Tuesday, September 15, 2009
Losing freedom to drive can be trying
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to firstname.lastname@example.org with “Age Matters” in the subject line.
Dear Dr. Camardi,
It has been a flat-out living hell in this house since they took away my husband's keys.
We saw it coming because the doctors say he's got dementia and he keeps getting lost all over the place, even in the house, and people in the neighborhood were saying that he didn't stop for the stop signs anymore. My daughter and her husband hid the keys from him and then took his license out of his wallet.
He was OK when we first told him and that we'd take him wherever he wants to go, but he keeps forgetting he doesn't have his keys anymore and he gets angry as all can be when he can't find his keys.
Then we tell him he can't drive anymore and he gets so mad I have to give him a pill. I don't know anymore.
May I say at the outset that I commend you and your family for doing what had to be done. Understand that there is no easy way to navigate these waters and there is no "purely right" way.
The balance between the safety of others and the respect for an individual's desire for his or her freedom and independence that driving represents can be difficult and emotionally trying to their loved ones.
It takes no small amount of courage to face the fury I know these patients can project when their freedom to drive is taken away. Allow me to give you an overview of the problem so as to help you in your decision.
From what you have written, to return your husband to the road would be a grave mistake, especially if you have observed the following patterns of behavior:
He has become less coordinated and is losing control of his muscular function, for example, shaking or tremors in his hands.
He has difficulty judging distance and space, for example, in going down stairs.
He gets lost or feels disoriented in familiar places, for example, in going between different floors of the house or even coming in from the back yard.
He has difficulty multi-tasking.
He has increased memory loss, especially for recent events such as where or why he is going somewhere.
He is less alert to things happening around him such as not responding correctly or quickly enough to audio or visual clues such as a car horn, blinking lights or verbal warnings.
He has frequent mood swings, confusion of person, task or place.
In observing these warning signs, realize that these can be translated to the following difficulties behind the wheel:
Drives too slowly or stays at a slow constant rate of speed no matter the driving situation.
Stops in traffic for no reason or ignores traffic signs.
Becomes lost in routine driving situations.
Has difficulty with turns, lane changes or highway exits.
Drifts into other lanes of traffic or drives on the wrong side of the street.
Signals incorrectly or does not signal.
Has difficult seeing pedestrians, objects or other vehicles.
Falls asleep while driving or gets drowsy.
Gets frequently ticketed for traffic violations and/or accidents, near misses, or "fender benders."
Is increasingly nervous or irritated behind the wheel, demonstrating a lack of confidence.
With the picture presented above, withdrawing or limiting driving privileges is an appropriate public safety precaution.
Most individuals are already aware of the troubles they are having with driving and express relief that others are taking an interest in stopping their driving or at least limiting it by doing the following:
Drive only on well-known roads and not for long distances.
Avoid periods of the day known for heavy traffic.
Avoid driving after dusk and in bad weather.
Many people, however, will find the loss of driving privileges and the inherent loss of independence very upsetting. Including the patient on the discussion early in the process is important, as is offering alternative modes of transport to avoid the feeling of "being stuck in the house all the time."
Also, getting an independent driving evaluation by the DMV (if, and in some cases, when it becomes available) can be invaluable.
Dealing with dementia
All this said, it now becomes a circumstance where you can use the nature of dementia to help you.
For now, try not to be confrontational with your husband. Trying to refocus the demented patient to reality, while attractive in theory, is inconsistent in result and usually leads to many uncomfortable scenarios. Comply indirectly with his wishes and at the same time divert his attention to anything he likes.
For example, when he says he's going out and wants his keys, give him a set of old keys and at the same time divert his attention to something else he likes, such as a pet, TV show or any other activity he may feel comfortable with.
Deny his demand and anger will result, and he'll fixate on his frustration and it will be very difficult to divert him.
By the way, trying to medicate an angry demented patient has resulted in some unfortunate accidents for both caregivers and patients, so always look for the indirect approach in these matters. It calls for a some forethought and a little training, but it is far better for all concerned to take a proactive approach.
In teaching young doctors, I try, by role-reversal techniques, to put them in the shoes of the patient. It is fascinating to observe their reactions when faced with the frustrations and difficulties of living with dementia, but I think it opens a new channel of sensitivity they might not otherwise have.
By this I mean that we need to consider the personality traits and the fluctuating abilities of the person with dementia when making decisions over the course of this chronic disease.
Each family member must learn strategies that will work within situations as they arise. It is extremely challenging, but for those who have done it, learning this situational flexibility of response has given them a means of coping with this terrible disease.
Nothing good ever comes easy.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging. His columns run on the third Tuesday of each month in Extra.
If you have questions for Dr. Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014 or e-mail them to email@example.com with "Age Matters" in the subject line.