Ask the Expert

Question:
As a social worker and facilitator of an Alzheimer’s disease (AD) support group, I have seen many families (including mine with regard to my mother) in denial when their loved ones have been diagnosed with AD or dementia. In addition to denial in such cases, another important issue that troubles family members is their concern regarding the older adult’s driving. When an older adult gets lost and/or experiences impairment in decision-making processes, who should tell an elder that the individual may no longer drive? Should families rely on the elder’s physician?

Sandra L. Marsch, MSW
Drums, PA

Response:
Informing any older adult that he or she should stop driving presents a potentially delicate situation. The family—spouse, children, or other—is in a very risky position and can expect unfavorable reactions from a loved one that can vary from resistance and resentment to intense anger or even hostile responses. This is especially true when, as with your clients, cognitive impairment is present.

The physician is the ideal choice in most cases. This is especially effective and well received when the individual has an established and trusted relationship with the physician. In cases where there is not such a close physician-patient rapport, a pastor, rabbi, or other spiritual adviser can provide similar caring and authoritative communication of this important advice.

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In the absence of any such professional with a close relationship to the client, the primary physician may still be preferred since so many elders hold deferential respect for the role of the doctor and the medical profession, making this information and counsel more positive and likely to be accepted.

No matter who ultimately is designated to advise the individual about driving cessation, great sensitivity and tact are essential to this communication. Persuading the disabled elder driver to give up the independence of personal transportation is among the most challenging and common circumstances in clinical geriatrics. The situation is potentially problematic for the cognitively impaired older adult who, by nature, can be resistant to unwanted advice and is unable to reason through the most persuasive counseling. In my experience, when the need to stop driving rests solely on loss of safe physical performance, the elder usually has begun to recognize the emerging limitations and is more receptive to caring counsel about giving up the car.

In either case, the advice must be firm enough to avoid the suggestion of less restrictive options. The personal and public health consequences are too important to leave this to the individual’s choice for any significant period of time.

— Larry D. Wright, MD, is an assistant professor in the Donald W. Reynolds department of geriatrics at the University of Arkansas for Medical Sciences in Little Rock.