3 November 2007. The scenario is all too common: a person with dementia can no longer drive safely, yet family members are reluctant to take away the keys. The reasons are understandable—driving represents independence, and no one wants to act prematurely to diminish the autonomy and dignity of his or her loved one. Merely bringing up this highly sensitive subject can be difficult.
As a result, drivers with dementia are staying on the road too long. According to a study from researchers at the MIT AgeLab, Boston University, and The Hartford Financial Services Group, Inc., people with Alzheimer disease continued to drive for an average of 10 months longer than their caregivers felt was safe.
To address this problem, the three groups worked together to develop an educational program for caregivers that will help family members decide when their loved ones should limit or give up driving. The program consists of three 2-hour educational sessions, to be conducted by support group leaders. The course is designed to educate caregivers to evaluate driving ability and to help them take action.
“The diagnosis of dementia does not mean a person needs to immediately stop driving. Eventually, however, all people with dementia will lose the skills necessary to drive safely,” said Robert Stern of Boston University School of Medicine's Alzheimer's Disease Center, where the program was clinically evaluated. Unfortunately, Stern said, there is no simple way to determine when someone with mild dementia is unfit to drive, and this makes the decision of when to give up driving a major issue for patients and caregivers in the early stages of the disease.
Joseph Coughlin, who heads the MIT AgeLab, added, “The decision to take away the keys has been owned by family members, but they have been largely unequipped and lacking in knowledge of how to proceed. We have developed this tool to provide a process to come to a safe resolution of this issue. Our goal is to give caregivers the support they need to help their loved ones make the transition from driver to passenger.”
The researchers introduced the materials at a symposium held November 1 at MIT, where co-developer Lisa D’Ambrosio of the AgeLab presented the results of a just-completed study of the effectiveness of the intervention. The study enrolled 80 caregivers who received the entire course, an informational booklet but no additional training, or no information. In extensive before and after interviews, D’Ambrosio and colleagues found that the people who participated in the educational sessions felt better prepared to handle driving-related issues, were more likely to have made a plan to deal with their loved one’s driving, and were more likely to have talked with their relative about the issue. In addition, the caregivers reported less stress and better coping around the driving issue.
Support group leaders or other caregiver supporters can order the free kit online at www.thehartford.com/alzheimers. The material, entitled At the Crossroads: The Support Group Kit on Alzheimer’s Disease, Dementia and Driving, will also be distributed by regional chapters of the Alzheimer’s Association and the American Occupational Therapy Association.—Pat McCaffrey.