When is it time to stop driving or take the keys away?
At some time you will feel concern or even fear that your parents should no longer drive an automobile. AgingCare.com points out that in a recent year, over 14 million Americans were involved in accidents with elderly drivers. But is age the only issue in deciding if it is time to stop driving? Or, is it the risk of accidents?
Of course, it isn’t really just either of those!
If that were true, then, statistically, young adults should not drive! When driving, you are in control of a 4000-lb machine that can easily hurt you or someone else. And, we see people, young and old, who concern us while driving.
Physical and mental condition and abilities are probably the key area to consider. Even the airlines ask if you are “capable” of doing the things it takes to sit in the exit row. Why not ask this of other tasks, including driving?
What are some of the areas of concern?
Is there anything specific to dementia?
For the topic at hand, Alzheimer’s and dementia, there might be unique issues that cause changes to the abilities that can affect driving.
How can you evaluate the driving?
Ride with them. Watch how they drive. Observe without comments, but record what you see for later reference. Some of the warning signs showing that the ability to drive safely is beginning to decline include:
Check the vehicle. Look for dents on the car, especially at the corners. Ask about the missing mirror. Check the sides of the garage door for damage.
Again, a personal note … seeing how my mother-in-law drove even years before symptoms of Alzheimer’s appeared should have alerted us to impending problems. She had dents and dings on all four corners of the car and had some trouble being attentive to traffic. I didn’t want to ride with her anymore! We didn’t stop her from driving for a few more years, and fortunately, nothing serious happened.
How to actually take the keys, if you must…
Have a plan. If you take the keys, says the Huff Post website, you should be able to provide an alternative. You can drive, you can sign the driver up with a local transportation option, such as Durham Access, or even teach the driver how to use Uber. But, don’t leave them with no options.
Have a conversation. This is a shared decision, and your loved ones should be a part of the process. Elizabeth Dugan, author of the book, “The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families,” suggests that you ask them what to do and share your concerns (“I don’t want to lose you in an accident”). Use open-ended questions and focus on what you are worried about, not what they should do.
Involve a trusted third party. Leverage a doctor or therapist (or the DMV) for help.
Be creative. For some drivers, simply “losing the keys” is enough. We disconnected the battery, and the car just would not start.
What if your loved one still refuses to stop driving?
Here are two ideas from dailycaring.com to force the issue:
Contact the DMV. There is a form on the website (ncdot.gov) that allows you to report the driver and ask for a driving evalutaion. Failure to pass would limit their driving.
Use forgetfulness to your advantage. When mother-in-law’s car would not start, it wasn’t long before she stopped wanting to drive and accepted rides and help from others. If she asked, we simply suggested that the car could not be fixed. Similarly, you can lose the keys or even disable the car entirely (like we did with the battery cable).
Also, Protect your own car and keys. Some people will take another car in the household to drive. So, protect that car too by controlling your own keys.
If there is really a problem, don’t feel guilty. You are doing what is necessary.
What if you do take the keys?
If you feel that it is time for them to hand over the keys, recognize that you may run into resistance. Taking the car keys removes the parent’s independence, the ability to drive to the market or to meet friends for coffee, to church and the senior center, the library or to visit friends. The experience can be traumatic.
But, be aware that taking away the keys can mean an earlier move to assisted living. Is that affordable or even a good idea? Be prepared to step in with meaningful assistance during this transition.
The bottom line is that this is a hard conversation and will require patience and planning.
If you need help, check out the articles referenced on this blog or contact a geriatric professional care manager.
What is Sundowning?
And, what should I do about it?
The term “sundowning” refers to a state of confusion that often occurs in the late afternoon and may continue into the evening or night. Sundowning can cause or exaggerate some of the common behaviors associated with dementia. This could include confusion, anxiety, aggression, or ignoring directions. Your loved one might become demanding or suspicious. Sundowning can also lead to pacing or wandering.
Sundowning isn’t a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease.
What causes Sundowning?
The exact cause of this behavior is unknown. It might be related to light levels as the day wears on, or it might be related to fatigue if the person has been up and active for a while. They could even pick up on Caregiver fatigue!
There is speculation that the “internal clock” we all have is broken for people with dementia, so the day (and people around them) want them “awake” when their body tells them to “sleep”. Imagine how you would feel all mixed up, time-wise.
A more interesting theory to consider is that activity associated with later afternoon (shift changes, grandkids coming home from school, the dog needing a walk) may create a frustrating anxiety. The person with dementia might “remember” that they have to check on the dog, or pick up kids, or wrap up the day at work, even though this is not the current reality. Then, not being able to do it, or understand why they cannot, is frustrating and leads to behavior issues. That can include the need to “check in at home” which can lead to wandering behaviors.
Can it be prevented? How do we manage it?
