Rush Manual 4. Safety Concerns
TIPS FOR TRAVELING
___
When traveling, try to
follow the routine that is
followed at home. And
be sure to allow plenty
of time for everything.
___
Traveling long distances with a person in the early stage of
dementia may still be quite enjoyable. As dementia advances,
however, traveling may become unpredictable as the person
becomes more confused. Plan ahead for a trip by gathering
important documents: insurance cards, passports, your
physician's phone number, refills on medications and a copy of
medical records in case the person with dementia needs to see a
physician while away. It might be a good idea to pack these items
in carry-on bags so they will not get lost en route. Remember to
bring sufficient resources in case you must change your plans
suddenly and return home. Also, you may want to bring along a
brief letter from your physician to the airline or hotel to expedite
a change in plans.
When traveling, try to follow the routine that is followed at
home if possible. And be sure to allow plenty of time for each
activity. Plan for rest periods throughout the day. For example, if
you're taking a tour by bus, you may want to remain in the bus
on occasion so the person can take a nap instead of visiting all
the sights.
The person who is at risk of wandering may also do so in an
unfamiliar place. Make sure the person wears an identity bracelet
or necklace, provided by "The Safe Return" program through the
Alzheimer's Association. Put a card with the name and address
of the hotel where you are staying in the person's pocket. In
addition, you may want to carry a recent photo of the person in
case they get lost.
Traveling may also make the person more anxious, thus
bringing along an anti-anxiety medicine may be necessary. You
might want to pack items the person enjoys looking at or hold-
ing to provide comfort and reduce nervous energy. Toileting is an
issue that requires some forethought when you are traveling. If
you are driving, stop at rest-area toilets every couple of hours.
Make sure a full change of clothing is readily available. In hotel
rooms, be sure to keep the path to the toilet well-lighted and
leave the bathroom light on at night.
A few more travel tips to keep in mind: If you are traveling
by car, never leave the person with dementia alone in the car.
Try to bring along a relative or friend to share in the driving.
And if you are traveling by plane, you may want to notify the
airline ahead of time, so you can ask for any assistance.
THE DANGERS OF DRIVING
___
A person with dementia
may appear to be driving
safely but may have lost
the ability to respond
appropriately or react
quickly enough to an
unexpected problem
on the road.
___
Does the person you are caring for have problems driving a car?
This section addresses what caregivers can do when the person
with dementia should no longer be on the road. Driving a car
safely requires a complex set of skills and abilities. These include
good judgment, orientation, perception, memory, coordination,
alertness, and the ability to make quick decisions. Most of these
abilities are affected to some degree by dementia.
A person with dementia may appear to be driving safely but
may have lost the ability to respond appropriately or react
quickly enough to an unexpected problem on the road. For most
people, driving becomes routine and automatic. Even when
there are severe memory problems, people with dementia may be
able to follow their habitual way of driving. But if the person is
not able to change quickly from a habitual response to a new
response when the situation demands it, that person should not
be driving. To continue to do so may have grave consequences
for that person and the general public.
It is not always easy to know when driving should be termi-
nated. Drivers who have very mild cognitive problems may be
able to continue driving for a time with certain limitations.
These limitations may include driving only short distances from
home, not driving on expressways or during rush hours, not
driving at night or only driving with a companion.
The American Medical Association's guidelines on driving
state that "once the presence of dementia is established and it is
demonstrated that the person is at risk of making errors in judg-
ment likely to affect the ability to drive safely, an individual
should not drive again."
Most people with dementia voluntarily decide to stop
driving when they feel they are not as sharp as they used to be.
However, there are many people with dementia who are unaware
of their deficits and continue to drive beyond the point when
they are safe on the road. Family members need to monitor how
the person is doing when driving. They might watch for unac-
counted periods of time when the person is driving and might be
lost. They might check the car for unexplained bumps or dents.
Family members might try riding with the person to personally
assess how they are driving. Family members have the responsi-
bility to intervene if they feel the person is not able to make
good decisions behind the wheel.
How you can help the person to stop driving?
When the person's driving causes concern, try discussing this
with them if possible. In an understanding and helpful way, the
person should be made aware of the potential dangers of contin-
uing to drive. Alternatives should be suggested to help maintain
the person's independence and mobility. Some possibilities
include asking family or friends to drive or using a taxi service or
public transportation.
Sometimes a person will refuse to give up driving. If this
happens, here are some suggestions:
* Have the person's physician tell them to stop driving.
Physicians are usually willing to write the order "Do not
drive" on a prescription pad. This can be shown to the
person when a reminder is needed. A formal letter can also
be written.
