Dementia and driving: Humboldt County doctor is lead author on new guidelines [Times-Standard, Eureka, Calif.]

Apr. 18--A Eureka doctor authored some recently released guidelines intended to help caretakers and doctors determine when people with Alzheimer's disease or other forms of dementia should stop driving.

The American Academy of Neurology released the guidelines -- which say it may be safe for patients with mild dementia to keep driving -- earlier this week, prompting nationwide media interest.

Donald Iverson, a doctor with the Humboldt Neurological Medical Group in Eureka, was the lead author on the guidelines and said it is a topic that needs to be approached with sensitivity.

Iverson said balancing a patient's will to drive while addressing their safety and the safety of others is a difficult process.

"That's the whole conundrum," he said, adding that losing the ability to drive can be associated with increased depression symptoms.

Iverson, who was appointed to the academy's quality standards subcommittee, reviewed 6,000 studies over a period of five years in order to write the guidelines. The guidelines are normally reviewed every three or four years.

The previous guidelines implied a general policy that patients with dementia should not drive, but Iverson said the new guidelines break down some higher risk factors and groups, allowing caretakers and clinicians to get more quantitative estimates.

"We acknowledge that it's an eventuality, but our recommendation is soften," he said.

According to the guidelines, evidence shows driving skills deteriorate with increasing dementia severity. While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive.

The guidelines also acknowledge that caregivers who feel a patient or family member's dementia interferes with their ability to drive safely are usually correct in their assessment.

Maggie Kraft, the assistant director of services at the Alzheimer's Day Care and Resource Center in Eureka, said the discussion about when to stop driving is an important one for people with dementia.

"It's very emotional, it's very charged and it's upsetting to people," she said. Within the center's early stage dementia support group, about half are still driving, she said.

She is hoping to drum up enough interest to hold an educational workshop on dementia and driving developed by The Hartford Financial Services Group. She said the insurance group has a lot of online resources for caretakers.

The materials look at issues related to dementia and why it's important to give up on driving, Kraft said.

Iverson said it's important to remember that doctors are required by law to report any illness that could affect a person's ability to drive, including Alzheimer's.

He said the guidelines aren't a simple checklist that can determine who can and can't drive, but a tool for doctors and caretakers.

"I hope it's helpful to people and their families," he said.

Kraft said for many patients, education about why they need to stop driving is a key issue, especially since some may feel it's the way they are told by their physicians that makes it difficult.

"I think doctors have trouble with taLking to people about Alzheimer's and additional trouble with talking to people about driving," Kraft said, adding that doctors often just don't have the time to have that kind of conversation.

She said she hopes doctors can rely on resources like the Alzheimer's Day Care and Resource Center for support.

"When they get diagnosed, send them to us and we'll start having those conversations," she said.

For more information about the Alzheimer's Day Care and Resource Center, call 443-9747.

Donna Tam can be reached at 441-0532 or [email protected].

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Warning signs from unsafe drivers with dementia:

Decreased miles being driven

Collisions

Moving violations

Avoiding certain driving situations, such as driving at night or in the rain

Aggressive or impulsive personality traits

Source: American Academy of Neurology

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Ways to start the driving discussion:

For people with dementia:

Confide in a friend or family member about what driving means to you

Work with your family to create a transportation plan that meets your needs

Consider a written agreement as a way to balance your independence and safety

For caregivers:

Allow a relative with dementia to express how he or she feels about not driving

Initiate conversations about driving and transportation needs early and often

Observe the driving of the person with mild dementia

Keep a written record of observed driving behavior over time

Share observations of unsafe driving with the person with dementia and other family members

Create opportunities for you or others to drive the person with dementia

Source: The Hartford Financial Services Group

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Online resources:

Alzheimer's Day Care and Resource Center -- www.humsenior.org/alz

The Hartford Financial Services Group's Web site on Alzheimer's Disease, Dementia and Driving -- www.thehartford.com/alzheimers

American Academy of Neurology -- www.aan.com/go/practice/guidelines

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