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Disease & Conditions >>> Alzheimer's Articles & News

Safe Driving And Alzheimer's Disease

By: William G. Hammond, JD
Author of The Alzheimer's Legal Survival Guide and The Alzheimer's Resource Kit"

Naomi was hopelessly lost. As she drove, absolutely nothing looked familiar. She noticed a fluttering in her stomach. She had to admit that she was in a lovely area, with large shade trees and a lovely lawn, but there were no houses where she could stop to ask directions. And the road seemed so narrow. She was starting to feel confused again. And there was nowhere to turn around. So she stopped the car and placed the gearshift into park.

Some time passed before a groundskeeper noticed the car on the golf course cart path. He called the police. A patrolman checked Naomi's identification and called her husband. The police officer then notified the state driver's licensing authority that Naomi should be retested.

Knowing when and how to take away the keys to the car is one of the most troublesome issues facing families who have a loved one with the illness. As we age, our eyesight and hearing may worsen. Depth perception plays tricks. Our reaction time slows. These elements of normal aging may interfere with our ability to drive a motor vehicle safely. For someone with Alzheimer's disease, these normal processes are complicated by additional symptoms related to the disease's effect on the brain. In fact, studies show that a person with Alzheimer's disease has twice the chance of being involved in a motor vehicle accident as a driver of the same age without the illness.

While a person in early stages of Alzheimer's disease may retain the ability to drive a motor vehicle, as the disease progresses, the time is likely to come when he or she is no longer safe behind the wheel. At the same time, the person with Alzheimer's disease will cling to whatever sense of independence he or she can.

The American Psychiatric Association says that some Alzheimer's patients with moderate impairment and all severely impaired patients pose unacceptable risks to themselves and others behind the wheel of a motor vehicle. Even those in early stages of the disease may be unable to drive even short distances safely. Depending on the individual, family members and others have a responsibility to assess the situation and, when necessary, step in and take away the keys.

Warning Signs

How do you know when to restrict driving privileges in a person with Alzheimer's disease? Trust your instincts. If you feel uncomfortable riding with him or her-or letting your children ride along-you may have unconsciously decided that the time has come. Another indicator is the person's inability to follow a recipe or perform simple household tasks. These types of activities require some of the same mental abilities necessary for safely operating a motor vehicle.

Deterioration in the ability to concentrate, as well as impairment of judgment seen in people who have Alzheimer's disease, add to the concern about such patients driving motor vehicles. According to the Alzheimer's Association, some things to watch for include the following:

1. Getting lost.

Anyone can get lost in an unfamiliar area. Those with Alzheimer's disease may become disoriented and be unable to find his or her way in familiar locales.

2. Ignoring traffic signals.

Failure to notice or obey stop signs, traffic lights or other highway markers may mean the driver didn't notice them. In addition, the driver may have lost the ability to associate the sign with its meaning. He or she may see the sign, but not know what it means.

3. Lack of judgment.

Inability to estimate the speed of oncoming traffic, deciding whether to stop for a yellow light or slide through the intersection, or becoming confused at a four-way stop sign are some examples of poor judgment while driving. Being slow to make decisions-or making poor ones-when driving can result in accidents that can harm the driver, as well as others on the road.

4. Driving too fast or too slowly.

Erratic driving at inappropriate speeds can indicate a lack of concentration, as well as poor physical coordination. It may also indicate poor judgment.

5. Anger and confusion.

You don't have to have Alzheimer's disease to experience road rage. Frustration during driving can make anyone flustered or angry. If the driver has Alzheimer's disease, however, watch for frequent occurrences of anger or confusion, as well as inappropriate or exaggerated reactions, while driving.

Taking Away the Car Keys

If your family member's ability to drive is impaired, you have a moral responsibility to take action to keep him or her off the road. However, accomplishing this goal may not be easy. Any suggestion that car keys be relinquished could be met with resistance, frustration, anger, or hostility-especially when it comes from a family member who may already be providing care by assisting with activities of daily living like bathing, dressing, and meal preparation.

Ask the Doctor

Many Alzheimer's families turn to the loved one's physician for help with the issue. Your loved one may more easily accept advice not to drive from a health care professional he or she has an established trust relationship with. For one thing, a doctor is often seen as an authority figure. For another, such a third party can discuss the situation objectively and dispassionately with less chance of offending your loved one on a personal level. Many doctors understand the need for this intervention and will be willing to comply with requests of this nature from family members. In some cases, doctors will write the words "Do Not Drive" on a prescription slip. In others, you may need to ask the doctor to file a request for re-examination of your loved one's driving abilities by the state driver's licensing authority.

