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Should Someone With Dementia Drive?

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Should Someone With Dementia Drive?

By Carole Larkin

FINALLY, there are tests to help doctors determine whether a person with dementia can continue to drive.

Well, they are really screening tests to predict whether a person with dementia will fail a road driving test. I found an article about the screening tests in the September/October edition of the magazine Today’s Geriatric Medicine pages 13-15. (www.todaysgeriatricmedicine.com). They are meant for a doctor or his trained assistant to administer in the office when a family member or another person expresses concern about the person with dementia’s driving ability. It appears to me that it will take about a half hour to administer, grade and interpret the outcome of the tests. If the person “fails” or in my opinion, has less than a 50% score, (meaning that they have less than a 50-50 chance of passing a real driving test), then that indicates that they should have a thorough driving test given by specialized occupational therapists. That 50% cut off is just my opinion, you might think that under a 70% (or other percentage) score means that they need further evaluation. That’s up to you.

Where do you find these specialized occupational therapists? Usually in fairly large cities with large hospitals (teaching hospitals or regular hospitals). You’d probably have to call the hospitals to see if they have one in their occupational therapy department. You probably would have to talk to the occupational therapy department itself; I doubt anyone else in the hospital would even know about the specialized occupational therapists.

With this specialized evaluation, if the person with dementia fails those tests, you have proof in writing that they can no longer drive. It’s very hard for the person with dementia to argue that they can still drive when you show them in writing the proof that they can’t. If it was me, I’d make a number of copies of the findings, in case the person gets mad and rips them up every time they see them. (I believe in being prepared for the worst.) You might also send a copy of the tests to your state’s driving licensing authority, the insurance company that insures their car/truck, and the local police, just to be sure everybody involved in taking away the keys knows that the person can no longer drive.

Do I believe that primary care doctors have time to administer these tests on a regular basis? Heck no! Nowadays office visits average 7-10 minutes. Maybe some doctors will appoint someone in their office to train to administer the tests, and have them do it. That is, if they even have extra staff available to do it, along with their regular jobs. When have you seen extra staff at your doctor’s office? Aha- that’s what I thought. Instead the doctor could set aside a day a week/month when there somebody at the office to administer the tests, like maybe on a Saturday? We can hope!

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I am attaching the links to the two tests used in this screening and how to score them, so you can print them out and take them to your doctor. The first test is the MMSE the most common screening test used by doctors to discover cognitive deficits. (I think there are far better tests for cognitive deficits than the MMSE. The MOCA is one of my favorites. But hey, this is not about me!) The researchers used this test in developing their tool (the Fit2Drive app) to help decide whether to refer the patient for more thorough testing, so I’m including its link here.

http://www.unc.edu/~vreddy/index_files/Medical%20Resources/Clinical%20Topics/Geriatrics/MMSE%20MANUAL.pdf

The second test is the Trail-Making Test Part B. There is a Trail-Making Test Part A that is used to get the person being tested a little practice in doing that type of test before actually attempting the real test, Part B. I’ve included the Link to both Part A and Part B and how to score them.

http://www.canadiangeriatrics.ca/default/index.cfm/resources/family-physician/driving-assessment-tools-trials-a-and-b/

http://doa.alaska.gov/dmv/akol/pdfs/uiowa_trailmaking.pdf

After the two tests are taken and scored, the person testing takes the total score, adding the Score on the MMSE and the Trails B time it took to complete it correctly and enters them into the slots for each on the calculator at the website, http://Fit2Drive.us or by downloading its Mobil app to your cellphone, (both Apple and Android are available) from that same website. The answer will indicate the probability that the person could pass the road part of the driving test given by the special occupational therapists.

 

Remember, these two tests and the Fit2Drive tool are made for doctors or their trained assistants to administer, not the general public. If you wish to administer the tests and use the tool yourself, you are doing so at your own risk. You would have to read the instructions to train yourself how to do it 100% correctly, and most importantly, when you grade it you must do so with absolute impartiality, no matter how much you want the person to fail.  After all, how embarrassed would you be if you say the person failed and they didn’t, and they insisted on taking the more complete tests given by the occupational therapists and they passed them? Yikes! I’m just warning you up front, because there is NO WAY that I’m taking the fall for what happens out of the testing when you do it. It’s truly on you.

Of course, these screening tests can always be repeated after time passes to see if the person’s abilities have deteriorated more.

Hopefully this will help get some dangerous drivers off the road, and lower your stress level about your loved one driving with dementia.

Carole Larkin can be reached via Email.

