Care-giving for someone with Alzheimer's is one of the most difficult jobs in the world. In addition to making sure that your loved one's daily needs are met, you are also faced with the fact that your relationship with this person is no longer what it once was. Oh, and as a little side note, you are also trying to maintain some sort of life of your own. Many care-giving guides out there give very technical and clinical information to try to enable caregivers do a better job.
What you need is practical information and useful suggestions to make the everyday things of life easier: How can I get Mom to take a bath? What do I do when Dad won't sit down and eat? What do I do when my husband becomes agitated and upset? These are the things that, when faced everyday, lead to caregiver burnout. Caregiver burnout is what leads to the need to place your loved one in a 24 hour care setting.

Our free Alzheimer's Resource Center is designed to help relieve the frustration, stress, and anxiety involved in caring for a member of your family with Alzheimer's -- and help you decide when or if it's best to use alternative care.

Safe Driving in South Carolina

Driving and Alzheimer’s Disease

      Even though Carmen had been diagnosed with Alzheimer’s disease, she prided herself in her continuing ability to do all her own grocery shopping.  She also drove to her beauty parlor appointment every Saturday morning. Her husband, Jim, had noticed that Carmen sometimes seemed confused when driving, taking an occasional wrong turn. Increasingly, she had trouble with her depth perception, which caused her to hit the brakes too early before a traffic light. At other times she would forget to stop at all.

      One Saturday afternoon, a police officer knocked on the door of their home, and Carmen answered.   “I’m investigating a motor vehicle accident,” he said. “Someone ran into the car parked across the street from your driveway. Do you know anything about that?”    Carmen shook her head. “No, I didn’t see anything,” she said. “But I’ve been gone all morning. I went to my hair appointment about 10:30.”

      The police officer asked Carmen to accompany him outside. Together, they looked at the rear bumper of her car. The police officer pointed to a large area where the bumper had been scraped. Red paint clung to the scraped area. Across the street, a red Ford Taurus sat, its door panel crumpled by a deep dent.    “Has anyone else driven this car today?” the police officer asked.   “Why, no,” Carmen said. “But I don’t remember hitting anything.”

      Jim stood on the doorstep with his hands in his pockets. He was grateful no one had been hurt in the accident. He knew he could no longer postpone the difficult decision to keep Carmen from driving. Even though Carmen treasured the independence her automobile symbolized, Jim knew he had to take away Carmen’s car keys for good.

     If you have Alzheimer’s disease, you may someday be faced with a recommendation that you restrict your driving privileges. If you have recently been diagnosed in the disease’s early stage, you may be able to continue to drive. However, at some point, you or your family members may begin to notice effects the disease has on your memory, judgment and attention. Your depth perception may fail and your reaction time may increase. You may find yourself disoriented in once-familiar areas, misjudge the speed of oncoming traffic or fail to notice stop signs.

     You may be driving legally that is, you have a valid driver’s license. But, you might not be driving responsibly. The last thing you’d want to do is cause an accident, which could harm someone else and cause legal problems and financial burdens for you and your family. The independence that driving allows isn’t easy to give up. Some people even feel lowered self-esteem when they can no longer drive. We have all grown up in a culture where driving is important to us. And, no one wants to be a burden on others for transportation. So it’s common for Alzheimer’s patients not to admit difficulty behind the wheel.

      However, people with Alzheimer’s disease and their families and doctors have a responsibility to balance a person’s convenience with his or her safety and the safety of passengers and other drivers. Studies have found that, particularly in later stages, a person with Alzheimer’s disease is twice as likely to cause or be involved in motor vehicle accidents as a driver of the same age without the condition.

      Recently published American Psychiatric Association guidelines for restricting driving privileges of persons with Alzheimer’s disease say that all severely impaired Alzheimer’s patients pose unacceptable risks on the road. So do some people with moderate impairment. In the early stage of the disease, some people can drive safely for a while. Others, however, cannot drive even short distances without endangering themselves or others. Discuss this issue openly with your family members and doctor. Trust them to tell you when to turn over your car keys.

The Family’s Role

      Julianne had watched her widowed father’s mental condition deteriorate in the three years since he’d been diagnosed with Alzheimer’s disease. Despite his illness, he remained relatively independent, doing his own laundry and preparing his own meals. He drove to his Rotary Club meetings and church and ran occasional errands to the hardware store to get supplies for tinkering around the house.

