Doctors Advised To Tell Alzheimer’s Patients Not To Drive
Doctors should order Alzheimer’s patients to give up their car keys because victims can cause car crashes even in the early stages of the mind-robbing disease, the American Psychiatric Association recommended Wednesday.
Writing a prescription against driving - so relatives have something to use as leverage when patients forget - may help, the association advised. But in some cases, doctors may have to consider breaching patient confidentiality to report dangerous Alzheimer’s drivers to state authorities, say the association’s first guidelines on caring for the nation’s 4 million Alzheimer’s patients.
Also recommended: Large doses of vitamin E should be considered on top of patients’ regular medication. A recent study found vitamin E modestly slowed the loss of patients’ ability to bathe, dress and do other tasks. It did not aid memory, but two drugs, Cognex and Aricept, do mildly help some patients’ mental capacity.
When and how to get patients out of the driver’s seat, however, topped the guidelines because it is one of doctors’ biggest quandaries.
“Everyone agrees that this is a problem. Where there’s not yet agreement is on what should be done,” said Dr. Peter Rabins of Johns Hopkins University Hospital, who co-authored the guidelines and continually struggles with his own patients’ driving.
Early-stage patients deny they have a problem and refuse to quit, he said. Moderately ill patients forget his advice and lash out when relatives intervene to take their car keys.
Nobody knows how many Americans with Alzheimer’s cause car crashes, Rabins said. But a recent Scandinavian study published in the British medical journal The Lancet examined the brains of elderly car-crash victims and found a third showed clear evidence of early Alzheimer’s.
California requires that doctors report Alzheimer’s patients so state driving officials can determine when to revoke a license, the Alzheimer’s Association said.
“It is a good idea for physicians at the correct time to consider directing people to stop driving. The question is when,” said Thomas Kirk of the Alzheimer’s Association. “This is a very tough, sticky ethical issue,” and the association doesn’t want to discourage early diagnosis of Alzheimer’s “by saying they’re going to lose driving privileges,” he explained.
The moderately impaired - who can’t cook or perform simple household chores - “pose an unacceptable risk and should not drive,” the psychiatrists’ guidelines say.
Milder patients should be encouraged not to drive, and doctors should reassess driving ability at four- to six-month checkups.
Doctors should write a do-not-drive prescription for families to convince forgetful patients that an authority considers driving dangerous, and also should suggest hiding car keys or even removing ignition wires, the guidelines said.
On rare occasions when families can’t or won’t stop patients from driving, doctors may have to breach patient confidentiality to turn in a dangerous driver, the guidelines warned.
The guidelines also advise doctors that:
Offering families information and emotional support helps them care longer for patients at home.
Art, pet or recreational therapy can improve patients’ mood.
Certain psychological treatments to minimize problem behaviors or change environmental risks may help, but cognitive therapies like skills training can merely frustrate patients.