Additional Resources for those

Living and Dealing with Dementia

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Watch Team Members Below Explain

Why this initiative is important

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Two Sharecare Experts Join Forces to Celebrate National Alzheimer’s & Caregiver Month

Two of the Top 10 most influential online experts on Alzheimer’s disease according to ShareCare – the health and wellness experts site launched by Dr. Oz – Lori La Bey (#1) of Alzheimer’s Speaks and Sherri Snelling (#4) of Caregiving Club announced today a joint project in November to celebrate National Caregiver Month and National Alzheimer’s Awareness Month.

The “Let’s Talk Tuesdays” series of caregiving radio programs on La Bey’s Alzheimer’s Speaks blog talk radio channel features both ShareCare experts interviewing other thought leaders on caregiving topics to help empower, enlighten and engage the nation’s 65 million family caregivers. In addition to La Bey discussing the growing trend in Memory Cafes and Snelling talking about the tipping points and health risks caregivers face, the hosts have selected a line-up of experts ranging in topics from technology to volunteerism to entertainment and education programs.

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Click above to go directly to Alzheimer’s Speaks Radio page. 

Shows run 2 hours and start each Tuesday at

11am EST, 10am CST, 9am MST, 8am PST, 4pm London time

All programs are archived for ease of access.

The programs will air live every Tuesday in November from 10 a.m. to Noon CT and features: Eric Hall, Chairman of the Board of the newly launched Alzheimer’s Global Initiative; Brooks Kenny of Lotsa Helping Hands will talk about volunteering to help caregivers; Cathie Borrie, author of The Long Hello, will talk about adapting her memoir for the stage; Daniel and Ellen Potts will talk about the first middle school language arts curriculum for Alzheimer’s awareness Let Me Be Your Memory; Gary Kaye, founder of IntheBoomBox.TV will talk on caregiving technology; Walter Greenleaf Stanford Center on Longevity will discuss a global student design challenge to help early-stage dementia sufferers with safety and independence; Karen Love CCAL will discuss Advancing Person Center Living & Dementia Action Alliance on Building Alliances for Person-Centered Care; Carole Larkin from Third Age Services will discuss Memory Cafes.  Some members will also tell us what they think about these groups and Ruth Curran creator of Cranium Crunches will discuss brain games and smartphone apps to help caregivers engage with loved ones and learn to relax. Check the host web sites for detailed guest information.

“Caregivers often say they feel all alone which is why Lori and I teamed up for this special effort on her talk radio program to encourage caregivers, especially the 15 million Americans caring for a loved one with Alzheimer’s disease, to call in and talk to us as well as learn from other experts about resources and services to help them and to know they are not alone,” says Sherri Snelling, founder and CEO of Caregiving Club and author of “A Cast of Caregivers – Celebrities Stories to Help You Prepare to Care.” “Part of our role as ShareCare experts is providing guidance and advice to caregivers who don’t know where to turn. My personal mission is to help caregivers navigate caring for their loved one while also finding time to care for themselves – what I call the Sandwich Generation juggling act.”

“My goal is to shift the dementia care culture worldwide, from crisis to comfort, by giving a voice to all which is why this November we’re going to highlight caregiver challenges and solutions,” says Lori La Bey, founder of Alzheimer’s Speaks. “If we can help even one person with dementia or those caring for others as a result of these radio shows and help change how dementia care is perceived, received and delivered, then we’ll start the spark that will ignite a huge difference caregiver’s lives.”

About Caregiving Club
Sherri Snelling, CEO and founder of the Caregiving Club and author of A Cast of Caregivers – Celebrities Stories to Help You Prepare to Care, is a nationally recognized expert on America’s 65 million family caregivers with special emphasis on how to help caregivers balance self-care while caring for a loved one. Sherri has been honored as one of the Top 10 Influencers on Alzheimer’s by Sharecare, the online health and wellness experts site created by Dr. Mehmet Oz. She is a caregiving contributor reaching 15 million readers monthly through the Huffington Post, Forbes.com, PBS/Next Avenue, MariaShriver.com, MORE.com, Alzheimer’s Association and Caring.com. She is also a TV producer, program host and celebrity interviewer at red carpet galas, creator of the Me Time Monday weekly videos in support of the non-profit Healthy Mondays Campaign, Caregiver’s Network Webinar host for Lifecare’s 61,000 employer clients and the former Chairman of the National Alliance for Caregiving based in Washington, D.C. Sherri has been a caregiver for her maternal grandparents and recently for her father who passed away from prostate cancer.

