Physical appearance contributes to everyone's sense of self-esteem. Dressing ourselves is a very personal and private experience, and a statement of our independence from the time we are very young.

Driving is a complex activity that necessitates quick reactions, clear sensory abilities, and split-second decisions. However, a diagnosis of Alzheimer's disease is not, on its own, a sufficient reason to withdraw driving privileges. The determining factor in withdrawing driving privileges should be an individual's driving ability. When the individual poses a serious risk to self or others, driving privileges must be withheld.

Giving up driving can mean coming face to face with one's increasing limitations. Considering the person's feelings of loss of independence can aid families in their actions to help the person understand why he can no longer drive safely. Be firm and positive about not driving, and avoid arguing with the person or giving long explanations about why he/she cannot drive. Spend your time and energy helping to preserve the person's dignity by focusing on the activities he or she can still do and enjoy.

Below are several different approaches you can use to deal with the problem.

If necessary, control access to the car keys, park the car on another block or in a neighbor's driveway, so it is out of view, disable the car by removing the distributor cap or battery. You may have to confiscate the person's driver's license and replace it with a photo identification card.

If the spouse or caregiver does not drive, consider selling the car. You may find that you save enough on insurance premiums, gas, oil and maintenance costs to pay for public transportation, taxicabs or to hire someone else to do the driving.

• Discuss the problem frankly with the individual . You might say, "I am concerned about your safety and the safety of other people on the road."
• Look for ways that the person can save face . You might say, "We are taking a new route," "the weather conditions make the car difficult to drive," "It is your turn to enjoy the scenery," or "I want to let you rest today."
• Enlist help from others to talk with the person about not driving. You might ask your doctor to write a prescription that says, "No Driving", ask a respected family authority figure or your attorney to reinforce the message about not driving, or have the insurance company tell the individual that insurance will no longer be provided for someone with their medical condition.

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Adopted October 2001

• A diagnosis of Alzheimer's disease is not, on its own, a sufficient reason to withdraw driving privileges. The determining factor in withdrawing driving privileges should be an individual's driving ability. When the individual poses a serious risk to self or others, driving privileges must be withheld.

• If there is concern that an individual with Alzheimer's disease has impaired driving ability, and the person would like to continue driving, a formal assessment of driving skills should be administered. One type of assessment is an on-the-road driving evaluation by trained personnel. Such an assessment should lead to specific recommendations, consistent with state laws and regulations, as to whether the individual is able to drive and with what restrictions (if any).

• Physicians and other health professionals, public safety officials and state regulatory agencies are encouraged to address the issue of driving safety with individuals with Alzheimer's disease and their families. When appropriate, those individuals should be encouraged to participate in decisions about driving restrictions and cessation. Physicians and families must decide in the best interests of the individual whose decision-making capacity is impaired.

• Further research is needed to identify optimal methods for physicians and licensing bureaus to identify impaired drivers and, when necessary, to withdraw driving privileges in a manner that preserves the dignity of the individual with Alzheimer's disease. Specifically, these efforts should lead to: a clarification of the role of state regulatory agencies; a simple, reliable test to predict driving safety at various stages of dementia; and affordable accessible transportation options for individuals who no longer drive.

Sources: Alzheimer's disease and Related Disorder Association, Inc.; the National Capital Area Chapter of the Alzheimer's Association; (1) Lucas-Blaustein, J.J. et al. Journal of American Geriatrics 36: 1087-1091, 1988; (2) Friedland, R.P. et al. Annals of Neurology 24: 782-786, 1988.

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