Service Providers for Older Adults (cont'd)

Reaching Older Drivers with Complex Driving Issues

Alzheimer's Disease

A diagnosis of Alzheimer's does not mean a person should automatically be stripped of a driver's license.¹³ But the diagnosis usually means close monitoring. Although there is evidence that some people in the early stages of the disease are able to drive safely even though they may not remember routes, countering evidence shows that people in early stages of the disease are more likely to become involved in crashes.¹⁴ The unclear direction of these research results poses a dilemma in determining how to judge the driving ability of individuals with dementia.

One solution involves conducting a clinical and driving evaluation to ascertain driving capability. Another recommendation is to begin a transition away from driving during the early stages of Alzheimer's, while the person still understands the growing implications of the condition and the risk to self and others on the road. On the other hand, the person may reject the transition, still feeling capable of handling the wheel. If the older driver has moderate-to-severe dementia, there is never an easy method to regulate vehicle operation.¹⁵

The Alzheimer's Association recommends a series of steps:

1. Acknowledge the loss
   Be sensitive and reassuring. Try to involve the person in other aspects of travel. Put the person in charge of the radio and temperature controls. Ask for assistance in looking for important signs.
2. Arrange for transportation
   Reassure the person that a ride will be available when needed. Plan ahead.
3. Solicit the support of others
   Recruit a trusted authority such as a doctor to advise the person with Alzheimer's not to drive. Relatives and an insurance agent can reinforce the message.
4. Make the car less accessible
   Have the caregiver keep the car keys. If the car is not often used, disable it by removing the distributor cap or park it down the street.
5. Take the test
   Ask the DMV to retest the person. Remember that taking away a driver's license does not mean the person with dementia will stop driving.
6. Be firm
   Avoid arguments and long explanations. Focus on other activities the person with dementia enjoys.

Alcohol, Medications and Risky Drinking

Alcohol is the single most important factor in fatal crashes. Drivers of any age should never drink alcohol before getting behind the wheel. Alcohol misuse among older adults is especially lethal, because consumption of alcohol affects older adults differently:

• The physical effects of alcohol are intensified in older bodies
• As people age, they tend to increase their consumption of medications. Any amount of alcohol can intensify the actions of many medications, leading to increased sedation and disorientation, and increasing the risk of falls or car crashes

Alcohol misuse among the population over 60 years old:

• May be difficult to detect. Diseases and conditions associated with aging can mask alcohol abuse or may be intensified by the abuse
• May be an invisible problem. Older adults may see an alcohol problem as a moral issue associated with feelings of shame and guilt. The feelings prompt denial of abuse and result in hidden drinking
• Results in as many hospitalizations as those for heart attacks

¹³ Alzheimer's Association (1995) "Giving up the Car Keys." Alzheimer's Association National Newsletter 15(3):1, 7.

¹⁴ LePore, When You Are Concerned.

¹⁵ Aging Alert (2003) "Transportation."