Contact the State Licensing Authority

All states have a system in place to require retesting of persons with mental or physical impairments. However, state laws and re-examination processes vary. They may include medical evaluation, as well as written and road tests. Laws also vary concerning who is authorized to request re-examination. They may include police officers, judges, state's attorneys, physicians, family members, neighbors, friends, or other drivers. In some states, all older drivers must take driving tests for annual renewals. Check with your state's driver's licensing authority to see what rules and procedures exist for revoking driver's licenses for impaired drivers.

If your loved one's driver's license is ultimately revoked, he or she should get a state issued photo identification card to use for check cashing, air travel, and other uses.

Protecting Insurance Coverage

Even with a doctor's advice not to drive, or a driver's license revocation, a person with Alzheimer's may still get behind the wheel. He or she may forget that driving is no longer allowed. Or, stubbornness, anger, or frustration may encourage him or her to grab the keys and hit the road. If that happens and an accident occurs, serious consequences-beyond the risk of personal injury or death to the driver, passengers, or others-may result.

For example, although some state laws require insurance companies to honor claims involving insured motor vehicles, even if driven by an unlicensed driver, an insurance claim can be challenged. Insurance coverage may be cancelled. And future applications for motor vehicle insurance can be denied. In some states, insurance companies can cancel policies if a driver's license is revoked, regardless of whether an accident has happened or not. Should a driver without coverage become involved in a motor vehicle accident, his or her assets will be at risk from claims by accident victims for property damage or personal injury.

These issues are particularly important for an unimpaired spouse of a person with Alzheimer's disease. Insurance cancellation will jeopardize the spouse's insurability. Acceptance under a new policy may be difficult because of the spouse's older age. And the new policy may cost much more than the previous one. State insurance laws vary, and some states have regulations pertaining to such situations.

One option is for the impaired driver to exclude himself or herself from the policy, enabling the unimpaired spouse to continue insurance coverage. But if the excluded driver drives anyway, a claim for personal injury or property damage to the driver's car may not be honored to the full extent of the policy's limits. (Liability claims by others would likely be paid, however.) If that happened, the policy would most likely be canceled.

Action Steps for Family Members

Depending upon your loved one's abilities and desire to drive, regardless of driver's license status or doctor's orders, family members can take steps to prevent an impaired driver from operating the car. Here are six steps you can take: 1. Sell the car. If the car won't be driven, it makes sense to sell it. However, Americans love their cars. Some even name them the way they would name a pet dog or cat. If your loved one is attached to his or her motor vehicle, your suggestion to sell it may meet strong objection, even if the impaired driver seems to understand that driving is no longer allowed. If the loved one wants to keep the car, or is comforted by seeing it in the garage or driveway, you can disable the car so it can't be driven. 2. Hide the car keys. If the car remains in the family, someone must control access to all copies of the keys. Lock them in a safe place unknown to the impaired driver. 3. Replace the car key. If the impaired driver resists or refuses to hand over his or her set of keys, quietly replace the car key with one that looks like it, but that doesn't work in the vehicle. 4. Remove the tires. Removing the tires will disable the vehicle, but in some residential areas, parking a car on blocks is not allowed, except-perhaps-in an enclosed garage. Check with your local jurisdiction before taking this step. 5. Disable the vehicle. Ask a mechanic to show you how to disconnect the car's battery or how to disconnect the coil wire between the coil and distributor. If a spouse or other household member needs to use the car, reconnecting them is relatively easy. 6. Park the car elsewhere. Park the car down the street, around the corner, or out of sight in a neighbor's garage to make it inaccessible.

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Look for Alternatives

A person who has been driving for decades and who takes pride in his or her independence will likely resist attempts to restrict driving privileges. That independence is difficult to give up, especially in neighborhoods without good public transportation systems. The person may not want to burden friends or family to get where he or she wants to go.

In modern American culture, driving is important. For many, it involves self-esteem and status as well as mobility. For these reasons, those who have Alzheimer's disease are unlikely to admit difficulties they are experiencing when driving. So, family members and physicians must balance the person's convenience with the safety of the driver, as well as passengers and other drivers on the road.