The easiest approach to sundowning may be to change the stimuli of the environment. For example, keep lights brighter during the afternoon to “hold off” the shadows of evening. Close the blinds in the afternoon to avoid the changing light. The Alzheimer’s Association suggests the use of brighter lights during the evening.
You can also help the person get more or better sleep. Sometimes this might include little changes to medication or new patterns; talk to your doctor. You can arrange the bigger meal to be lunch rather than dinner/supper.
Schedule outside trips for times during the early part of the day. Go outside for a walk mid-day and limit mid-day naps, if possible. Avoid too much new activity during the time when the person with dementia seems to get agitated. Reduce noise and activity in the evening. Some people note that the TV is too distracting and suggest quiet music instead. Music can work wonders for some people with Alzheimer’s.
Care for the caregiver
Caregivers are stressed too. Take time to recover, sleep well, and relax as much as you can. Get respite help when necessary. There is no shame in asking for help and/or taking time for yourself.
For more information or help, contact a professional care manager, a home care agency, or an attorney familiar with these sorts of issues. Here is a more extensive case-study article.
Symptoms of Dementia
In the past couple of emails, I noted that the dementia is progressive. That means it starts without symptoms, and then gradually the symptoms increase. Eventually, they interfere with daily life.
So, what should you look for?
Early signs of forgetfulness is often a key. This is sometimes described as forgetting why I went into a room, or where I left my keys. Of course, such things do not mean you have dementia, but they are possible symptoms. Forgetting directions to a common destination can also happen.
For others, poor decisions might be more apparent first. This can show up as a “lack of filter” in comments. I’ve heard seniors say amazing things they would never have said before the onset of dementia, and you probably have too. Another common example of poor decisions involves financial concerns. For example, a client lost multiple $100,000+ “investments” because he could no longer gauge the risk associated with the choices he was making.
Dementia in the general sense is different from the case of Alzheimer’s in the specific. Here is a list of Alzheimer’s symptoms you can read if you want more information.
What if I see a change?
People with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends than it is to the person. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. If you see these kinds of changes in yourself or a loved one, don’t panic. It does not mean that dementia is starting! But, it is a good idea to check things out for yourself, and pay attention.
Keep an eye on changes, and consider planning ahead. You should look into legal documents, and be certain that IF there is a significant change in capacity, the family will be able to adapt and assist.
Help is available
If you or a loved one has been diagnosed with Alzheimer’s or a related dementia, you are not alone. The Alzheimer’s Association is the trusted resource for reliable information, education, referral and support to millions of people affected by the disease.
You are gaining knowledge by reading about dementia and Alzheimer’s disease, so use that knowledge to help your loved ones or yourself.
What is Alzheimer’s disease?
Yesterday I discussed dementia in general. Today, let’s look at Alzheimer’s in more detail.
According to the Alzheimer’s Association, Alzheimer’s disease is the most common form of dementia. While it is a form of dementia, it may represent 60-80% of all the cases. And, remember that “dementia” is a condition in which memory loss and a decline in other cognitive abilities is serious enough to interfere with daily life.
What characterizes Alzheimer’s specifically?
Essentially in my layman’s terms, your brain works through the activity of neurons, the connections between which create memory and hold all the details you use to think and reason. I explain it as the neuron connections that you need to think are getting interrupted. But, that isn’t all that happens. The damage spreads … and it is permanent. Eventually, the symptoms start to show up as forgetfulness and confusion.
Can you make it easy to understand?
I can try … in your brain are many complex processes. One of those goes haywire and accidentally starts to destroy neurons. Then, the brain’s response just makes it worse. Eventually, the disease actually shrinks your brain as tissue is affected. As that happens your memories, and your capability to think and reason, are lost.
There is a lot going on at a very deep level inside the brain of a person with Alzheimer’s.
When do symptoms start?
As you might tell from the description, Alzheimer’s begins without showing symptoms, and it might take years, but it is relentless and ultimately fatal.
This initial part is called the pre-clinical stage, which isn’t even part of the official stages of Alzheimer’s. Some estimates are that people are “asymptomatic” for 10-20 years! That means that their brains are changing, and no one can tell early enough for treatments to start. In fact, this makes medical research studies difficult because we really do not know if a person without symptoms has the disease or not.
Planning is important
Does this worry you? It probably shouldn’t!
Sure, you, or I, could be living with a disease that stays hidden for years, but that can be true with other diseases as well. My advice is not to worry … each day has worries enough. Knowledge and planning will make a difference for you and your loved ones, no matter what the eventual troubles really become.
If you already have a diagnosis of Alzheimer’s or any other dementia, you have had to process that knowledge personally and for many people it is discouraging, disappointing, and even terrifying. But, there is a ton of research going on, and we still work toward a cure.
