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Deciding when an older adult is no longer fit to drive is a challenging issue with no clear answer. When it comes to dementia, the decision can be especially tricky. A recent study in the journal Neurology found that as many as 76 percent of people with mild dementia are still able to pass an on-road test and drive appropriately. Yet virtually all dementia sufferers will have to stop driving eventually, as the disease worsens and memory, spatial orientation, and cognitive function decrease over time. Earlier this year, the American Academy of Neurology released new guidelines to help determine when people with Alzheimer’s disease or other forms of dementia should stop driving.
Caregivers are frequently the first line of defense when it comes to reporting unsafe driving in a person with dementia, and doctors should listen to what they have to say, according to the American Academy of Neurology’s report. “Caregivers are often proven correct when they report dangerous driving,” says Peter Rabins, M.D., M.P.H., director of the division of geriatric psychiatry at Johns Hopkins and a Health After 50 board member. “They are more likely than the patient to give a realistic assessment of the patient’s driving abilities.”
But the most reliable measure of a dementia sufferer’s driving ability is a driving test. If a doctor has doubts about a patient’s fitness to drive, he or she may refer the patient for an on-road driving test, according to Dr. Rabins. Some states actually mandate behind-the-wheel road tests by the Department of Motor Vehicles for older drivers to renew their licenses, while other states allow occupational therapists trained to assess driving ability to evaluate patients. States also differ in physician requirements for reporting a driver who is too impaired by dementia to drive.
Often, enforcing a decision that a person with dementia is unfit to drive comes down to the patient’s family or caregiver. Dementia patients may forget they were told not to drive or not agree with the assessment that they are unfit to drive. It’s a very difficult topic to approach, but beginning discussions about driving with the person early on, reducing the need to drive, and arranging alternative transportation can help make for a smoother transition to life after driving.
How can you tell if a driver with dementia may no longer have the skills needed behind the wheel? If someone shows one or more of the signs below, it’s time to have a serious conversation with the driver and his or her doctor:
• Stops in traffic for no reason or ignores traffic signs
• Fails to signal or signals inappropriately
• Drifts into other lanes of traffic or drives on the wrong side of the street
• Becomes lost on a familiar route
• Parks inappropriately
• Has difficulty seeing pedestrians or other vehicles
• Has difficulty making turns or changing lanes
• Gets drowsy or falls asleep while driving
• Lacks good judgment
• Has minor accidents or near misses
If you’re depressed, you may not want to do anything or see anybody. But isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel.
Some ways to combat and prevent depression include:
- Getting out in to the world – Try not to stay cooped up at home all day. Go to the park, take a trip to the hairdresser, or have lunch with a friend.
- Connecting to others – Limit the time you’re alone. If you can’t get out to socialize, invite loved ones to visit you, or keep in touch over the phone or email.
- Participating in activities you enjoy – Pursue whatever hobbies or pastimes bring or used to bring you joy.
- Volunteering your time – Helping others is one of the best ways to feel better about yourself and regain perspective.
- Taking care of a pet – Get a pet to keep you company.
- Learning a new skill – Pick something that you’ve always wanted to learn, or that sparks your imagination and creativity.
- Enjoying jokes and stories – Laughter provides a mood boost, so swap humurous stories and jokes with your loved ones, watch a comedy, or read a funny book.
- Maintaining a healthy diet – Avoid eating too much sugar and junk food. Choose healthy foods that provide nourishment and energy, and take a daily multivitamin.
- Exercising – Even if you’re ill, frail, or disabled, there are many safe exercises you can do to build your strength and boost your mood—even from a chair or wheelchair.
The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult. Some seniors don’t believe depression is a real illness. Others are too proud or ashamed to ask for assistance, for fear of becoming a burden to their families. With such roadblocks, assistance from others can mean the difference between suffering and recovery.
If a senior citizen you care about is depressed, you can make a difference by offering emotional support. Listen to your loved one with patience and compassion. Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that your friend or family member gets and accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.
Other tips for helping a depressed elderly friend or relative:
- Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, an art class, a trip to the museum or the movies—anything that provides mental or physical stimulation.
- Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others.
- Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.
- Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies.
- Make sure all medications are taken as instructed. Remind the person to obey doctor’s orders about the use of alcohol while on medication. Help them remember when to take their dose.
- Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.
Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression red flags include:
- Sadness
- Fatigue
- Abandoning or losing interest in hobbies or other pleasurable pastimes
- Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
- Weight loss; loss of appetite
- Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
- Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
- Increased use of alcohol or other drugs
- Fixation on death; suicidal thoughts or attempts
Depression without sadness occurs occasionally with the elderly. Older adults don’t always fit the typical picture of depression. Many depressed seniors don’t claim to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or headaches that have gotten worse, are often the predominant symptom of depression in the elderly.
Older adults with depression are also more likely to show symptoms of anxiety or irritability. They may constantly wring their hands, pace around the room, or fret obsessively about money, their health, or the state of the world.
Many elderly adults face significant life changes and stressors that put them at risk for depression. Those at the highest risk include older adults with a personal or family history of depression, failing health, substance abuse problems, or inadequate social support.
Causes and risk factors that contribute to depression in the elderly include:
- Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
- Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
- Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
- Medications – Many prescription medications can trigger or exacerbate depression.
- Fears – Fear of death or dying; anxiety over financial problems or health issues.
- Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.
You may at some time receive a call that one of your parents has just been diagnosed with an illness or condition that will permanently change their lifestyle. Someone may have to step up to the plate, accepting some of the former responsibilities of the parent with declining health.
Take time to learn about the illness. Consult with your own physician or your parent’s attending physician. It is important to learn about the illness and its stages. Reality can be painful, but it helps to prepare in order to prevent misunderstanding.
There may be a support group for this illness meeting in your community. It is so helpful to have the support of others who are in similar circumstances. Remain connected to friends and family for the needed emotional support.
Parents may require special assistance in their own houses such as hand rails in the bathroom or steps leaving the home. Geriatric social workers may be able to offer suggestions regarding what is need in the future as well as immediate needs.
The illness may require your parents to consider living with you or in an assisted living facility. Assisted living may allow your parents to experience some level of independence rather than prematurely turning to nursing homes.
As we age, we deal with biological, environmental, and status changes which can leave us feeling more vulnerable. Instead of focusing on what people can not do, acknowledge the abilities that remain, and in many cases, the wisdom that only comes with longevity and the survival of many life phases.
Outside of the typical guidelines of treating people with courtesy, there can be considerations in talking to others as their abilities change. The following suggestions are adapted from Success with Seniors (Koonin and Stone):
à Do not infer one deficit from another (trouble seeing=trouble hearing).
à Being old does not mean being impaired.
à Problems of memory retrieval are normal effects of aging. Concentrate on the positive.
à Do not hurry older persons – anxiety causes worse problems.
à Speak directly to the person. Make sure he or she can see your face.
à Double check the quality of the lighting.
à Touch becomes as important as sight and hearing.
à Reminiscences are used to rework the past, to prepare for what is ending, and to orient for what is coming.
à Many elderly are not afraid of death but of the withdrawal of those around them. They need to matter until they die. Allow them to talk about death if they wish.
Sharing the account of one’s life is an important part of this final stage whose primary task is to reflect on living and accomplishments and to resolve “unfinished business”. It is very important to listen to one who is recounting his or her life story. Cherish the story and the teller, before there is silence.
Christian Counseling Center 