Questions About:
The
Study
The Findings
Dementia/Alzheimer's Disease
Dementia, Alzheimer's Disease and Driving
Driver Testing
The
Study
What's this study
all about?
The Hartford Financial Services Group, Inc. and the MIT AgeLab
conducted research with caregivers and people with dementia to
learn how families perceive and manage driving and transportation
issues when a person has dementia. The study was initiated because
most information about dementia warns against driving, but does
not describe how individuals and caregivers can determine when to
stop. About The Study provides more information
on the study and the participants.
The primary purpose was to help
caregivers, families and persons with dementia with the very difficult
issue of driving.
Why are you (The
Hartford) doing this?
The Hartford is one of the leading insurers of people over the
age of 50. We became interested in this type of study as a result
of our customers and their families asking for help. In some cases
they would ask us to take insurance away from a spouse, father or
mother for fear that they were going to injure themselves or someone
else. So it was truly customer inspired. The report is timely because
recent advances in the ability to diagnose this disease earlier,
require that we adjust our approach to problem-solving on issues
like driving. Since many people in the early stages of this disease
function well in other aspects of their lives, driving remains a
vital connection to the world. Maintaining driving privileges for
as long as it is safe to drive is especially important. The Hartford
is committed to finding ways to enhance the quality of life for
all Americans as they grow older. Since independence and mobility
are essential to maintaining qualify of life, it was a natural fit
for us to work on this project.
The
Findings
Does statistical
evidence exist to suggest that driving with dementia is a problem?
Yes, there is enough small-scale research to tell us that over time,
driving and dementia don't mix. The harder question is exactly when
driving skills deteriorate? This question is harder to answer and
the research is not clear enough to give a simple answer. That is
why we recommend an approach that includes observation of driving
skills right from the point of diagnosis and planning ahead for
the time when the person must stop driving.
Does this study mean
that nobody with dementia should be driving?
Every situation is different. There comes a time in the
course of Alzheimer's
Disease when a
person should not be driving - in his/her best interest as well
as the public's. But a diagnosis of dementia alone does not necessarily
mean that driving should stop immediately. The driving decision
should be based primarily on driving skills, not just the diagnosis.
However, a diagnosis is a strong signal to begin monitoring driving
skills and planning for the future.
Is this less of an
issue in rural areas? Isn't this only an issue in the more crowded
urban and suburban areas?
No, this issue applies to persons with dementia in any area.
In fact, there are certain risks inherent in driving in any environment.
Persons with dementia who continue to drive should be monitored,
regardless of where they drive.
When do you know
that a person should stop driving?
The decision to continue or stop driving needs to be based on
a number of observations and continuing discussions with the person
with dementia, medical providers and caregivers. Those who have
the ability to continue driving can reduce their risks by driving
only on familiar roads, driving shorter distances and on less traveled
roads, driving during daytime hours only, and avoiding rush hour
traffic and bad weather driving. Keep in mind that driving even short
distances in good weather can pose a risk if driving skills are
impaired. Most accidents happen close to home.
What are the warning
signs that a person with dementia should stop driving?
A single occurrence of poor driving usually is not cause for
a person to stop driving. It does, however, signal the need for
increased monitoring and assessment.
Warning signs of driving problems include:
- Decrease in confidence while driving
- Difficulty turning to see when backing up
- Riding the brake
- Easily distracted while driving
- Other drivers often honk horns
- Incorrect signaling
- Difficulty parking within a defined space
- Hitting curbs
- Scrapes or dents on the car, mailbox or garage
- Increased agitation or irritation when driving
- Failure to notice activity on the side of the road
- Failure to notice traffic signs
- Trouble navigating turns
- Driving at inappropriate speeds
- Not anticipating potential dangerous situations
- Uses a "copilot"
- Bad judgment on making left hand turns
- Near misses
- Delayed response to unexpected situations
- Moving into wrong lane
- Difficulty maintaining lane position
- Confusion at exits
- Ticketed moving violations or warnings
- Getting lost in familiar places
- Car accident
- Failure to stop at stop sign or red light
- Confusing the gas and brake pedals
- Stopping in traffic for no apparent reason
Families need to consider
the circumstances and seriousness of unsafe driving practices to
decide whether to continue monitoring, modify driving or stop driving
immediately.