Follow on Twitter: @SherriSnelling and @CaregivingClub and learn more at: caregivingclub.com

About Alzheimer’s Speaks
Lori La Bey is founder of Alzheimer’s Speaks, a U.S.- based advocacy group that provides education and support for those dealing with Alzheimer’s disease and dementia. She was named the #1 Influencer online for Alzheimer’s by Sharecare with Dr. Oz in November of 2012. Her training programs are designed for people with memory loss, care partners, professionals and the public. She is a highly sought after speaker, trainer, and advocate for new delivery systems and attitudes towards those with memory loss. Her mission is to deliver programs such as her Dementia Chats Webinar™, platforms and collaborations such as Memory Cafes and Dementia Friendly Campaigns to the US. Along with the newly launched Resource Directory which allows the world to share knowledge in an easy to use format. In addition to her radio show, Lori has been a contributing author in four books and is currently working on two books. Lori is a long-time caregiver for her mother who has Alzheimer’s disease and has also been a caregiver for her father.

Follow on Twitter at: @AlzSpks and learn more at: www.alzheimersspeaks.com

About ShareCare
Sharecare, created by Dr. Mehmet Oz and Jeff Arnold, is the online destination for content contributors including the most prestigious associations, leading brands, eminent hospitals and significant healthcare organizations and professional societies that represent the world’s foremost medical expertise. From the American Red Cross to Colgate to Johns Hopkins Medicine to the National Academy of Sports Medicine, Sharecare.com is bringing together diversity in thought leadership from the top minds in the healthcare field to provide consumers with multiple perspectives within a single web site dedicated to improving health. SharecareNow, a partnership of Sharecare and powered by WCG, is dedicated to facilitating more meaningful online conversations about health and wellness among patients, physicians, brands and associated healthcare organizations and professionals. They have identified the Top 10 influencers on a variety of topics including Depression, Diabetes, Heart Disease, Nutrition, Eye Health, Breast Cancer and Children’s Health. In 2012 they added influencers for Alzheimer’s disease. Learn more at: sharecare.com

 

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The File Clerks of Our Minds

By Carole Larkin 

Once upon a time, not so long ago, there was an office where two clerks took important information people gave them and filed it away for later use. This office looked much like most other offices of its type. There was a long front counter where people would come to bring their information, two desks for the two file clerks and, in the back, rows upon rows of file cabinets to hold the information brought into the office. The file clerks’ names were Ella and Fino. Ella was the clerk who took the information from the people as they came in. She put the papers in a basket for Fino to pick up and put into the file cabinets in the back. They had worked together for years and years. They knew each other very well. They worked perfectly together. All was well.

But one day, Ella wasn’t feeling well, not well at all, but she didn’t want to go home from work; she needed the money. Ella was tired and a little cranky. She really didn’t want to carry the information she received over to Fino’s basket. So that day, instead of taking everything she received to Fino’s basket, she started throwing some of it in the trash can located right under the counter; not much, just a little bit. Fino, who was busy filing, never noticed. The trash was taken away that night, and all evidence of Ella’s little secret duty-shirking was gone.

Ella came back the next day and thinks, “ Hmmmm, maybe I’m on to something here. Life can get a little easier for me at work. All I have to do is throw the information in the trash instead of giving it to Fino. I think I’ll do it again today and see what happens.” And so she did. Again, Fino didn’t notice. She just kept on with her filing of the information.

As time goes by, Ella starts throwing a teeny bit more into the trash can every day, but more people are bringing more information in as well, so Fino never notices.” Well,” Ella thinks to herself, “I’ve got a great thing working for me here: less work for the same pay! I’m gonna keep doing this, and throw away even more, from now on.” And so she does.  More time passes, and by now Ella is throwing away almost half of what was taken in. Amazingly, Fino who is still hard at work never notices Ella throw the information into the trash because she’s frantically rushing around trying to do her job.

More time goes by. Then one day, Fino stubbed her toe while rushing around like crazy, and stopped to rub it. She looks up, and for the first time sees Ella throwing papers in the garbage instead of putting them in her basket. Fino is outraged. “How dare she (Ella) be a slacker while I (Fino) am rushing around like crazy to get the job done? Well, I’ll show her!” and with that Fino gets a garbage can from behind the building, drags it into the back corner and starts throwing a little bit of  information from the file drawers into that garbage can. “Two can play this game.” She harrumphs. So on and on they go, Ella in the front, and now Fino in the back, dumping more and more information into the trash.

One day, someone come in and wanted the information that Ella and Fino filed away. Ella went back to the file cabinet where it was supposed to be filed and, oops, it wasn’t  there!  Ella called Fino and they both searched for it, but It was nowhere to be found. Ella must have thrown it out, or if it was very recent, maybe Fino threw it out. Either way, it was not there to be given back to the person. The person stomped out angry as all get out, and Ella and Fino were embarrassed. Nevertheless, they both went back to throwing out the information in their areas at an even greater level than before.