When restricting driving privileges becomes an issue, you can ease the transition by investigating alternative methods of getting from place to place. Here are some choices you can make available to your loved one in place of a personal motor vehicle.

1. Friends and family.

Are you willing to provide all or part of your loved one's transportation needs? What about other family members? If friends say, "let me know if I can do anything to help," suggest they give your loved one a ride to the grocery store, hairdresser, or doctor's appointment. You can also ask for volunteers at your place of worship.

2. Public Transportation.

Gather information about bus routes, train schedules, and taxi services. See whether they offer discounts for older individuals or those with disabilities. Calculate round-trip fares from your loved one's home to frequently visited locations, such as the grocery store, doctor's office, barber shop, or library.

3. Government -funded transportation.

Investigate availability of government-funded transportation for people with disabilities. Inquire about how to qualify for such programs.

4. Delivery Services.

To reduce the need for trips outside the home, look for pharmacies, office supply stores, restaurants, and other businesses and organizations that deliver goods and services to the home. Find a courier service that operates in your area, or see whether a taxi service will perform that function. Look into the Meals on Wheels program in your area.

State Driver's Licensing Authorities

State driver's licensing authorities can give you information about how to request a review of driving privileges. Contact them if taking away the car keys from a person who has Alzheimer's disease becomes necessary.

Driver's License Division
Department of Public Safety
500 Dexter Ave.
PO Box 1471
Montgomery, AL 36102

Division of Motor Vehicles
Department of Administration
5700 E. Tudor Rd.
Anchorage, AK 99507-1225

Motor Vehicles Division
Department of Transportation
1801 W. Jefferson
Phoenix, AZ 85007

Policy and Legal Revenue Division
Department of Finance and Administration
PO Box 1272
Little Rock, AR 72203

Headquarters Operation
Department of Motor Vehicles
PO Box 932328
Sacramento, CA 94232-3280

Division of Motor Vehicles Hearings
Department of Revenue
Denver, CO 80261-0016

Department of Motor Vehicles
60 State St.
Wethersfield, CT 06109

Division of Motor Vehicles
Department of Public Safety
PO Box 698
Dover, DE 19903

Motor Vehicles Division
Highway Safety and Motor Vehicles
Neil Kirkman Building
2900 Apalachee Pkwy.
Tallahassee, FL 32399-0500

Motor Vehicle Division
270 Washington St., SW, Room 104
Atlanta, GA 30303

Driver's License Section
PO Box 30340
Honolulu, HI 96820

Motor Vehicle Bureau
Department of Transportation
PO Box 7129
Boise, ID 83707-1129

Secretary of State
Medical Review
2701 S. Dirksen Pkwy.
Springfield, IL 62723

Bureau of Motor Vehicles
IGC-North, Room 440
Indianapolis, IN 46204

Motor Vehicle Division
Department of Transportation
PO Box 10382
Des Moines, IA 50306

Division of Vehicles
Department of Revenue
Docking State Office Building, Room 162-S
915 Harrison St.
Topeka, KS 66626-0001

Transportation Cabinet
Department of Vehicle Regulation
State Office Building, Room 308
501 High St.
Frankfort, KY 40601

Office of Motor Vehicles
Public Safety and Corrections Department
PO Box 66614
Baton Rouge, LA 70896

Division of Motor Vehicles
Department of State
29 State House Station
Augusta, ME 04333

Motor Vehicle Administration
Maryland Department of Transportation
6601 Ritchie Highway, NE, Room 120
Glen Burnie, MD 21062

Registry of Motor Vehicles/Medical Affairs
PO Box 199100
Boston, MA 02119

Department of State
Driver Assessment Support Unit
7064 Crowner Dr.
Lansing, MI 48918

Driver and Vehicle Services Division
Department of Public Safety
445 Minnesota St., Ste. 195
St. Paul, MN 55101-5195

Motor Vehicle Commission
1755 Lelia Dr., Ste. 200
Jackson, MS 39236

Division of Motor Vehicles and Drivers Licensing
PO Box 200
Jefferson City, MO 65105-0200

Department of Justice
Motor Vehicle Division
Attention: Medical Department
303 N. Roberts
PO Box 201430
Helena, MT 59620-1430

Department of Motor Vehicles
PO Box 94789
Lincoln, NE 68509-4789

Department of Motor Vehicles and Public Safety
555 Wright Way
Carson City, NV 89711-0900

