Driving and CareGiver Backbone

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To Drive or Not to Drive...

What should you do when driving becomes a problem?

Driving is a sign of independence to most people, but when your loved one starts to become a danger to himself or others, it is time to think about taking away his or her driving privileges. In early Alzheimer's a person's memory is affected, so it is very easy for a person to get lost or disoriented, making it difficult to get back home. Not only is this dangerous, it is also very frightening to the patient! He or she may also become confused or scared with all of the noise and commotion of the traffic going on around them as they drive. This could be the breeding ground of an accident. Here are some signs to watch for to determine if it's time to stop your loved one from driving:

Memory lapse that causes them to become lost or unable to locate familiar places.

Confusion or disorientation while driving.

Inablility or failure to heed and obey traffic signs and/or speed limits.

Inability to make good judgements in traffic situations.

So how do you go about telling your loved one that you can no longer allow them to drive?

Here are a few things you can do that may help prevent them from driving:

Talk to them about their driving and the dangers they face, but don't become critical of them. Tell your loved one that you have to take the keys away for his or her safety. Make sure they know that you understand how they feel, and that you are there to support them.

Never leave the keys out where the loved one can find them. Be sure to have a good hiding place.

Make sure that the person knows he or she can depend on you to take them whereever they want/need to go.

Often times, one must take more extreme measures to ensure their loved ones don't drive. In a lot of states, you may be able to report a driver with dementia to the state's Department of Motor Vehicles. In some states, it is required that the physician report cases of Alzheimer's to the DMV. You should check with your state's DMV for more information.

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Reduced Driving Safety in PD (AAN 2000)

E-MOVE reports from the 52nd Annual Meeting of the American Academy of Neurology, held in San Diego, California, 30 April-5 May 2000. Citation numbers below refer to abstracts of presentations and posters, which are published in Neurology 2000;54(suppl.3).

Driving safety in Parkinson's disease
TA Zesiewicz, CR Cimino, NM Gardner, P Leaverton, RA Hauser
S80.005

The risk of automobile accidents increases with parkinsonian disability, according to this study.

Thirty-nine PD patients (including 17 who had reduced or stopped driving after disease onset) underwent driving tests in a driving simulator. Total collisions in the simulator were elevated approximately six-fold compared to age-matched controls (p<0.01), and remained significantly elevated even after removing non-driving PD patients from the analysis. Number of collisions was significantly correlated with UPDRS motor score and Hoehn and Yahr stage, but not with patient self-report of driving ability, or with presence of tremor or dyskinesia. While the present study did not test it, the authors noted that, anecdotally, physician assessment of driving-related ability is not correlated with driving ability as determined by the simulator.

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Recently and from time to time in the past, CareGivers have said they are reluctant to tell their PWPs that the time has come to stop driving. If the doctor can do it convincingly, well and good. If not, the CareGiver really must say it calmly, kindly and firmly and must do whatever is necessary to carry through.

If the PWP has always been the primary driver, he may become very angry, but there are things worse than an angry spouse. If the PWP maims or kills someone, you both will have a load of grief and regret to add to the burden you already have.

It's hard to change the dynamics in a family. If it's nothing important, don't bother. But if someone's life may be in danger, stand up straight and do what has to be done.

(Easy for me to talk, I was lucky. Since my husband didn't learn to drive until he was 36, it seemed natural to him for me to take over the driving.)

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I also had the concern about my husbands driving, especially with all the medicine's he is on, but you cannot take the risk. My husband stopped driving last November and we fortunately had good neighbors that worked at the same base that could help with the driving. It has been hard since my husband is now only 52, but I rather have the responsibility of driving him around than to lose him in an accident or someone else. Keep the faith.

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My family is addressing this issue. My husband is only 44. His neuro feels that he is progressed enough that he does not need to be driving. My husbands profession was a professional truck driver so I was expecting problems when it came time to face this issue. He has been very compliant with what has occurred, not sure yet what he is thinking on the inside though. I feel 100% calmer and less stressed already.

This are getting tougher for the children, 15 and 10. I guess as they get older and understand more they experience more emotions and belligerence because of the situation. As my daughter says, "I am having to grow up too fast."

I just keep on hanging, wondering how many more knots I have until I get to the end of my rope!!

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MY WIFE WHO IS THE PWP FELL ASLEEP AT THE WHEEL. WE WERE BOTH STRAPPED IN BUT NO AIRBAGS. WE WENT AIRBORNE AND LUCKILY A BIG TREE STOPPED US BECAUSE IN FRONT WAS A CLIFF TO THE OCEAN.

FOR SOME REASON I WAS ABLE TO OPEN MY DOOR AND COMEAROUND TO HER SIDE. SHE WAS OK EXCEPT... NOW SHE HAS NO RIGHT HAND.... THE WRIST WAS REMOVED BECAUSE IT WAS SO SHATTERED AND SHE CAN ONLY USE HER THUMB AND FOREFINGER. OH YES, SHE HIT HER HAND SO HARD HER ENGAGEMENT RING CRACKED. NOW WITH CARPELTUNNEL SETTING IN ON THE LEFT SIDE, SHE AGREES ONLY TO DRIVE HER SCOOTER.

I printed this large and bold so every CG/CP who is in this discussion can show their PWP.

TUNE OUT THE ARGUMENT HIDE THE KEYS

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Thank you for giving us the courage to do what we need to do in regard to driving and to stick with our decisions.

I've recently let my husband know that he can't drive any more. It is such a hard thing to do when he doesn't think that there is any real problem and won't really talk about it. It had been months since he had driven and one day he went to the grocery store while I golfed, the only time I'm away and the car is home. Still worries me but he has agreed to not drive unless he tells me and then admitted that meant the he probably wouldn't drive again. I'll have to be alert to changes that would indicate he is thinking about driving or no longer remembers what he promised.