You know what’s coming now, don’t you? Yep. Finally, it was all thrown out. Fino and Ella have nothing to do. The company decided they weren’t needed any more. They were fired! Woe is me!!!!! They ended up homeless and living under the bridge.

So, what is our take away lesson? The first lesson is: if it’s never taken in it can’t be retrieved. The second lesson is:  after a long period of time, even if it was taken in, it still may not be retrieved.

And so, everybody, this is how our memory works. Ella is our hippocampus (a portion of our brain). If she dogs it- the information never is put in and so can’t be taken out. If Fino dogs it, even if the information is taken in, it may still not be able to be taken out. Depending on when the information came to the office, you may or may not ever get it out.

Your final take away lesson is: think before you use the word “remember?” to a person with a dementia, because maybe they won’t be able to remember, and you will both be embarrassed.

carole_larkin_pic_jpegBy Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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Book Review by Carole Larkin

You Say Goodbye and We Say Hello,

The Montessori Method for Positive Dementia  Care

brenners_bookTo say that Tom and Karen Brenner’s book “You Say Goodbye and We Say Hello, The Montessori Method for Positive Dementia  Care”  is the Guidepost ( to use their words) for books to be read by family and professional caregivers does the book and injustice. The book is far, far better than that.  I think this book should be required reading for every caregiver support group (dementia or not) in America, and maybe in the whole world (in translation of course). Tom and Karen are clearly gentle souls with deeply compassionate hearts. Even the words that they choose to convey their thoughts in this book are soothing, calming and yet upbeat. They truly walk their talk.

They give us a thoroughly thought out system (the Montessori system) to use as the conveyance for us to follow their lead in drills down to compassion and positivity. They give us specific tools (Montessori based activities and thorough explanations of how to carry out those activities) to use to accomplish the interactions that lead to a good day for both caregiver and the person with dementia. Tom and Karen teach us in a number of different ways, via straight instruction, via stories about themselves, and most effectively with stories about those with dementia that have been positively impacted by the Montessori method of care. They give us “Guideposts”, a one sentence snippet that is easy for caregivers to remember, while succinctly getting across the essence of what they are teaching us at that moment. They even tie their message to Beatles songs which is of course, perfect for us Baby Boomers and younger generations.

 This book is so good, you instantly feel calmer and more confident in yourself even while reading it. And isn’t that what we need in our 24/7 roles as caregivers for our loved ones? Don’t wait another minute. Get this book NOW!

Amazon

Tom and Karen Brenner’s Website

Link to Brenner’s Radio Interview On Alzheimer’s Speaks

Carole Larkin

Carole Larkin

By Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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For Additional Resources Check Out Our Website

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Wandering:

 

Try these tips to prevent wandering out of the house by your loved one.

 

  1. If there is a securely locked high fence around the whole perimeter of the property, let your loved one go outside, in good weather.  Go outside with them.
  2. If there is no secure fence or there is other danger to allowing them to go outside at will, try these approaches:
    1. Remove from site triggers that would make the loved one or person with dementia think of going out, such as coats, umbrellas, shoes, purse, etc…
    2. Tell your loved one or person with dementia frequently where they are and why, in a calm tone of voice. Reassure them with words like, “XXX will return in an hour to be with you” or “Your family knows where you are”.
    3. Don’t confront or argue with the person, walk with them and redirect to another part of the house or to an activity. Use humor if possible.
    4. Purchase childproof doorknob covers, or deadbolts to put on the door above the loved one or person with dementia’s eye level, or slide bolts on the top or bottom of the door. These items will never be used when the loved one or person with dementia is alone in the home, only when someone is with them.
    5. If you don’t want to do any of the above, place warning bells above the outside doors, or activate the house alarm system, or get a monitor that goes on the loved one or person with dementia (such as a toddler monitor) or a pressure mat alarm, so at least you know when your loved one or person with dementia has left the house.
    6.  Try putting a full-length mirror on the inside face of the outside door. Sometimes people don’t recognize themselves and think someone is standing there and turn around and go back.
    7. Try putting a black throw rug in front of the outside door. To some people, it looks like a hole in the floor and that they won’t attempt to cross it.
    8. You might try to hide the outside door by putting a curtain in front of it, or maybe by making sure it is the same color as the surrounding walls, that way it may not be seen by the loved one or person with dementia.
    9. Put a big sign on the outside door saying “Stop” or “Do Not Enter” or “Danger- Do not Open”.
    10. Sew ID labels in the loved one or person with dementia’s clothes, or get a special Medic alert bracelet for the loved one or person with dementia, if they have a history of escaping the house. Also they need to have a current picture and a piece of unwashed clothes (for tracking dogs) handy to give to the police, in case the loved one or person with dementia does escape.
    11. If the loved one or person with dementia escapes while you are in the bathroom , grab your cell phone, and run out side, look around the whole block the house is on. Cover the whole block, if not found, call 911 and tell them that a person with dementia has escaped the house and is lost. Try to convince them that this person needs to be found immediately, they need their medicines badly.
    12. If the loved one or person with dementia doesn’t recognize his or her home as where they live, they may want to leave to go “Home”. They may be thinking of a home they lived in previously, such as in their childhood. Instead of telling them that this is their home, talk about the home they are thinking of. Reminiscing about it sometimes lessens their urge to leave.
    13. If they still want to go “home” tell them you will walk with them, and take a walk with them or tell them that you will drive them there, and take them out for a drive. It may help if you stop to get a treat, an ice cream cone, or snack. They probably will have forgotten about the other home by the time you get back, and may even recognize where they live now as home.