Meanwhile, learning how the disease affects people and their families and caregivers is important. Talking with your loved ones, diagnosed or not, is important for a healthy response to any medical condition.
That is the point of my emails … to help you understand the issues and to develop new ways of thinking or relating to people with and without the disease. Working together, we make a difference in lives around us.
Tomorrow, I’ll look deeper into the symptoms and later into the stages of the disease.
See you then!
P.S. Here is another slightly more accurate description of the process
For some reason, Alzheimer’s patients had unusual buildups of proteins called amyloids in their brains. These proteins are a normal part of everyday function in healthy people, but instead of breaking down as they should, they form plaques that eventually destroy neurons.
Simultaneously—although it’s unclear if this is because of the amyloid buildups or in addition to them—proteins called tau, which form connections within and between neurons, become dense with extra phosphorus atoms. Eventually, the tau proteins become knotted, and end up destroying affected neurons, which also impairs the connection between other neurons. Worse, the tau then starts spreading. The destruction starts in the hippocampus, the tiny, seahorse-shaped memory hub at the base of the center of the brain, and extends outward, eventually overwhelming the entire organ.
For a while, the brain maintains normal function with these malformed proteins and dying neurons, but eventually, it hits a tipping point. The hippocampus starts to shrink and people who could once remember to-do lists, names, and directions start to become more forgetful and confused, which understandably leads to intense anxiety and confusion. The cognitive symptoms only get worse from there, followed by physical decline that is eventually fatal.
The damage caused by the disease is permanent.
P.P.S. – Here is the really technical explanation… continue at your own risk!
According to Dr. Sara Adaes, writing for “Brain Blogger” in 2015, the technical details are this:
There are some pathological features in AD brain tissue that are considered hallmarks of the disease. Specifically, amyloid plaques – extracellular deposits of the amyloid-beta (A-beta) peptide – and neurofibrillary tangles, intracellular accumulations of the hyperphosphorylated tau (p-tau), a microtubule assembly protein. Other characteristic changes include increased microglial reactivity and widespread loss of neurons, white matter and synapses.
Ok, that is a mouthful.
Dementia creates a huge cost for US business.
This comes in the form of a gradual decline in productivity, early retirements, workers leaving to care for their loved ones, and eventually insurance costs for care. It is a national problem that needs resolution.
Dementia is various things, but one easy descriptionis that it is a progressive diminishing of the brain’s cognitive functions. That means that practically, if you have dementia, you will gradually lose the ability to make complex judgments or certain kinds of decisions. You might lose the ability to manage your money, or drive the car.
These changes are gradual, and usually fairly slowly developing. So, you might have episodes for years that are frustrating but not a problem. Then, sometimes as a surprise, you can’t function like you used to.
Why does that matter?
If you are a younger worker, you might lose productivity or efficiency. If you are an older worker, you might need accomodations. Or, you might need to retire sooner than you had hoped. This can affect you, your co-workers, your company, and even the community. We are not talking about the cost of care … that is further down the timeline. But, studies show that in 2010 distracted workers cost the national industry in the US alone over $650Billion a year. That was back in 2010, according to a business journal. Imagine what it is today, and what just a few minutes of confusion or having to repeat things can do.
Early retirements are the next factor. Workers are retiring earlier than usual when dementia is involved. And it isn’t just here in the US… it is a global issue. In the UK, “Early retirement of those diagnosed with dementia is estimated to cost businesses a further £627m a year” (see this article)
Finally, workers often leave to care for their loved ones. This can reduce the workforce and coast companies in terms of retraining, disruptions, and overall corporate health costs.
How many people are affected?
A poll, “commissioned by Workplace Options in conjunction with the Alzheimer’s Association, showed that nearly 70% of those who work or worked while providing care had to modify their schedules. They went in late, left early or took time off during the day.
- 32% had to take a leave of absence.
- 26% changed jobs for a less demanding role.
- 23% had to go from working full time to part time.
- 20% said their work performance suffered to the point of possible dismissal.
- 24% had to give up working entirely.
Other issues that come up while being a working caretaker are physical exhaustion and psychological problems such as depression and anxiety. For some, it amounts to a second job.” (See the article)
What can we do?
As business owners, we need to adapt the way we work to accommodate people who need to care for others. We need to understand what our people need for their own health. And, we need plans that appropriately and legally adjust our practices and procedures.
It is a big task, and growing every day.
You can help by getting behind initiatives to study dementia, by taking care of yourself, and working to support your co-workers and family. Together, we can adapt while we wait for the cure.
According to the Alzheimer’s organization, Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia. (see alz.org )
They go on to say, “Dementia is not a specific disease. It’s an overall term that describes a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.
Do you want to know more about signs of Dementia? Download this article from Alz.org.
