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Driving and Dementia

 

Warm sunny weather brings more summer driving!

 

Driving is a very personal issue that involves strong emotions. For many seniors, driving is a privilege they’ve had for decades, and their personal sense of identity and independence is often linked to their ability to drive. When driving seems so second nature, it can be difficult for people to remember that driving is truly a privilege, not a right.

So, when is it time to give up the privilege of driving?

 

Oftentimes, the person who is suffering from dementia is the least aware that anything is wrong. They may not notice that their reaction time has changed, or that their judgment is off. The family are often the first ones to be concerned about driving, and rightfully so, as research shows that someone with dementia is eight times more likely to be in an accident than the average population.

 

Some warning signs to watch for if you have an elderly who is driving with dementia:

  • Damage to the car
  • Traffic tickets
  • Difficulty navigating familiar routes
  • Simple errands taking hours longer than necessary with no explanation
  • Mixing up the gas and brake pedals
  • Missing stop signs or traffic lights
  • Problems with lane changes and merging
  • Passenger input is required
  • Family refuse to get into the car

Consider the “grandchild question”: do you feel comfortable allowing the grandchildren to ride with their grandparent behind the wheel? If your answer is no, there are likely significant concerns about your loved ones’ driving ability.

 

If you are concerned about your loved ones’ driving, you need to speak to their doctor. It is ideal to attend a doctor’s visit with your loved one; you may also write letters to inform the doctor of the changes your loved one is experiencing.

 

The family doctor is required to notify the Ministry of Transportation, and it is the MTO who will revoke the licence (not the family doctor). After being notified by the family doctor, the MTO will send a letter directly to your loved one (not to the family doctor). The letter will state whether they may continue to drive, they need an assessment, more medical evidence is required, or the licence is revoked.

 

What happens when their licence is revoked?

 

If the licence is revoked, it is HIGHLY advised that your loved one’s car be removed from the property. Someone with dementia may no longer remember that they are not allowed to drive. Disabling the vehicle is an option, though it is remarkable how handy and mechanically-minded many seniors from that generation can be, so the simple options of unplugging the spark plugs or draining the battery may be insufficient. The most ideal solution is to have the vehicle removed from the property altogether to ensure that your loved one is safe, and to ensure that others are safe as well.

 

It is important to understand how devastating the loss of a licence can be for many seniors. It can result in loss of independence, reduced social interaction, loneliness, lowered self-esteem, depression, and increased stress on family and friends. For all of these reasons, family doctors do not just send letters to the MTO easily; they must have concrete evidence of imminent safety concerns. To minimize the negative impact of losing a licence, family and friends can assist by providing alternate means of transportation and socialization.

There are volunteer driving services that can be accessed through your local community centres or the Alzheimer’s Society. Taxi companies are often able to offer discounts to “frequent riders”. If your loved one drives less than 4000—5000km per year, then it is cheaper to take a taxi everywhere than it is to maintain the car. From a purely economic standpoint, driving may simply be too expensive compared to alternate options! Appealing to your loved one’s financial sense may be more effective than having them agree that their driving is no longer safe.

 

 

 

What are the Activities of Daily Living? (ADL's) 

 

 

There’s a set list, agreed upon by the medical community and insurance companies alike. There are a total of 6 ADLs. That’s it! Only six. Here are the six ADLs:

 

1. Bathing—bath, shower, or sponge bathe as preferred
2. Dressing—ability to dress and remove all clothing items
3. Feeding—eating independently (not cooking, just eating)
4. Transferring—moving from one spot to another (ie: from wheelchair to the couch)
5. Toileting—the ability to get on and off the toilet
6. Continence—the ability to control bladder and bowel and be aware of the need to toilet

 

You will notice that transportation, e.g. driving, is not on the list. If you are interested in learning more about driving and dementia click here.

 

As you can see from the list, the ADLs cover the most necessary elements of daily living. These are also the most personal and intimate forms of daily activity and care. You want to remain capable of these six ADLs for as long as possible.

 

 

Alongside ADLs are IADLs — Instrumental Activities of Daily Living.  Instrumental activities are those tasks which support the basic six ADLs.  For instance, cooking is an IADL.  Someone might have their ADL of eating — they can still feed themselves independently — but without food to eat, they cannot utilize their ADL.  Instrumental ADLs are all the things you do throughout the day to support the six ADLs.  Cooking, cleaning, laundry, grocery shopping, etc. are all IADLs.

 

A caregiver’s role is to complete IADLs so that clients can retain their ADLs.  A caregiver may do the laundry so that a client has fresh, clean clothes to put on.  If assistance is necessary, then of course, the caregiver will help with dressing but encouraging independence is crucial. Even if dressing takes four times as long when the client does it, it is worth it to help them protect that ADL.

 

 

If you don’t use it you lose it.

 

You’ve heard the saying before, “if you don’t use it you’ll lose it” and that is certainly true.  It is called learned helplessness. Someone learns that they can sit back and wait for a caregiver to take over and do the task for them.  Eventually, their ability to complete the task will diminish. 

 

Caregivers should always encourage clients to complete their own ADLs and only assist as necessary to prevent learned helplessness from occurring. There are only 6 basic ADLs so protect them at all costs!

 

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