carole_larkin_pic_jpegBy Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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Driving and Dementia

  What specific driving abilities decline in older drivers, even ones without dementia?

 

Well for one, older drivers have declines in their physical ability, meaning that they have declines in their muscle strength, their coordination, their reach, and in their range of motion for their arms, legs, upper body, and neck. Some may lose consciousness periodically when having TIA’s (also known as mini strokes).

Secondly, older adults lose what is called their psychomotor ability.  They lose the ability to respond quickly to something happening immediately in front of them like a dog running out in the street followed by a child chasing the dog.  They may not be able to respond differently to different types of things happening to them — such as their car skidding or hydroplaning on a wet patch of road, after driving on dry roads just a second before that.  In other words, their hand-eye and their foot-eye coordination can decline or slow down.

 

Additionally their visual ability declines just because they are older adults. They find it more difficult to differentiate things clearly under low light (night) and low-contrast (dusk) situations.  It’s also harder for them to see objects in motion (like a child darting out into the street) and when there is glare and right after glare is gone. Also many people’s peripheral vision becomes blurry or dark and they can develop glaucoma, cataracts and macular degeneration.

How does dementia add to declining driving abilities?

Dementia causes perceptual ability to decline. Perceptual ability is the ability of the brain to correctly interpret and act on what a person sees and hears, for example detecting the actual speed and motion of other cars on the road. A cognitively impaired person could stop at a red light, then pull out into traffic going on the green light without realizing that those cars were entering the intersection. A person with dementia may not recognize the sound of a train whistle while they are crossing a railroad track.  Sometimes the perceptual ability just slows down, meaning that the person does recognize what they see or hear but the recognition happens too slowly to react in enough time to avoid an accident.  Some cognitively impaired people have hallucinations and react to things that are just not there, thus causing danger to themselves and other drivers.

In people with dementia, the ability to pay attention to things going on while driving lessens in several important ways. The person’s attention span is shortened. They may forget to properly react just seconds after seeing something that needs to be acted upon. They may not be able to share their attention between several different things happening at the same time and get confused as to which to respond to, or may not respond to anything that is going on. Also they may not be able to easily shift their attention from one set of circumstances to another, or just shift attention fast enough.

Certainly in people with Alzheimer’s and some others dementias their memory declines. At any given moment they may not be able to retrieve the memory of what to do when a situation arises.  For example, remembering to allow the vehicle on your right to proceed first when both cars are stopped at an intersection simultaneously.  Or remembering what a stop sign means.

Other cognitive abilities decrease as well. Declines in executive functions such as logic, decision making, self awareness, impulse control, and initiation of action can and do lead to dangerous situations. Even if the person performs adequately most of the time, you never know when they will have that moment of failure of executive function. The fluctuation in abilities can and does change from moment to moment.

Are there any ways to counteract these losses, to keep the person with dementia driving safely   early in the disease?

Yes.  Some things can be tried such as:

Going to an Occupational Therapist who specializes in assessing driving skills in the elderly is a start.  After the therapist determines the deficits, they suggest ways to compensate for some of the deficits. Some methods involve vehicle control assists, and some involve training or retraining driving skills.

For cognitive deficits, sometimes Psychologists can train a person to help with mental processing of stimuli, which might lead to improved performance in driving skills for a short period of time.

Restricting the amount, times and locations of driving is another method. Some elderly drivers impose these restrictions on themselves, but for those who do not, the family needs to impose them — and monitor compliance on a routine basis (at least once every week or two).

Generally, experts agree that it is beneficial for people with dementia to be able to drive as long as they are not a danger to themselves or others.  When they hang up the car keys they are in danger of losing their access to friends and family, to medical providers, to shopping and other services crucial to keeping them independent. Isolation leads to depression and other physical and mental issues.

 What are some of the warning signs that driving behaviors can cause safety problems?