Is observation key
to assessing one's ability? Over how long a period must that take
place? Can it be done over a long weekend?
That's a tough question. The answer will depend upon the driving
behavior that is observed over a period of time - one weekend will
not suffice. For example, if you're riding with your relative who
has dementia and he seems confused and drives right through a red
light, immediate action to stop driving is in order. On the other
hand, if your relative has always been a pretty good driver and
has mild dementia (maybe she is a bit forgetful and recently cannot
balance her checkbook) and seems OK on the road, monitoring her
driving over a longer period of time would be necessary. Just remember
that your relative will experience some decline in her driving skills
as time goes on.
Dementia/Alzheimer's
Disease
What is dementia?
Dementia refers to the new onset of memory difficulties and other
cognitive problems severe enough to impair daily living. Dementia
is a syndrome and is not, in itself, a diagnosis. It does not refer
to a specific disease or cause. There are many causes of dementia.
In addition, there are reversible and irreversible causes of dementia.
Reversible causes include such factors as depression, thyroid
abnormalities, vitamin deficiencies, and infections. Irreversible
causes of dementia include vascular disease and frontotemporal
dementia, among others.
What is Alzheimer's
disease?
Alzheimer's disease is the most common cause of dementia. It is a progressive, irreversible brain disorder. Symptoms of Alzheimer's disease are memory loss (i.e., the inability to learn and recall new information), decreased judgment, mood and personality changes, and difficulty with reasoning and activities of daily living (from tasks such as making change, making telephone calls to bathing and dressing). Eventually, most people with Alzheimer's disease become unable to care for themselves. More than 70 percent of people with alzheimer's disease live at home.
How many people have
Alzheimer's or dementia in the U.S. today? Is that number expected
to climb?
Currently more than five million people in the U.S. have Alzheimer's
Disease or a related dementia. That number is expected to climb
to 14 million in the next 50 years, unless prevention or a cure
is found.
How is Alzheimer's
Disease diagnosed? Medically? Behaviorally?
There is no single diagnostic test for Alzheimer's disease. Diagnosis
is made by a process of elimination, ruling out any possible related
conditions. The patient exam usually consists of physical, psychological
and neurological exams and a thorough medical history. A diagnosis
of probable Alzheimer's disease can be obtained through evaluation
with approximately 90 percent accuracy. The only way to confirm
a diagnosis of Alzheimer's disease is through autopsy.
Is there a cure or
any effective treatment?
Some forms of dementia can be treated or reversed. Alzheimer's Disease
is the most common form of dementia and has no cure today. In recent
years, some drugs have come to market to delay or control some of
the symptoms. Research continues looking for a cure or prevention
such as a vaccine.
At what age does
Alzheimer's strike?
Alzheimer's Disease is most commonly diagnosed after age 65. While
it is less common at younger ages, it does occur. This is generally
referred to as "early onset Alzheimer's Disease."
Does Dementia happen
only to older people?
Dementia is more common in older adults, but it can happen to younger
adults as well.
Does Alzheimer's
Disease happen more to men or women?
Alzheimer's Disease affects men and women almost equally, although
more women live to the age of greatest risk.
Does Alzheimer's
Disease happen to everyone if they live long enough?
Absolutely not. Dementia and Alzheimer's Disease are not a normal
part of aging.
Are people who are
diagnosed with Alzheimer's Disease unable to take care of themselves?
