By JUDD MATSUNAGA, Esq.
Here’s an interesting story. Years ago, a 90-year-old Japanese man from Montebello was driving down the 60 Freeway when his wife calls. “Daddy, please be careful. The news on TV said there’s a car driving the wrong way on the 60 through Montebello!” The husband replied, “Mommy, it’s not just one car, it’s dozens of them!!!”
Do you know that Japan requires that new drivers place a multi-colored marker on the front and back fenders of their car to tell others that there’s a beginner behind the wheel. But, because of the aging population, Japan also requires a similar symbol for older drivers because many seniors have trouble seeing or hearing. The patch is recommended for drivers over 70 and mandatory for those over 75. (Source: https://en.wikipedia.org/wiki/K%C5%8Dreisha_mark)
Good idea? You bet. When you drive, different regions of your brain cooperate to receive sensory data (through sight and hearing), prioritize information, recall related past experiences, anticipate likely scenarios, analyze options, plan ahead use proper judgment, synchronize movement responses, and juggle more than one task at a time. And, because of the nature of driving, each of these required tasks needs to be accomplished with adequate speed.
Not so in America. America is all about the rights of the individual, i.e., “It shouldn’t be a question of age, it’s about the ability of the driver.” Every individual with dementia may present a different pattern of difficulties based on the specific areas of brain damage — one or more of these functions may be impaired. It’s the specific profile of these difficulties that can pose a driving risk for some individuals in the early stages of dementia.
Since the Rafu Shimpo community is getting up in age (even the Sansei!!!), I found the following helpful information from a safe driving guide from The Hartford Center for Mature Market Excellence and the MIT AgeLab. According to the guide, more than 5 million people in the U.S. suffer from dementia, with Alzheimer’s disease being the most common form. And this number is expected to grow as the population ages.
If you have a loved one diagnosed with dementia, it’s difficult to decide when someone with dementia should stop driving, since you need to balance safety considerations with the person’s sense of independence, pride and control. The challenge with driving and dementia is to preserve a person’s sense of independence for as long as possible, while simultaneously protecting the safety of that person and others.
Many times, family members will allow a person with dementia to continue driving even though they believe it’s unsafe. They might not want to hurt that person’s feelings, or they may worry about what others might think. Some want more support from family, friends or professionals before intervening, and others want to delay taking on the responsibility of providing transportation.
At the other extreme, some family members overreact to common driving errors such as failure to complete a stop at a stop sign. They may blame such errors on the disease, when, in fact, the person may have always had this bad driving habit. A single occurrence of poor driving doesn’t mean the person has to stop driving. But it does signal the need for increased monitoring and assessment.
For most people, driving represents freedom and control. It’s a way to access healthcare, to buy necessities, to be productive and to stay connected to family, friends and the community. Giving up driving can be a deeply personal and emotional issue.
“Our children talked to him about possibly not driving. They don’t know it, but he cried that night. Driving is extremely important to him. I don’t want to strip him of his dignity.” – Wife whose husband has mild dementia.
As we age, even those of us without dementia may experience physical changes that affect driving – including eyesight problems and slower reaction times. In response, most people will modify the way they drive by avoiding driving on certain roads or at night. They usually can assess and regulate their driving without family intervention and can continue to drive safely throughout their lives.
But it’s different for those with Alzheimer’s disease or other dementias – particularly because the condition can be gradual and unpredictable. Drivers with dementia often modify their driving by driving less at night or in unfamiliar areas, but as their abilities diminish, they lose the capacity to determine when they should stop driving. They’re likely to minimize the complexity of driving and overestimate their abilities.
“My sons and daughters had a meeting without me and decided that they want me to stop driving, but they’re making a big deal out of nothing. I’m very comfortable on the road. I’ve driven longer than they’ve been alive.” — Person recently diagnosed with dementia.
They may lose the ability to be aware of their own neurological and thinking problems. They may make excuses or blame others for their high-risk driving behaviors and may say things like:
• “Just because I got lost doesn’t mean I can’t drive.”
• “I make sure I look where I’m going.”
• “I’ve driven many, many years and haven’t had an accident yet.”
Do you have a relative with dementia who’s still driving? Do you worry about him or her driving? Or are you just hoping his or her driving is “good enough?” Driving, of course, can be an immediate and life-threatening issue – making it a family priority. Most information about dementia warns against driving but doesn’t help you determine when it should stop. According to AARP, here are a few warning signs of unsafe driving:
● Delayed response to unexpected situations
● Becoming easily distracted while driving
● Decrease in confidence while driving
● Having difficulty moving into or maintaining the correct lane of traffic
● Hitting curbs when making right turns or backing up
● Getting scrapes or dents on car, garage or mailbox
● Having frequent close calls
● Driving too fast or too slow for road conditions
If you’ve noticed that your loved one shows some of these warning signs, it means it is time to talk with them. But how are you supposed to sensitively broach the topic of stopping or limiting driving and have a productive conversation? First, it’s important to remember that limiting or stopping driving is a complex and emotionally charged discussion.
So the Hartford Center guide included a section titled “Sound Advice from Experiened Caregivers” that I thought would be helpful: Caregivers who have wrestled with driving and transportation issues were asked: “If you could do it over, what would you do differently?” and “What advice would you give others who are in similar situations?” They revealed four basic principles that can help you and your loved ones manage these decisions.
1. There is no easy answer, no right way. You need to consider the personality and the abilities of the person with dementia when making decisions throughout the course of the disease. You must take into account the roles and relationships within the family that affect decisions and their outcomes. Each family must select strategies that will work within its unique situation.
2. Begin discussions and planning early and involve the person with dementia. Ideally, a person with dementia should make the transition from driver to passenger over a period of time. The Agreement with My Family about Driving can serve as the starting point for meaningful discussions about driving. Open, early and continual communication can help the person with dementia and the family to agree on a course of action before a crisis occurs.
3. Base decisions on driving behavior observed over a period of time. Regular monitoring and assessment of driving can help caregivers respond appropriately. A diagnosis alone may not be sufficient reason for a person to stop driving, but when it’s clearly no longer safe for the person to drive, caregivers must take the necessary steps immediately. In hindsight, many caregivers regret permitting a loved one to drive longer than it was safe.
4. Get support when making and implementing decisions about driving. It’s not healthy for anyone when one person shoulders all of the responsibility for the decisions about driving and dementia. Caregivers can make reasonable requests of both family and non-family members and should turn to others for help in meeting the emotional, social and transportation needs of the person with dementia.
In conclusion, people diagnosed with dementia rightfully want to drive for as long as it is safe. Family members must constantly weigh the need to respect a person’s desire to drive with the need for safety. Doctors, occupational therapists, lawyers, care managers, financial planners and local Alzheimer’s support groups can provide information and perspective to reinforce the family’s efforts – helping to ensure that the person with dementia gets the best support.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.