 

The American Academy of Neurology came out with recommendations and warning signs of unsafe driving on April 12th 2010 but I find the list issued by the Hartford Insurance Company  in their brochure “We need to talk… Family conversations with older drivers”  is more complete. It is free, and can be ordered at www.thehartford.com/talkwitholderdrivers.

They list the signs from the minor signs to very serious issues.  Family members should observe (ride with) the person with dementia for a minimum once a week, and over a period of time. The person observing should keep notes so that changes in driving ability can be seen. The observer should look for a pattern of warning signs and for an increase in the frequency of occurrence of those signs. The signs are as follows:

 

A decrease in confidence while driving.

Difficulty turning to see when backing up.

Riding the brake.

Easily distracted while driving.

Other drivers often honking their horns.

Incorrect signaling.

Parking inappropriately.

Hitting curbs regularly.

Scraping or denting the car, mailbox or garage.

Increased agitation or irritation when driving.

Failure to notice important activity on the side of the road.

Failure to notice traffic signs.

Trouble navigating turns.

Driving at inappropriate speeds.

Not anticipating potential dangerous situations.

Using a “copilot”.

Bad judgment making left hand turns.

Near misses.

Delayed response to unexpected situations.

Moving into the 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.

 

The rule of thumb is once you are nervous or uncomfortable riding with that person, the person needs to stop driving.

 

How do families broach the subject of stopping driving?

 

The most effective method is with several short conversations centering on health and safety. That way a pattern of open, calm, non-threatening dialogue has been started. There is no direct confrontation, no strain of asking them to change their driving behaviors. Opportunities to open discussion might be shortly after a car accident or near miss, or after seeing the doctor and new medicine has been prescribed for your family member.

 

Things that you can say to open dialogue might be:

“Have you talked to your doctor about the effects of your new medicine on your

driving?”

“That was a close call yesterday. I worry about your safety on the road.”

“Driving isn’t what it used to be.  There is so much more traffic nowadays, and people are driving more aggressively than ever. I read about road rage accidents and incidents in the paper all the time now”

“I worry about your getting lost.”

Of course, the comments should be appropriate to your loved one’s personal situation. Be prepared for negative reactions. After all, your loved one knows where these conversations are leading.  They understand that a big portion of their independence is at risk. They know that they will be more dependent on family members and others and that they will have fewer social opportunities. They might become depressed or even angry at the thought of giving up their driving privileges, even if they secretly agree with the assessment of their driving ability.

Who should be the one to start these conversations?

A Harvard/MIT survey concluded that married drivers prefer to hear about driving concerns first from their spouses. Those living alone prefer to have these conversations with their doctor, their adult children or a close friend, in that order.  Adults over the age of seventy-five allow their adult children to have more influence than younger seniors. Older drivers DO NOT want to have conversations with police officers on this subject. Would you?

How does a person prepare for these talks?

First, do your homework before you ask your loved one to restrict or stop driving.

Make sure that you have observed them behind the wheel a number of times over an extended period of time.

Have the knowledge. Learn the warning signs of driving problems and cite them in your discussion.

Speak to your family members’ doctor to see if they would be willing to help. Some doctors may take an active role in giving an opinion or writing a prescription to stop driving. Others may refer a concerned patient and their family to a driving rehabilitation therapist (OT) for assessment.

Have ready other options for transportation. Offer yourself or other family members to drive to doctor’s appointments, to the grocery store or for other errands, to social events, as your schedule allows. (If your loved one can still take public transportation find out what’s available to them. Many cities and towns have special buses for disabled adults. Prearranging for a regular pick up and drop off to the same location may work for awhile. Offer to pay for a taxi if your loved one can still handle that. Make sure the taxi driver knows not to let them off anywhere other than the designated location and watches them to ensure that they go in the door of the designated building. Private transportation is available as well. Look for companies offering rides for seniors. The same instructions would be given to the operator of the senior ride as are given to taxi drivers.

Be calm and supportive. Always let your loved one know that your concern is for their safety and well-being and that you love them. You might use some of the following direct appeals to your loved one.

“Even if you were not at fault in an accident, you could be seriously injured or die.”

“I know you would feel terrible if someone was hurt when you were driving.”

“I’m afraid to let the grandchildren ride with you”

“Let’s talk with your doctor about this.”

What if your family member refuses to stop driving?

