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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.
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.
ACTION
POINT! Check with your state’s drivers’ licensing agency to
see what provisions exist for revoking an impaired driver’s
license. (See list at the end of this report.)
Protecting
Insurance Coverage
Unfortunately,
even with a doctor’s order not to drive, or a license revocation,
no guarantee exists that your loved one won’t drive. He or she
may simply forget the admonition not to drive or forget that
driving privileges have been revoked. Frustration or stubbornness
may also help put an impaired driver behind the wheel.
In short, despite loss of driving
privileges, a person with Alzheimer’s disease may drive anyway.
Should that person be involved in a motor vehicle accident,
serious consequences may result. Depending on the state, these
consequences may include a challenged insurance claim or cancellation
or denial of motor vehicle insurance.
In some states, for example,
state law requires insurance companies to honor claims from
a motor vehicle accident that involves an insured vehicle driven
by a driver without a license. The insurance company would pay
the claim, but may subsequently cancel the insurance policy.
If the state revokes a driver’s
license, the insurance company may cancel the policy even if
no accident has occurred. That’s because the revocation becomes
part of the driver’s driving record. Many insurance companies
routinely run periodic driving record checks on their insured
drivers. Once the insurance company learns its insured has no
driver’s license, especially if no other drivers reside in the
home, the company would likely terminate the policy. If that
happens, an impaired person who drives without insurance coverage
would be at risk. In the event of an accident, the canceled
insurance policy would not cover his or her assets from claims
of accident victims for property damage or personal injury.
Insurance cancellation would
also jeopardize the insurability of an unimpaired spouse, who,
because of his or her older age, would likely have trouble obtaining
another policy without paying rates far higher than the couple
had been paying. Some states do, however, provide a remedy for
this kind of situation.
For example, sometimes an impaired
driver can submit a letter to the insurance company excluding
himself or herself from an insurance policy so the unimpaired
spouse can get auto insurance. If a loss results because the
excluded driver drives anyway, the insurance company may pay
liability claims for property damage or injuries to others.
However, it might not pay the full amount of the policy’s limits
for personal injury to the driver or damage to the insured’s
vehicle. Again, the company would likely then cancel the insurance
policy.
WARNING!
State laws concerning motor vehicle insurance vary. If revocation
of a driver’s license becomes an issue, consult the insurance
department of your state government for information concerning
your situation. You may also want to consult an attorney to
find out what your responsibilities are.
If the person with Alzheimer’s disease lives alone and should
no longer be driving, the best course of action may be to sell
his or her car. If the idea of selling the impaired driver’s
car meets with objection, families can and should take other
steps. For example, you could remove the car’s tires or otherwise
disable the car. One way to disable a car is to disconnect the
battery. Another is to disconnect the coil wire that leads from
the coil to the distributor, which is as easy as unplugging
an electrical cord from a wall socket.
The effect of disconnecting the
coil wire is similar to the effect of removing the flint from
a cigarette lighter. You can flick the lighter all you want,
but it won’t fire up. With a car, you can turn the key, but
the spark created by the coil cannot reach the distributor to
start the car. Replacing the wire when an unimpaired driver
wants to use the car is easy, too. Ask an auto mechanic to show
you how.
Alternatively, the unimpaired
spouse could give the loved one with Alzheimer’s disease a “new”
set of car keys that look like the old ones but don’t fit the
car. Parking the car out of sight, perhaps down the street,
around the corner or in a neighbor’s garage is also a good idea.
If you have a loved one who should no longer drive, for his
or her own safety as well as for the safety of others, take
action to keep him or her off the road.
Driver’s
License Agencies
Alabama
Driver License Division
Dept. of Public Safety
500 Dexter Ave.
PO Box 1471
Montgomery, AL 36102
Alaska
Division of Motor Vehicles
Department of Administration
5700 E. Tudor Rd.
Anchorage, AK 99507-1225
Arizona
Motor Vehicles Div.
