Caring Currents

3 Off-Road Warning Signs About Older Drivers With Memory Loss

Last updated: Feb 10, 2009

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The day I feared for years has come: My firstborn just got his learner's permit. The creature who once depended on me to live now has my life in his hands, in the car at least. Which is scarier: Having a teenage driver with his not-quite-finished brain, or a parent who's still driving despite signs of a deteriorating brain?

Having experienced both, I'd say the aging adult with memory loss. A teenager grows more mature (cross fingers), but Alzheimer's disease or another form of progressive dementia will only worsen.

Deciding whether to intervene is hardest in cases of increasing memory loss or early Alzheimer's. There are some great lists of warning signs of driving problems (tailgating, tension, neglecting to buckle up). Here are three more considerations that new research and my new teen driver got me thinking about:

1. Off-road behavior

My son started training relatively late (no license til 17, though around here 14-year-olds can start driver's ed) because, among other things, he couldn't be counted on to remember his bike helmet every time he rode. Likewise, observations of an older relative's behavior when she's not behind the wheel can give pretty good clues about how much you should worry about her on the road, research shows.

Today's issue of Neurology, for example, reports that tests measuring thinking, movement, and visual skills that are done when a person with Alzheimer's Disease isn't on the road can help determine whether he or she can still safely drive. University of Iowa researchers found that drivers who have Alzheimer's make 27 percent more safety mistakes than drivers without the disease. But drivers with Alzheimer's who scored best on off-road assessments made the fewest on-road errors.

Upshot: Trust your gut. If you're concerned about a relative's growing inability to manage everyday activities (cooking, remembering where the keys are), that's a sign you're right to worry about something as old-hat as driving, too. There's no standard driving assessment yet (although plenty of federal and private interest in it). Many community senior-services centers, memory disorder clinics, and occupational therapists offer them and they can help guide the driving decision.

2. Crash history

If your teenager's friend has a wreck, wouldn't you be less likely to allow your child to ride with him, even if the friend insisted he was "just going to the store and back" and would "be more careful"?

Last week a study in Journals of Gerontology confirmed that older drivers who have had accidents or are aware of their declining ability do tend to drive less over the next five years – but those who keep driving, even rarely, are nevertheless twice as likely to have subsequent at-fault crashes. And people with significant cognitive impairment are least likely to quit, probably because they lack the self awareness to see there's a problem.

Upshot: Especially when it comes to Alzheimer's and dementia, the persons with dementia aren't the best judge of their fitness to drive; they (and everybody else on the road) depend on someone to step in.

3. Altered states

Parents worry about teenagers driving under the influence of alcohol or while high. Meanwhile there's relatively little fuss made about the millions of older drivers who are taking drugs for chronic conditions. Many, many of these -- including the most common Alzheimer's meds, Aricept and Namenda -- urge using caution when driving. "Caution" doesn't mean "don't." But safety experts say drugged older drivers is a growing problem not yet being sufficiently studied.

Upshot: The more meds your relative is taking that warn about driving, the less the person ought to drive. Silver lining: Starting a new med could be the wedge issue to get a doctor to advise a patient with iffy driving skills to give up the keys.

At least most of older adults aren't texting while they drive. Yet.