     Lately, though, Julianne noticed he’d been having trouble. Several times when she stopped by, she found wet laundry that had sat for several days in the washing machine. And the last time he made beef stew, he had added one-fourth cup of salt rather than one-fourth teaspoon, making it inedible.

      Her father had driven the night before when they went out for dinner at a new restaurant in town. They enjoyed roast chicken and simple conversation. (Julianne had become accustomed to his repetitive questions and hardly noticed.) What she did notice, however, was his erratic driving when he took her home. He changed lanes without looking, nearly sideswiping a van. Then he swore at another driver who honked at him for running a red light.

     Julianne resolved to keep her father from driving, but she knew from past discussions that he would ignore a plea from her to turn over the keys. Instead, she phoned her father’s doctor and asked him to write “Do Not Drive” on a prescription form and hand it to him at his next appointment.

      If you are a family member of someone with Alzheimer’s disease, keeping an impaired driver off the road is your moral responsibility. Because of the independence an automobile represents, many people with Alzheimer’s disease resist giving up their driving privilege. If family members are providing care for the patient, this issue can be divisive. If you try to takeaway your loved one’s car keys, you may face his or her frustration and anger. Helping a frustrated, angry person bathe, dress or perform other activities of daily life adds tension to an already stressful situation. For these reasons, many families turn to their loved one’s doctor or the state motor vehicle department for help.

  ACTION POINT! How do you know when the time has come to stop your loved one’s driving? A good rule of thumb is when you no longer feel comfortable riding with him or her or letting your child go along. Another sign is when you notice your loved one can no longer follow recipes or perform simple household tasks. Mental abilities required for these activities are critical for driving.

      Once you decide the time has arrived, you may find several actions helpful. First, consult your loved one’s doctor. An older person may find it easier to hear advice not to drive from a health care professional he or she trusts rather than from a family member. Understanding this role, many doctors are willing to comply with such a request from the patient’s family. In some states, doctors can also file a request for re-examination with the agency responsible for licensing drivers. People authorized to file such a request depend on laws in each state. Those who can ask the state to re-examine a driver’s ability to operate a motor vehicle may include police officers, family members, neighbors or others.

      For example, both Kansas and Missouri laws and practices provide for retesting of drivers whose mental or physical impairments may prevent them from driving safely. In Missouri, the law authorizes the director of revenue (who oversees driver’s licensing) to require a road test, medical evaluation or both if there is cause to believe a driver is incompetent or unqualified to keep his or her driver’s license. Under the law, the Department of Revenue can order an examination of driving skills after receiving a written medical report from a physician or a letter from a law enforcement officer, family member or licensed health care worker who presents personal observation or physical evidence of unsafe driving. Reports must be in writing (no action is taken on telephone calls). The report must include the name, address, telephone number and signature of the person making the report.

      Kansas law provides for additional tests to determine whether a person with mental or physical disability can keep a driver’s license. Another law authorizes the Division of Motor Vehicles to revoke driving privileges of people who are incompetent to drive.

      A doctor, police officer, family member, employer, neighbor or anyone else who questions a driver’s ability can send a letter of concern to the state director of vehicles. Such letter must state a specific reason for the concern. It must also be signed. The letter is kept confidential; the writer’s name can be revealed only by court order.

      When the director receives a letter of concern, the driver is contacted and asked to have a doctor complete a medical form. If the doctor says the driver may continue to drive, the state requires the driver to take a road test. If the doctor says the driver may not drive, the state revokes the driver’s license. (Revoked drivers may appeal the decision.)

      Other states have different rules and practices. In New Mexico, for instance, drivers 75 and older must get a new driver’s license each year. In addition, the state Motor Vehicle Division can require an individual to complete all testing phases if it receives information concerning the driver’s inability to operate a motor vehicle safely. Most often, information comes from a member of the driver’s family.

      In some states, such as Illinois, the driver’s license authority cannot act on information that comes from a driver’s family members. Under Illinois law, the state agency must receive official notification from one of four authorized sources: the motorist’s physician, a law enforcement agency, a judge or a state’s attorney. The information must be firsthand knowledge of the condition that may impair driving ability and the reason the authorized source believes the state should take action. Family members who wish to keep a driver from behind the wheel must turn to one of the four authorized sources for a professional analysis of driving skills.