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A diagnosis of dementia has a profound effect on caregivers who need to respond to challenges as sociated with progressive cognitive decline. One of the most difficult decisions that caregivers face involves making decisions about when the person should stop driving.1 Dementia, even in the early stages, can impair cognitive and functional skills that are required for safe driving.1 Older adults with dementia are more likely to drive off the road, drive slower than the posted speed limit, apply less break pressure when attempting to stop, and make slower turns.2 Because driving is closely associated with personal identity, societal roles, quality of life, and independence, many older adults resist giving up driving.1 As many as 30% of individuals with cognitive impairment continue to drive.3 As a care provider for my mother with mild cognitive impairment that progressed to dementia, this was something that I experienced firsthand.
I remember an incident that happened in early December of 2008. My mother wanted to drop off some items for our upcoming holiday celebration and didn't want to wait for me to come and get them from her, so she decided to make the 7-mile trip from her condominium to my home to get this item "out of her in-box." She looked a little shaken following the trip so I offered her a small glass of wine, with the promise that I would drive her home, so she wouldn't have to get behind the wheel. After our visit, I walked her out to her car and helped her get into the passenger seat. Everything was fine until I sat in the driver's seat and almost fell into the back seat because the seat was fully reclined. When I asked her why the seat was reclined, she laughed and replied that she couldn't figure out how to get the seat back up. To this day, I still can't figure out how my mother was able to drive to my home with her seat fully reclined. After I fixed the seat and adjusted the mirrors, I pulled out of the driveway and had to pull over immediately when I heard a "thwack-thwack-thwack" sound coming from the car. As I got out of the car to inspect it, I discovered that the tread had separated and was ready to slide off the base of 2 of her tires. While mom knew that her car was making a strange sound, she wasn't able to appreciate the safety risk to herself and others. Fortunately, my husband and I were able to convince her to give up driving and let us chauffeur her to the store and to her medical appointments.
That afternoon made me very aware of my need for information on driving safely for individuals with cognitive impairment. I see that it is critical that we work closely with family caregivers to ensure that they are knowledgeable about the challenges and risks associated with driving with cognitive impairment. We also need to ensure that they know where to go to obtain an independent driving evaluation and for support during this transition from driving to not driving.
In this issue of Alzheimer's Care Today, the Tips and Strategies and Moving from Research to Best Practice departments are devoted to providing guidance on dementia and driving for caregivers, persons with dementia, and professionals. The Tips and Strategies department is designed as a tear-out section that you can give to caregivers you know or to individuals who are in the early stages of dementia. Hopefully, this information will help them be better prepared for transitions in driving and transportation. I know that this information would have been very helpful to me as I worked through driving issues with my mother.
1. Adler G. Intervention approaches to driving and dementia. Health Soc Work. 2007;32(1):75-79. [Context Link]
2. Carr DB, Ott BR. The older adult driver with cognitive impairment. JAMA. 2010;303(16):1632-1641. [Context Link]
3. Kennedy GJ. Advanced age, dementia, and driving: guidance for the patient, family and physician. Prim Psychiatry. 2009;16(9):19-23. [Context Link]
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