. “They realize that they are growing less comfortable with driving, so they simply stop," Passmore says.
Jodi Olshevski, a gerontologist with The Hartford, says the insurance company's research confirms that older drivers voluntarily limit their driving. But, he adds, “self-regulation becomes less certain for individuals diagnosed with Alzheimer’s because judgment will at some point be impaired. It’s not a matter of whether they’ll need to take themselves off the road, but when.”
With this in mind, here are five steps that caregivers can take when a friend or loved one is diagnosed with Alzheimer's, which affects an estimated 5.4 million Americans.
1. Make a plan. Speak openly with the driver soon after diagnosis so the patient feels he or she has a voice in the process. Discuss transportation options after the person with Alzheimer's gives up the car keys, such as tapping family members and friends, public buses and community transportation services.
Because it can be an uncomfortable issue to discuss, many caregivers put off the conversation, but Olshevski says research by The Hartford indicates it's best to put a plan in place early. Among the free resources available on The Hartford's website is “At the Crossroads: Family Conversations about Alzheimer’s Disease, Dementia & Driving,” which contains an “Agreement With My Family About Driving.” Although not a legal document, the agreement empowers the caregiver to feel more comfortable taking action.
2. Watch for signs that driving is impaired. These include:
• Difficulty locating familiar places, such as a grocery store or church.
• Errors at traffic signals or intersections.
• Slower reaction times.
• Driving at inappropriate speeds.
• Anger or confusion while driving.
• Hitting curbs.
• Confusing the brake with the gas pedal.
Olshevski recommends that caregivers consistently ride with someone who has Alzheimer's to observe his or her driving habits.
3. Get an evaluation. If driving is becoming a safety concern, have an occupational therapist or your state's department of motor vehicles perform a driving evaluation. The evaluation takes about three hours and provides a clinical approach regarding whether someone with Alzheimer's should be driving. The Alzheimer’s Association offers referrals to local organizations that perform driving evaluations.
4. Check with your car insurance company. While there are no direct car insurance implications for people with Alzheimer’s, recurring accidents would make the driver a greater risk and insurance premiums could go up. Some insurers provide resources for people with Alzheimer’s and their caregivers; check with your car insurance company or agent for details.
5. Take action. When it's clear that driving has become dangerous and the patient refuses to give it up, the Alzheimer’s Associations suggests these alternatives:
• Encourage the police to issue a citation.
• Ask a doctor to write the person a "do not drive" prescription.
• Control access to the car keys.
• Keep the person's car out of sight.
• Be sure a ride is available if the patient needs to go somewhere. Provide a list of contacts who have offered to provide transportation.
• Reduce the need to drive by having prescription medicines, groceries or meals delivered.