Sometimes it takes more than just conversations. Maybe not renewing their driver’s license or canceling insurance will be enough. The State licensing authority can be notified in writing of your concern about the ability of your loved one with dementia’s ability to drive safely. Ask them to retest in all three areas: vision test, written test and driving test. Sometimes the prospect of being tested will make your loved one give up the keys voluntarily. Sometimes they can’t pass all the tests. Even if they do pass all the tests, you can ask that your loved one be tested again, say in 3 months or so. You may have to consider disabling the car, filing down the keys, or removing the car from their premises. These are drastic measures, and only to be taken when all other interventions have been tried and have failed. They probably will be very angry with you, but usually in time the anger fades. It’s really a small price to pay to keep your loved one safe and alive.

What dangers arise for families who do not address their loved ones with dementia’s declining driving skills?

The danger that always is cited first is that their loved one will get lost. People with dementia get lost driving every day. The longer into the disease they drive, the higher the chance that they will get lost, even driving to their self limited locations, such as the closest grocery store or drug store. Nonprofits such as the Alzheimer’s Association as well as a variety of corporations have systems for finding lost dementia patients. Technology can be used such as GPS or cellular tracking. They are good of course, but it is like closing the door after the house is already out of the barn. The real answer is for the family to be proactive and monitor their loved one with dementia’s driving skills and stop them from driving before they reach the point of getting lost.

 

Another danger to the person with dementia and the family is the much higher risk of liability from causing an accident — causing property damage, injury or even death. The family should check the limits of their loved one’s liability insurance, and increase the coverage as much as they can afford. Even then, there may not be enough coverage to protect the person from losing their income, home and retirement savings and other assets. If your loved one hits a bus full of people from the retirement home up the street, or a school bus full of children, will their insurance cover the costs from law suits that families of those injured or killed will file against them? I don’t think so.

One of these days, a judge somewhere will rule that the other family members (meaning adult children) are liable as accessories, if they knew that their loved one should not be driving, yet took no action to stop them. The likelihood of this ruling will rise with the number of people killed or injured by demented drivers. As more and more people enter older adulthood, and the epidemic of Alzheimer’s and other dementias continues, this result seems inevitable. When the ruling occurs, it will have an immediate impact on the income and assets of the family members who knew and did not take action. That would be devastating to all the family members affected.

 

carole_larkin_pic_jpegBy Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias.  . Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com

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A Guide to Safe Guarding Your Home

When A Loved One Has Dementia

By Carole Larkin

For many people, their home represents their life accomplishments; this is especially true for individuals diagnosed with dementia or Alzheimer’s disease and their caregivers. Most families want to keep their loved one at home for as long as possible so the person can be in familiar surroundings. Therefore, it is important to create a safe environment for your loved one to live in while they can still remain at home.

When caring for a person with Alzheimer’s or memory problems in the home it is important to avoid accidents, minimize injuries in the event of an accident, and remove “triggers” that could cause agitation or challenging behaviors.

The following are suggestions for safe proofing your home. It is important to accommodate the needs of the caregiver as well as the senior with dementia. There are no fixed rules. Each person’s home is different, just like each person with dementia or Alzheimer’s related memory loss. There will be unique behaviors or characteristics that require continual reassessment. Be sure to walk throughout the home as the disease progresses to monitor it for safety issues that may arise.

Start with a Plan—Survey your home thoroughly prior to making changes. Look for areas and items that could be hazardous to your loved one. Survey the home as if you were the senior person with dementia then decide what area should be tackled first. The following suggestions can assist you with beginning your plan:

Simplify—As Alzheimer’s Disease progresses, it becomes more difficult for seniors to process environmental information. The simpler things are in the home, the fewer environmental inputs there are to interpret and distract the person.

Create walking paths throughout the home—Paths should be as straight and direct as possible. For example, a path from the kitchen to the dining room will need to be free of furniture and decorative items (ALL THROW RUGS SHOULD BE REMOVED or tacked down).

Reduce clutter—Open spaces make both access and decision making easier, while decreasing the potential for over-stimulation.

 Utilize labels—Labeling areas and items in the home may provide visual cues to maintain the senior’s independence within the household. For example, attaching pictures of silverware outside the utensil drawer or hanging a “BATHROOM” sign or a large picture of a toilet on the bathroom door. It is important to use symbols and/or the language the person can relate to at their current level of function. Therefore, it may be necessary to change the kind of labels you use as the cognitive level changes.

Danger Zone — This is an area that should be off-limits to your loved one. This zone includes any places, objects or features that may be potentially dangerous. These types of rooms should be secured and can be used to store breakables, tools, chemicals, or any other items deemed unsafe for seniors with dementia. Doors leading to these rooms should be kept locked and alarmed if possible.

