Question: Does the Alzheimer patient keep insisting that he or she can drive safely and that nothing is wrong?
Dr. Amy: For many people, cars are an expression of our identity. They tell the world a little about who we are and what we value. They are also a powerful symbol of independence. They let us go where we want, when we want, without having to rely on others. We're deeply attached to our cars—especially in the US and Canada. One sign of our love affairs with cars is the fact that there are at least 229 car magazines. The same publisher did a roundup of decorating magazines—a mere 48. I confess I found that surprising, and would have thought there'd be more decorating magazines.
Because cars mean so much, it's not just Alzheimer's patients who insist they can drive safely, even when it's obvious to friends and family the time has come to hang up the keys and find other forms of transportation. I experienced this with my father, whose brain was perfectly healthy right up to the end. His coordination and eyesight got worse as he got older—he had age-related macular degeneration—but this happened so slowly he did not notice. When I brought it up, boy did we have some difficult conversations. And then, six months after he stopped driving, he told me he was thinking of getting his driver's license again and buying a new car. I was shocked and how I reacted put him on the defensive. Luckily, I realized what I had done and corrected my course. I told him how sorry I was and that I could not imagine what it was like to not be able to drive anymore. My empathy made it easier for my dad to share how hard it was to lose his independence and how much he missed driving. We talked about this for a few minutes and after that he never brought up the idea of driving again. I believe it was because he had the opportunity to express his feelings and to know that someone understood what he was experiencing.
Depending on the stage of the Alzheimer's, your patient may be in 'garden-variety' denial like my dad, where the denial has nothing to do with the disease. On the other hand, Alzheimer's disease does cause brain cells to die. With the death of these cells comes difficulty thinking and planning. Since driving involves a lot of thinking, planning and remembering, sooner or later it will make driving impossible. The Alzheimer's Association has published a very helpful explanation of how the brain is changed by the disease. And here is a great article by the US Department of Transportation that talks more about Alzheimer's and driving.
Since each person who struggles with Alzheimer's is different, the medical doctor caring for this patient is likely the best person to decide on when it's the right time to stop driving. Perhaps he or she can help you have the conversation.
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