* Arrange for a formal evaluation at a driver evaluation
program under the direction of an expert on driving perfor-
mance. The evaluation, which can cost from $125 to $500,
includes a "behind-the-wheel" test as well as other tests of
driving skills. A written report describes their driving perfor-
mance and a recommendation is made as to whether driving
should continue or discontinue. Such a report may persuade
a person to stop driving if they are deemed unsafe. Call a staff
member at the Rush Alzheimer's Disease Center at (312)
942-4463 for a list of driver evaluation programs in the local
area.
* Make the automobile unavailable to the person. This can be
accomplished in a number of ways. The car can be parked
some distance from the house, the car keys can be
conveniently "lost," or the car itself may be disabled by a
variety of means such as disconnecting the battery or remov-
ing the distributor cap. The latter is a simple procedure that
can be easily reversed when others need the car. Ask a
service station attendant to demonstrate how this can be
done.
Restricting or stopping driving may become an added
burden if the person's spouse does not drive. If this is the case,
the spouse may consider taking driving lessons. Also, people
with dementia who become too impaired to take public
transportation may qualify for special services provided for the
disabled. An application for these special transportation services
can be obtained from your local transit authority. In most areas,
disabled people are picked up in a van and may be escorted by
the caregiver. A nominal fee is charged for this service.
In Chicago, call (312) 521-1154 for information about
CTA Special Services. Transportation services are also available
in suburban Cook County for disabled seniors. For this informa-
tion, call the Suburban Area Agency on Aging, (708) 383-0258.
Local governments may also sponsor special transportation
services.
In some states, the department of motor vehicles may inves-
tigate and suspend a license if it receives written notice from a
physician that a person's medical condition prevents safe driving.
If an impaired person continues to drive in Illinois, the Medical
Review Board of the Department of Motor Vehicles in
Springfield should be notified by calling (217) 782-7246. The
person may be ordered for testing or their license may be revoked
outright.
If a person has been told by a physician not to drive and
continues to do so, the caregiver may be found negligent if that
person has an accident or injures someone. This could lead to
serious consequences. In many respects, you face a dilemma
when determining a person's ability to drive. Concern for depriv-
ing the person of independence needs to be weighed against the
potential risks of unsafe driving. Please consult your physician
when such decisions need to be made.
CREATING A SAFE HOME
___
If the person wanders, put
tape or a piece of fabric
across the door frame at
eye level to keep them
from wandering outdoors.
Install safety gates at the
tops of stairways so the
person won't fall down
the stairs.
Secure all doors and
windows; special locks
may be necessary.
___
The environments in which we live or our everyday surroundings
are made up of a rich variety of things we see, hear, smell, taste
and touch. Though many of us may not pay much attention to
our surroundings, we can usually identify things that we find
uncomfortable or distressing and take action to correct any situa-
tions that cause us discomfort. To block out a noisy street, we
can shut the window. If it's chilly, we might put on a sweater. But
for the person with dementia, these solutions are not so simple.
Dementia changes a person's ability to understand, interpret
and respond to what is happening in the environment. The
person may easily be confused by what goes on around them. As
a caregiver, one of your most important responsibilities is to
monitor the home environment. Start by paying careful atten-
tion to how the person responds to the sounds and sights of their
surroundings.
Controlling noise and activity
Noise and activity can confuse and trouble the person with
dementia. They may become overwhelmed by noise or not be
able to track where sounds are coming from and think what's
happening on television is actually taking place in the room.
Similarly, when they hear someone talking loudly, they may
think they are being scolded. The individual may feel threatened
and become tearful or aggressive. Loud noises such as from a
hammer or blender can cause stress and confusion. Even certain
music may be disturbing to the person. Try as much as possible to
limit confusing noise in the environment. Shut off the radio and
television when they aren't in use. If noisy activities must take
place in the home, see that the person is away during that time.
When entertaining guests, limit the numbers of people coming
and going at one time to keep commotion to a minimum.
Handling problems with visual stimuli
Just as noises can overwhelm and confuse the person, so can
visual stimuli. Patterns on drapes, floor coverings or clothing
may look three-dimensional to the person with dementia. They
may try to pick up the "pieces" or trip on a patterned floor.
Seeing one's face in a mirror might confuse them and they might
also mistake their image for that of another person. Rearranged
furniture in a room or the addition of holiday decorations can
also be troubling.
The key is to keep the environment consistent. Minimize
clutter in the person's surroundings. This will help them get
around more safely. If mirrors are troublesome, cover or remove
them. To prevent slips or falls, remove area rugs or tack them
down. If you're installing floor covering, choose a simple pattern
not a busy one. Night-lights in the hallways will help the person
see at night. An excellent book that is full of practical advice
about home safety is Homes That Help: Advice From Caregivers for
Creating a Supportive Home.See "Selected Resources" at the end
of this Manual.
___
Lock up anything that
could be dangerous to
the person such as tools,
firearms, kitchen knives,
cleaning fluids, even medi-
cines.
In the bathroom, put
nonskid mats in the bath-
tub or shower and install
"grab bars" near the tub,
shower or toilet.
___