Examples Include:

a)      Garage (access to a car, tools, garden chemicals, etc.)

b)      Basement

c)      Attics

d)      Workshops

e)      Hobby rooms (machinery, paint, etc.)

f)       Staircases

g)      Outdoors (pools, spas, unfenced areas)

h)      Computer rooms

i)        Kitchen
If you cannot lock these areas, then removing dangerous items and/or disabling potentially dangerous applications and machinery is a must.
Respite Zone — This space should be considered a sanctuary for the caregiver. This is a place where the caregiver can relax undisturbed and conduct personal affairs. Having a place to get away and have time alone can greatly reduce burnout and stress.

Examples Include:

a)      Renovated attic

b)      Spare room

c)      Office in the home

Safe Zone — This zone should include everything else in the house not identified as a danger or respite zone. It is preferable to safety-proof a room than declare it off limits. As much of the house as possible should remain available to the senior with Alzheimer’s to wander, hide things, rummage and exhibit the behaviors that are common with the disease. This zone should be free from agitating or harmful situations.

The following are helpful hints to creating safe areas:

Lighting — Reducing shadows and dark areas in the home can help eliminate sights that may be misinterpreted or trigger confusion. Ways to enhance lighting include adding night-lights to hallways, pathways and bathrooms, and replacing light bulbs in lamps with brighter wattages.

Bathrooms — This room can be one of the most dangerous rooms in the home. Possible dangers include: slips and falls, burns, poisoning, cuts, electrocution, and drowning. The following are ways to create a safer bathroom:

a)      Adding shelving units behind the toilet to display toilet paper, clean towels, Kleenex and other items (shelving must be able to double as a grab bar). Having these items displayed and easily available will eliminate confusion.

b)      Safety proof or relocate wall hooks, glass shelves, throw rugs, mouthwash, laxatives, sleeping aides, cough syrup, and other medications (prescription and over the counter).

c)      Remove all electrical appliances that can be dropped in water: electric razors, lighted portable mirrors, space heaters, irons, electric rollers, hairdryers, small radios or TV’s.

d)      Identify or mark hot and cold faucets with large letters.

e)      Lower household hot water temperature to 105 – 110 degrees when practical.

f)       Modify the door to give access to the caregiver in case of an emergency (possibly remove the lock, move it to an unusual place, or have it specially keyed)

g)      Make the room warmer – install a heating lamp in the ceiling with a timer (space heaters are never advised). Many people with dementia stop using the bathroom (because it seems too cold) without being able to verbalize this discomfort.

h)      Install firmly mounted grab bars along the wall of the bath/shower and toilet. Consider shower seats and adding non-slip floor surfaces to wet areas.

i)        Consider eliminating exhaust fans that whirl or make noise, as this may cause further confusion and/or irritation.

Kitchen—Dangers may include the same found in bathroom zones. Reducing items on shelves and cutting out pictures and taping them on cabinets to identify its contents are just two ways to simplify decision making and eliminate confusion for your loved one with Alzheimer’s. Eventually the kitchen may become a danger zone and off limits as the disease progresses. The following tips can be useful for safety proofing your kitchen:

a)      Remove products, appliances or other items that may be dangerous and accessible such as stove knobs, oven door handles, and chemicals.

b)      Remove all spoiled food from the refrigerator and check expiration dates on all products.

c)      Remove any medications stored in the refrigerator or install a lock on the door.

d)      Consider installing a childproof lock on the oven to prevent it from being turned on and forgotten, as well as, being used to store or hide household items.

e)      Disconnect or remove the microwave to prevent it from becoming an ‘explosive.’

f)       Use the fuse box or install timers to control electrical outlets for stoves, coffee makers and other appliances.

Windows & Doors—Some people with Alzheimer’s dementia will never wander; however, many do. It is important to take the necessary precautions before your loved one exhibits this behavior to ensure their maximum safety. Following are tips for enhancing safety with windows and doors:

a)      Make “Safe Zone” doors easy to use. Door levers are easier to operate than round, smooth, hard to grip knobs.

b)      Install safety handles, locks and/or alarms on all doors that lead outside or to “Danger Zones.”

c)      Make sliding glass doors as visible as possible. Install decals at the person’s eye level to prevent the person from walking into the glass door.

d)      Adding fake windowpanes may help camouflage door access to “Danger Zones.”

e)      Install devices on your windows and sliding glass doors that will limit how far they can be opened. Simple clamps or pins can easily be installed.

f)       Reduce glare or reflections from windows that can be misunderstood by your loved one.

Preparing your home to care for a loved one with Alzheimer’s Disease or any dementia related disorder is difficult. It is important to plan ahead rather than react to a crisis. Careful planning, foresight, knowledge, and patience are needed to safe proof your home but you will be happy that you have made the effort. Take care of the most dangerous things first, and then tackle the others. It takes time and money to work through these things. As I always say, when entering the water- one toe at a time!

carole_larkin_pic_jpegBy Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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