Dept. of Transportation
1801 W. Jefferson
Phoenix, AZ 85007
Arkansas
Policy and Legal Revenue Division
Department of Finance and Administration
PO Box 1272
Little Rock, AR 72203
California
Headquarters Operation
Department of Motor Vehicles
PO Box 932328
Sacramento, CA 94232-3280
Colorado
Division of Motor Vehicles Hearings
Department of Revenue
Denver, CO 80261-0016
Connecticut
Department of Motor Vehicles
60 State St.
Wethersfield, CT 06109
Delaware
Division of Motor Vehicles
Department of Public Safety
PO Box 698
Dover, DE 19903
District
of Columbia
Bureau of Motor Vehicle Services
Municipal Center
301 C St. NW
Washington, DC 20001
Florida
Motor Vehicles Divison
Hwy. Safety and Motor Vehicles
Neil Kirkman Bldg.
2900 Apalachee Pkwy.
Tallahassee, FL 32399-0500
Georgia
Motor Vehicle Division
270 Washington St., SW, Room 104
Atlanta, GA 30303
Hawaii
Driver’s License Section
PO Box 30340
Honolulu, HI 96820
Idaho
Motor Vehicle Bureau
Department of Transportation
PO Box 7129
Boise, ID 83707-1129
Illinois
Secretary of State
Medical Review
2701 S. Dirksen Pkwy.
Springfield, IL 62723
Bureau
of Motor Vehicles
IGC-North, Rm. 440
Indianapolis, IN 46204
Iowa
Motor Vehicle Division
Department of Transportation
PO Box 10382
Des Moines, IA 50306
Kansas
Division of Vehicles
Department of Revenue
Docking State Office Building, Room 162-S
915 Harrison St.
Topeka, KS 66626-0001
Kentucky
Transportation Cabinet
Department of Vehicle Regulation
State Office Building, Room 308
501 High St.
Frankfort, KY 40601
Louisiana
Office of Motor Vehicles
Public Safety and Corrections Department
PO Box 66614
Baton Rouge, LA 70896
Maine
Division of Motor Vehicles
Department of State
29 State House Station
Augusta, ME 04333
Maryland
Motor Vehicle Administration
MD Dept. of Transportation
6601 Ritchie Hwy., NE, Room 120
Glen Burnie, MD 21062
Massachusetts
Registry of Motor Vehicles/Medical Affairs
PO Box 199100
Boston, MA 02119
Michigan
Department of State
Driver Assessment Support Unit
7064 Crowner Drive
Lansing, MI 48918
Minnesota
Driver and Vehicle Services Division
Department of Public Safety
445 Minnesota St., Ste. 195
St. Paul, MN 55101-5195
Mississippi
Motor Vehicle Commission
1755 Lelia Dr., Ste. 200
PO Box 16873
Jackson, MS 39236
Missouri
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
Nebraska
Department of Motor Vehicles
PO Box 94789
Lincoln, NE 68509-4789
Nevada
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
Ohio
Bureau of Motor Vehicles
Department of Public Safety
4300 Kimberly Pkwy.
Columbus, OH 43232-0801
Oklahoma
Motor Vehicle Division
Tax Commission
4334 NW Expy, Ste. 183
Oklahoma, OK 73116
Oregon
Motor Vehicles Division
Department of Transportation
1905 Lana Ave., NE
Salem, OR 97314
Pennsylvania
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
Tennessee
Department of Safety
Driver Improvement Section
1150 Foster Ave.
Nashville, TN 37249
Texas
Motor Vehicle Division
Department of Transportation
200 E. Riverside Dr., Building 150
Austin, TX 78704
Utah
Department of Public Safety
Driver’s License Division
PO Box 30560
Salt Lake City, UT 84130-0560
Vermont
Agency of Transportation
Department of Motor Vehicles
133 State St.
Montpelier, VT 05602
Virginia
Department of Motor Vehicles
2300 W. Broad St.
Richmond, VA 23220
Washington
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
Wisconsin
Division of Motor Vehicles
Department of Transportation
4802 Sheboygan Ave., Room 221
PO Box 7949
Madison, WI 53707
Wyoming
Department of Transportation
Driver License Control
5300 Bishop Blvd.
Box 1708
Cheyenne, WY 82002
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