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Getting Behind the Wheel

Everyone who has dementia eventually has to come face-to-face with decisions regarding whether or not it is safe to continue driving.  This is not a decision that should be made lightly, or without giving the matter careful consideration.  Depending on how early the individual is diagnosed with dementia, and what symptoms are present, he/she may actually be able to continue driving for a time.  But there are certain things to look for, and different ways of handling the situation when the time comes.

For many people, driving falls within the realm of procedural memory, something that is described in more detail elsewhere in this site.  Basically, it has become an almost automatic activity, which can be done without much conscious thought.  That said, however, there are many complex mental operations that take place while driving, and often these “executive functions” are the processes first affected by the disease.  Here are some of the things a person needs to be able to do while driving:

— Understand and respond to everything they see and hear

— “Read the road”

— Understand and follow road signs

— Understand, anticipate, and react quickly to the actions of other drivers

— Do whatever is necessary to avoid accidents

— Remember where they are going

If an individual with dementia is unsure of their ability to drive, they can ask to take a driving assessment.  This is not just a driving test, but also a way of measuring just how the person’s dementia is affecting their ability to make decisions, and so on.  Many people with dementia voluntarily give up driving when it becomes too stressful for them, or when they begin to lose confidence in their ability.  Some factors that may influence a person’s decision to give up driving include:

— Feeling less confident or more irritated while driving

— Feeling confused if something happens to disrupt the normal route or routine (road work, or traffic delays)

— Becoming concerned about having an accident

Someone who is considering giving up driving will need a lot of support from his family and others closes to him.  This is a big decision, and will forever change his ability to be as independent as he once was.  He may feel as if he’s being a burden to those who will have to drive him around, or be unsure of how he’s going to find and use public transportation.  Those closest to him should provide gentle reassurance and support.

In some areas, it may actually be against the law for a person with a dementia diagnosis to continue driving, unless certain provisions have been met.  The local governmental agency in charge of such matters can provide any necessary information on this matter.  It may be that the person will be allowed to continue driving, once they provide certain information to the regulatory agency, and also notify their insurance carrier.

It is possible for a person with dementia to continue driving, while minimizing the risks involved.  Such actions can involve things like driving on familiar roads at times of the day when there will be less traffic.  The use of medications for depression or anxiety, for instance, can also present problems due to their side effects.

Sometimes, the person with dementia will refuse to give up driving even when it is clear to others that he should do so.  In this case, gentle encouragement from family and friends is in order.  These well-meaning individuals need to acknowledge that this is a difficult decision, and that the person is understandably reluctant to give up their independence in this way.  Helping them to find alternative means of transportation can help, possibly by setting up a system whereby family or members of their church or other friends and acquaintances can provide needed assistance.  Or one can point out possible means of public transportation, organize their schedule, and accompany them on a trip or two to familiarize themselves with the process.  Some alternatives to driving may include:

— Taking a taxi to get groceries once a week.  Taxis could be arranged for in advance, and account could be set up to arrange for payment.

— There may be a bus to the supermarket and back.

— Shopping can be done over the telephone or online, with groceries delivered to their home.

— There may be a community agency that provides rides to doctor’s appointments, and similar errands.

— Bills can be paid automatically or online, to save having to make trips to the bank and so on.

One of the ways to help a person make the decision to stop driving is to point out the advantages of doing so.  For instance:

— They would no longer have to look for parking spaces, or fight traffic.

— Money that would have been spent on gas, upkeep on the car, and insurance, can now be used for other things.

— They will no longer have to worry about losing their way.

— They may meet a nice person on the bus to talk to.

— Walking can provide needed exercise.

If a person still refuses to stop driving, it might be helpful to have a trusted physician make the recommendation.  Some people might consider taking the word of such an authority figure over that of family and friends.

(Adapted from information provided at http://www.alzheiemers.org.uk

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