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Hanging Up the Keys

Hanging Up the Keys
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Spring 2021
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When driving becomes dangerous, difficult conversations are a must

Mike Belleville knew something was wrong as soon as he pulled into the driveway. “I looked up, and it wasn’t my house. I had pulled into someone else’s driveway,” he says.

Mike, a telecommunications technician, had been experiencing problems at work. In situations when the Bellingham, Massachusetts, native would have easily handled a request in the past, he now struggled. The growing stress and anxiety he felt while driving were also signs that something was wrong.

Mike Belleville, who is living with dementia, says giving up driving is the hardest thing he's ever had to do.“I would get lost, and one time, I had to call my wife because I didn’t know where I was,” he says. “The multitasking it takes to drive began to take a lot out of me.” Mike started to become frustrated behind the wheel and would yell at other drivers.

In 2013, at age 52, Mike was diagnosed with younger-onset Alzheimer’s, which was later changed to a diagnosis of dementia with Lewy bodies. When the topic of driving came up, Mike’s doctor recommended he stop for safety reasons. “To this day, it’s the hardest thing that I’ve ever had to do — to give up that independence and rely on others to get around,” he says.

The decision to give up driving — or to ask another person to give it up — is never easy. For many, driving equals independence and self-reliance. But research shows that even slight changes in the brain can greatly impair a person’s ability to drive safely.
 

The science behind the wheel

To better understand the connection between Alzheimer’s and driving, researchers Ganesh Babulal, Ph.D., OTD, and Catherine Roe, Ph.D., from the Washington University School of Medicine in St. Louis studied the habits and performance of cognitively unimpaired older adults.

Participants took multiple controlled road tests over time, which revealed changes in driving performance that were otherwise undetectable.

“Older adults with preclinical Alzheimer’s disease — an early stage when biological markers are present without any apparent symptoms — made more errors and were much faster to fail the road test,” Babulal says.

The researchers then installed GPS data loggers in participants’ personal vehicles to observe their daily behavior over the course of several years.

“We found that individuals with preclinical Alzheimer’s disease self-regulated their behavior by driving less frequently, logging fewer miles and showing less-aggressive driving behaviors over time,” Babulal says.

The findings suggest that changes in driving habits may be an early indicator of cognitive impairment, even before other signs like memory and thinking difficulties are noticeable or measurable. The research team is using this data to develop an assessment tool to help older adults and their physicians know when driving needs to be scaled back.
 

When driving is unsafe

While the signs vary from person to person, there are some telltale changes in ability that indicate driving is unsafe. 

“Look for a pattern of changes from their baseline traffic behavior,” says David Carr, M.D., a geriatrician and professor of medicine and neurology at the Washington University School of Medicine in St. Louis. “I usually ask family members and patients if they’ve had an at-fault crash, a moving violation or are showing reckless behavior in traffic. However, some individuals living with dementia drive too slowly — they just can’t keep up and it can be a hazard.”

Driving and dementia

We have additional resources for having the tough conversation, planning ahead and striking the balance between independence and safety.

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Other signs include forgetting how to find familiar destinations, inappropriate emotional responses such as road rage, and an inability to follow basic safety maneuvers, like merging into traffic.

“Approximately half of my patients decide to stop driving on their own,” Dr. Carr says. “But if any of these signs arise, it’s time to have a conversation.”
 

Make a plan

Driving is a sensitive subject. If possible, plan ahead and discuss how retirement from driving will be handled before it becomes a safety issue. Appealing to the individual’s sense of responsibility is a good place to start.

“Let them know they are at risk of hurting themselves or someone else on the road,” Dr. Carr says. “Be honest about how their driving makes you feel unsafe.”

When it is time to have the conversation, a physician can help.

Research shows that even slight changes in the brain can greatly impair a person’s ability to drive safely.“I’ll write a prescription or a letter stating that the person living with Alzheimer’s must not drive,” Dr. Carr says. “This can be used later to remind them of the decision.”

Ultimately, driving is about independence, so experts recommend empathy and understanding — and a willingness to work together to find solutions. For instance, offer to arrange a ride schedule with family and friends, or find local transportation programs that serve older adults. Identifying grocery and meal delivery services can also be useful.

One conversation may not be enough to reach an agreement. Continue to be patient and firm, and as a last resort consider disabling or selling the car.

Mike’s wife and son now take care of the driving, but he hopes that options for individuals living with dementia continue to grow, such as specialized ride-sharing services.

“I still want to live my life — I want to be as independent for as long as possible,” Mike says.
 

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