I just wish that he would really talk about his feeling regarding it. It has to be more difficult for him than it is for me. But he won't talk, never would talk about feelings.

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I think I have mentioned this before but here goes again. I absolutely put my foot down on my husband's driving when he put our Caddy through the garage door. It looked like an accordion. He complains from time-to-time but I just tell him them's the brakes. I'd rather drive him than have to tell someone's family how sorry I am that he killed them while he was driving. I also told him to ask one of our kids if he could drive their vehicle and if they said yes I'd give him the car keys back. All of the kids (6) said, No Way, Dad. I still have the car keys.

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We've had this conversation with Dad several times. My refusing to get into the car when he was driving was a real shock to him, but he still insisted that he could drive. At one time, I told him that while he still knew what to do mentally, his body just wouldn't do it anymore. He has quit driving the car now. Instead, he looks forward to driving the scooter.

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Driving has been a big issue in our home. Our neuro sent us for a second opinion and driving came up. The doctor said no way should Charles be behind the wheel of a lethal weapon. Needless to say Charles does not want to see that doctor again. When it came time for license renewal he insisted on going. I had the aid take him because If he was denied I didn't want him blaming me. Guess what he told the lady he had had a stroke and the Dr expected him to get better. She gave him a license.

Several months ago we were down at our second house( which Charles bought in one of his manic states 10 years ago), He got out of the car and said he was going to take the truck for safety inspection. He got rather belligerent about it and I told him I would call the cops if he got in the truck and left our property. He finally got back in the car and we came home. This week at the Lake of the Ozarks he insisted on riding in the pontoon boat and did we.. Had to go down two long flights of steps but our two sons did help. Then he want to drive the boat. We let him for a short while. Guess that helped his ego. It was a week day and traffic on the lake down and Scott was behind him all the time.

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Here in California, the doctor is required to report to the DMV any patient who says he is going to drive even if advised not to. The DMV then sends a letter revoking the driving license. The person can appeal and have a special test to get the license back, but it is pretty hard to do since they have the doctor's report.

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I spoke to a friend of mine with the Illinois State's Attorney's Office who told me that as long as both names are on the car title and on the insurance, both the CareGiver and patient are liable for whatever the patient does while behind the wheel - especially if property is damaged or someone is hurt. The CareGiver may be doubly liable if he/she is the guardian of the patient and supposed to keep that patient safe (to himself and to others). He suggests buying a lockbox with only one key that the patient knows nothing about (nor knows where the key is located) and keep the car keys locked in that box when not in use (these boxes are generally tamper-proof whereas a locked drawer can be pried open). He also suggests taking the patient's name OFF the car's title and canceling the patient's insurance - blaming it on the insurance company if necessary.

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In California you can anonymously report someone who you think shouldn't be driving. Also, licensed physicians are REQUIRED to report people who oughtn't drive. If you live in California and you think your PWP oughtn't drive but is still driving, let his/her doctor know. The doctor probably assumes that the PWP is no longer driving and doesn't know otherwise unless you inform him or her! By law the doctor must report a person who is not competent to drive. Any doctor who fails to do so is a lawbreaker.

Click here for a relevant web page, which contains links to a list of local Driver Safety Offices and to the relevant California law that is binding upon physicians. (The law mostly discusses lapse of consciousness, but other lapses such as freezing and general motor impairment also apply.) Click here for the California Lapse of Consciousness Glossary.

Other states may have similar laws.

How do I let DMV know about a family member, relative or acquaintance whom I believe may no longer be a safe driver?

You may write to your local Driver Safety Office and give the full name of the driver, his or her driver license number (if you can obtain it), his or her date of birth, his or her current address, and a detailed description of the facts you have observed which lead you to believe that the person may be unable to drive safely.

Please indicate in your letter if you wish the referral to remain confidential. However, you must identify yourself in the letter, as DMV will not act upon anonymous referrals. The letter will be evaluated by a Driver Safety Hearing Officer to decide whether the person should have his or her driving qualifications reexamined.

What types of medical conditions must a physician report to DMV?

Physicians are required by law (Heath & Safety Code Section 103900) to report disorders characterized by lapses of consciousness, as well as Alzheimer's disease and related disorders. Additionally, they may report any other condition if they believe it would affect the driver's ability to drive safely.

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I've watched this thread on driving and have added most to the CARE web page. I finally decided to throw in my 02 cents.

I remember when my friend, having gone to a new doctor, reacting very poorly to the notification by the State of washington that she would no longer be allowed to drive at the recommendation of this doctor. This was the angriest that I ever saw her. During the doctor's visit she had had an off time and this was the reason for his recommendation. The anger was directed at the doctor for making a judgment based on a single, very short event, and at the Department of Licensing for removing yet one more area of her life where she had a semblance of control.

The parkinson's had already robbed her of so many areas of control that to have one more taken away, and this was a biggy, was just too much. Granted, there were off times where she knew she shouldn't drive but they always came on her with enough warning that she could, if need be, pull off the road. The truth was that she drove very little but with the option available to her she felt that here was one area where she was in control and was OK. The PWP's prison seems to expand uncontrollably and always does so at a different pace for each individual. Each time another door is shut and locked the PWP feels the walls closing in and feels a sense of loss of self and self worth. It's no wonder so many resist letting go of an area of their lives that meant so much freedom for so long. The prison just expanded, thus robbing them of one more freedom. The tragedy is that the designer disease of parkinsons enslaves both the PWP and the CareGiver, each in his or her own personal cage.

My friend went back to the doctor and explained the situation. He recanted his recommendation with the caveat that she be tested by the state to ensure that she should drive. She still drives *VERY* little but with the option available, she feels better about herself.

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