Caregiving: Take away the keys?

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Caring for a person with dementia or Alzheimer's disease presents a range of challenges. Spouses, family members, and friends must deal with feelings of loss as the person they know seems to slip away. Supporting a loved one with basic activities of daily living can be time consuming and exhausting. And it is difficult to balance protecting the person you're caring for and preserving what independence remains.

One of the trickiest problems to negotiate is driving. The consequences of a misstep behind the wheel can be deadly.

Get your copy of Alzheimer's disease

Have you noticed memory problems piling up in ways that affect daily life in yourself or someone you love? Do you find yourself struggling to follow a conversation or find the right word, becoming confused in new places, or botching tasks that once came easily? About 5.4 million Americans have Alzheimer’s disease, and estimates suggest it will affect 7.7 million by 2030. Already, it is the sixth leading cause of death in the United States. This Special Health Report includes in-depth information on diagnosing Alzheimer’s and treating its symptoms.

Decisions about driving

Whether or not it is safe to drive can be complicated, particularly when the person is only mildly impaired. Some believe that driving privileges should not be taken away until a person is clearly an unsafe driver.

But can you identify an unsafe driver before an accident occurs?

Driving requires amazing coordination — the eyes, brain, and muscles must process information and respond to it quickly. Driving skills may seem sufficient until an unexpected situation occurs when a person with dementia can panic or freeze with indecision. A University of California study found that the driving skills of people with mild Alzheimer's were significantly poorer than those of other elderly people, including those with some other forms of dementia.

One way to gauge the risk is to observe the person's general behavior. If friends and family see their loved one exhibit poor judgment, inattentiveness to what's going on around him or her, clumsiness, and slow or inappropriate reactions, then that person should not get behind the wheel.

Taking away the keys

Ideally, a tactful and respectful approach will preserve the person's self-esteem while getting them off the road. Some people may agree to stop driving for other reasons — for instance, the car needs repair or the license or registration has expired. You can also opt for a road test with a driver's rehabilitation specialist, who can offer an independent assessment of safety. People with Alzheimer's disease sometimes take seriously a written prescription from a physician that says, "Do not drive."

In some states, doctors have a legal duty to report unsafe drivers and drivers with certain medical problems to the state department of motor vehicles. If all else fails, you may need to seek advice from a lawyer or an official with the Department of Public Safety in your state. Procedures vary, but generally a driver's license can be suspended on the basis of a physician's written statement.

For more on preventing, diagnosing and treating Alzheimer's, buy A guide to coping with Alzheimer's Disease, a Special Health Report from Harvard Medical School.

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