New Hampshire
Division of Motor Vehicles
Department of Safety
10 Hazen Dr.
Concord, NH 03305-0002

New Jersey
Division of Motor Vehicle Services
Department of Law and Public Safety
225 E. State St.
PO Box 160
Trenton, NJ 08625-0160

New Mexico
Motor Vehicle Division
Department of Taxation and Revenue
PO Box 1028
Santa Fe, NM 87504-1028

New York
Department of Motor Vehicles
Swan St. Building, 5th Floor
Empire State Plaza
Albany, NY 12228

North Carolina
Division of Motor Vehicles
Department of Transportation
1100 New Bern Ave.

Raleigh, NC 27697-0001

North Dakota
Driver License and Traffic Safety Division
Department of Transportation
608 E. Blvd. Ave.
Bismarck, ND 58505-0700

Motor Vehicle Division
Tax Commission
4334 NW Expressway, STE. 183
Oklahoma City, OK 73116

Motor Vehicles Division
Department of Transportation
1905 Lana Ave., NE
Salem, OR 97314

Bureau of Motor Vehicles
Department of Transportation
1101 S. Front St., 4th Floor
Harrisburg, PA 17104

Rhode Island
Division of Motor Vehicles
286 Main St.
Pawtucket, RI 02860

South Carolina
Division of Motor Vehicles
Department of Public Safety
5410 Broad River Rd.
Columbia, SC 29210

South Dakota
Division of Drivers Licensing
Department of Commerce and Regulation
Public Safety Building
118 W. Capitol Ave.
Pierre, SD 57501

Department of Safety
Driver Improvement Section
1150 Foster Ave.
Nashville, TN 37249

Motor Vehicle Division
Department of Transportation
200 E. Riverside Dr., Bldg. 150
Austin, TX 78704

Department of Public Safety
Driver's License Division
PO Box 30560
Salt Lake City, UT 84130-0560

Agency of Transportation
Department of Motor Vehicles
133 State St.
Montpelier, VT 05602

Department of Motor Vehicles
2300 W. Broad St.
Richmond, VA 23220

Vehicle Services
Department of Licensing
PO Box 48020
Olympia, WA 98507-8020

West Virginia
Division of Motor Vehicles
Department of Transportation
Bldg. 3, Room 337
1900 Kanawha Blvd., E.
Charleston, WV 25305

Division of Motor Vehicles
Department of Transportation
4802 Sheboygan Ave., Room 221
PO Box 7949
Madison, WI 53707

Department of Transportation
Driver License Control
5300 Bishop Blvd.
Box 1708
Cheyenne, WY 82002

Copyright, 2000-2004 The Alzheimer's Resource Center, Inc. All rights reserved.


Editor's Note:

My good friend and Elder Law Attorney William Hammond founded The Elder & Disability Law Firm in 1996, as he puts it, "out of necessity." Hammond's mother-in-law fell and broke her hip the previous year and Bill and his wife Mary became her primary caregivers. The law firm grew out of his frustration in trying to track down the answers to legal questions that he was now facing on a daily basis. Bill decided that the answers to the questions he and his wife were facing needed to be more available to the public and so the firm was founded.

Today The Elder & Disability Law Firm serves clients all over the states of Kansas and Missouri. It's not unusual to have people drive in from several hours away to meet with the staff and attorneys of the firm and to get help with their most pressing elder law issues.

Almost from the first day that the firm opened its doors, the families who have a loved one with Alzheimer's have been flocking to the firm. Over and over again issues of caring for a loved one with Alzheimer's have been raised. Over the years the attorneys and staff at the law firm have developed a real expertise in helping people suffering from memory loss. That in turn lead to the establishment of the Alzheimer's Resource Center.

The Alzheimer's Resource Center is dedicated to helping families throughout the U.S. understand better how to care for and plan for their loved one who has Alzheimer's Disease. The Resource Center is dedicated to helping families learn more about the disease and, more importantly, learn specific strategies that the families can use to reduce caregiver and Alzheimer's patient stress and keep the loved one at home as long as possible.

To this end the firm offers its Alzheimer's Survival Kit "the standard of information for the industry" as well as frequent Telecoaching Seminars teaching families the "hands-on" skills they need to learn to better care for their loved one.

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Copyright © 2004 Bob Cairns. All rights reserved.