Not necessarily. Progress in medical science is allowing for
more and more people to be diagnosed in the earlier mild stages
of the disease. Alzheimer's Disease affects people in different
ways, making it difficult for medical professionals to predict how
an individual's disease will progress. Some experts classify the
disease by stage (early, middle and late). But specific behaviors
and how long they last vary greatly, even within each stage of the
disease. Persons with Alzheimer's Disease will eventually be unable
to care for themselves - if they live long enough with the disease.
In the early stages
of this disease are people still capable of doing things and enjoying
life?
Yes. People in early stages commonly function well in some aspects
of their lives and not very well in others. For example, you may
have someone who still goes to a gym and works out several times
a week, but can no longer balance the checkbook.
Dementia,
Alzheimer's Disease and Driving
Why is there so little
research and information available on Alzheimer's and driving?
Alzheimer's Disease remains somewhat of a medical mystery. The
cause is not understood, nor is there a cure. Most research has
been focused on the causes and the hope for treatment or cure. Unfortunately,
driving has not received enough attention. Also, in the past, the
diagnosis was often made in a later stage of the disease, making
driving less of a critical issue because most people were no longer
driving.
Do individuals in
the early stages of the disease exhibit poor driving behavior?
Usually not. The existing research does not give us an indication
that early stage driving is a major issue. However, every person
will have a different experience. You may find that someone who
never had very good driving skills really needs to limit driving
earlier. Or, someone who immediately upon diagnosis begins to limit
the amount and type of driving (local, short trips) may extend their
safe driving time.
For people in the
early stages, isn't it easier for them and their families if they
just stop driving immediately?
The abrupt termination of driving freedom is difficult for the
person with dementia and often invokes guilt for families. That
is why we recommend families first give early thought to ways to
reduce driving and then to prepare for the time when driving is
no longer safe. This allows the person with dementia opportunity
to feel more involved in the decision and time to adjust to the
loss of independence. It gives families time to adjust to the added
responsibilities for driving and doing errands for the person with
dementia.
Will everybody with
the disease eventually become an unsafe driver?
Advances in treatment that delay the progression of the disease may extend the safe driving period. However, everyone with Alzheimer's Disease or other irreversible causes of dementia will eventually lose the ability to drive safely, due to problems with:
- judgment,
- multi-tasking,
- slowed reaction times,
- impaired spatial skills,
- and other cognitive deficits.
Why is there a controversy
over driving cessation? Isn't the approach cut and dry?
There are a variety of opinions expressed by some very reputable
organizations. They sometimes are at odds because there is not enough
research and understanding to know definitively when driving should
stop. For example, some suggest that driving cease at the time of
diagnosis, but that really depends on when in the course of the
illness a person is diagnosed. In addition, some of the guidelines
which suggest that a person with dementia stop driving immediately
upon diagnosis were issued prior to the recent advancements in earlier
diagnosis and better medications. As diagnostic science advances,
doctors are learning to diagnose earlier and offer treatments that
may delay decline of functioning.
Don't older drivers
show signs of aging in their driving anyway? How do you distinguish
between Alzheimer's driving and normal aging?
Older drivers as a group are very safe drivers. Most older drivers
self-regulate their driving to accommodate changes in skill, thereby
enabling them to remain safe on the road. But persons with dementia
may not be able to recognize and respond to their skill deficits,
perceive distance or make quick and appropriate decisions on the
road.
Driver
Testing
If someone with dementia
wants to be tested for driving safety, where do they go? If I take
a test, will the results be reported to driver licensing authorities?
If someone wants to be tested to determine whether they are
still safe to drive, they can seek local resources such as rehabilitation
programs, hospitals, AAA or motor vehicle departments. Asking your
doctor for a referral is often helpful. Although it is unlikely
that results would be reported to licensing authorities, it would
be important to ask the person conducting the test. It is important
to remember that a person with Alzheimer's Disease has a progressive
disease. That means they may pass a safety test only to begin to
have problems several months later. Re-testing may be necessary.
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