People with dementia may have problems with short-term memory. This is common, and looks like trouble keeping track of a purse or wallet, paying bills, remembering appointments or traveling. Even just out of the neighborhood. We often see this when a person who used to cook stops, or has trouble planning and preparing meals, or leaving food in the microwave or stove.
Most dementias are progressive and gradual, meaning that your symptoms start out slowly and over time get worse. If you or anyone you know is experiencing memory skills issues, please do not ignore them. Get an evaluation from a doctor who understands dementia.
Each year, many of us have to consider changes or updates to life insurance. Maybe this is that time of year for you.
If so, please consider insurance for lots of different things. For example, for your
- Auto and Home (this is obvious, I suppose, but according to one source, up to 20% of NC drivers might have lapsed insurance!)).
- Life (many options are available, depending on your needs and your age).
- Health (basic coverage, Medicare Parts A-D, supplementals, and more).
- Umbrella (protects your assets from high-value claims).
- Business (general liability, errors and omissions or malpractice, life insurance for key-man, etc. – a complicated but essential set of policies).
- Long-term care insurance (protects you from the extremely high costs of care in skilled nursing or assisted living communities. About 75% of all people over 90 end up needing some level of long-term care, according to various organizations).
- Children (insuring your children isn’t a bad plan to protect your investment in them. And later, insurance allows you to pass the coverage on to their families. If your child has special needs, insurance can fund Special Needs Trusts for their protection down the road).
- Estate Planning (many uses, including using insurance for protecting assets, leveraging assets for generations to come, or providing for charitable donations with a minimal up-front cost).
Each of these present different needs, opportunities, and options. You should review them with your favorite insurance agents, but be advised that not all agents will be able to discuss every aspect of your needs. If in doubt, ask questions, and consider shopping around. Price isn’t the only consideration … scope of services, personal attention, proximity to your home or office … all can be relevant is selecting an agent.
Don’t guess about your insurance needs. Find an agent and ask appropriate questions. Ask us if you need referrals.
In my practice, Long-term care insurance is addressed as part of nearly every initial consult. Yes, it is that important. New options make it affordable and well-leveraged for most people. But, like all insurance, it works best and is least expensive the earlier you purchase it (and you should have it before you need it!!).
If you want to provide insurance for your employees, check out sites like this one.
Here is a review resource you might find useful for a review of different companies for certain types of personal insurance …
I don’t personally direct you to one company or agent, but if you ask for referrals, I’ll find some names for people my clients or I have worked with who might fit your needs.
“Mom had money in her account last I looked, but now it is gone! What can I do?”
This is a too common issue for our older population. Financial exploitation can come in many forms, including scams, theft, cons, and so on. It can happen by phone or email, or in person. For example, consider the sales person who offers to paint the house for an outrageous sum, and then does a poor job or simply never shows up. Mom doesn’t want to complain because “he was nice a nice young man!” And, she is embarrassed to ask you for help. Yes, it happens more often than you think, and you don’t have to be incompetent to fall for a scam or a “nice young man”.
But maybe the most common form of financial exploitation (or financial abuse) is when a relative takes money from the elder’s bank accounts. We have had several clients recently for whom this has happened. As a family member, how can you prevent it?
- have her evaluated and found incompetent
- get a formal letter from a doctor that states that
- notify the banks she deals with and anyone else she might work with for financial matters that she has been found incompetent and that you are the proper authority, give them copies of the letter and the FPOA
- Keep an eye on her bank accounts for improper activity
- If she does sign or spend due to another person’s influence, file for the guardianship and press charges or get Adult Protective Services involved as needed.
Sometimes, people will have a significant list of items in their home to go to others. But, when it is time to downsize, and move to a new smaller residence or to assisted living, what should a person do with them?
- Does the testator (the person writing the Will) need money that would be gained through sale of the items?
- Can the testator fit certain (or all) the items in the new downsize residence? Does she even want to take them all? Can she afford the cost of moving the items?
- Will the persons to whom the items were intended be a able to take them now, and/or be upset if the items were not available in the future? This might happen, for example, when grandkids are the intended recipient and they do not have a place of their own or are still living at school.
Give the gift now!
- Gift them as instructed in the will – it fulfills her wishes ahead of time, and it will prevent hurt feelings when the will is later revealed and everyone sees that the “wrong person” ended up with the necklace, piano, painting (or whatever).
- Then, mark a copy of the will with gifts given out and identify which she still has with her. That will make the executor’s job a lot easier in the future!
The choice to downsize can be a difficult time for lots of reasons. Derive immediate joy by gifting the important personal possession now.
Sometimes I am asked about the Health Care Power of Attorney .. .that is the document that names an “agent” who will be able to make medical decisions for you when you cannot. It is an important role. But, what do you put in the various spots?