Who should take the car keys away from Alzheimer's patients?

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Who should take the car keys away from Alzheimer's patients?

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By Diane C. Lade

South Florida Sun-Sentinel

August 9, 2006

A doctor told Marilyn Pennachio that her father's increasingly bizarre behavior

was due to Alzheimer's disease, and then prescribed a medication to ease the

symptoms. He suggested her father shouldn't live alone in his Lauderdale Lakes

apartment any more, and shouldn't drive.

But Pennachio said she needed more out of that office visit -- more on living

day-to-day with an incurable disease that only would get worse. And she said she

needed more specifics about what to do if her father refused to give up the car

keys, especially since the elderly man told the doctor that he had no intention

of doing so.

" They evaluate you, they send you away, but then what does the caregiver do? "

said Pennachio. " I wanted to say, `So how can I stop this man from driving,

doctor? This is my loved one, my father, and I am taking on all this

responsibility.' "

One group of medical professionals agrees that it's time for doctors and other

health professionals to take a more active role in helping dementia patients and

their families cope. The American Association for Geriatric Psychiatry recently

released a checklist that, for the first time, outlines nonmedical but critical

things practitioners should discuss with their patients and families.

At the top are safety issues, including whether a patient should continue

driving -- an emotional topic doctors often are loath to broach.

Kathy Townley, of Boynton Beach, agreed that doctors should be the ones to tell

Alzheimer's patients when to give up the keys.

" Doctors have more clout than we do, " said Townley, who took a caregiver

education class at North Broward Medical Center.

She has an elderly relative with Alzheimer's who refused his family's pleas to

stop driving, despite three near accidents. Yet while he was angry when his

doctor told him the same thing, Townley said he then agreed to stay off the

roads.

" [Doctors] need to be proactive in terms of telling people how to deal with

issues on a practical basis, " she said.

In addition to recommending that doctors address concerns about driving, the

association's checklist urges physicians to help caregivers deal with stress,

plan for assisted living or nursing home care, and encourage patients to stay

active and healthy for as long as possible.

" When it comes to this whole issue of the doctor-patient relationship ... we

need to improve our ability to be empathetic listeners, " said Dr.

Colenda, association president and dean of the College of Medicine at Texas A & M

University. " We need to be able to say the right thing at the right time in the

right manner. "

The checklist recommendations, more than a year in the making, are separate from

the physician guidelines for testing, diagnosis and treatment. The checklist

could be used by any doctor or health professional -- not just psychiatrists --

who regularly deals with Alzheimer's patients, Colenda said.

Physicians are bracing for an explosion in Alzheimer's cases during the next

decade, as Baby Boomers retire. The chances of developing the disorder increase

with age, with some studies suggesting one of two people over age 85 are at

risk.

" We don't have a cure, and we're a long ways from one, " said Dr. Marc Agronin, a

geriatric psychiatrist who directs the Memory Center at the Miami Jewish Home

and Hospital for the Aged. " We've been focused on screening and behavioral

issues. We have to be equally focused on lifestyle and safety issues. "

The stop-driving talk remains a stumbling block for most doctors, even though

they're often best qualified to judge driving ability and whose opinions the

patients are most likely to respect.

A recent survey of more then 3,800 midlife and older adults by The Hartford

insurance company and the Massachusetts Institute of Technology found 92 percent

thought their doctor was the one who should tell them if they should hang up the

keys.

The American Medical Association also has been advocating more involvement by

doctors in their patients' decisions about driving. Three years ago, the AMA

drafted a guide on driving cessation and next year an AMA-trained team will make

appearances at Florida medical conventions to encourage physicians to use it.

Florida is one of six states where physician reports to licensing bureaus are

confidential and one of 30 states where physicians are immune from legal action

by their patients in such cases, according to the American Association of Motor

Vehicle Administrators.

Three states -- California, Nevada and Pennsylvania -- have laws holding

physicians responsible if they do not report specific medical conditions and one

of their patients later causes a crash. The California law is the only one

specifically mentioning Alzheimer's disease.

Drivers age 80 and older in Florida must take a visual exam to renew their

licenses, but no driving tests are tied to cognitive ability. A license is

automatically suspended only when a driver racks up 12 points in a 12-month

period, with points given for traffic tickets or accidents. Police, physicians,

judges and the general public, however, can report at-risk drivers to the

licensing bureau's Medical Review Board, which decides if a retest is necessary.

The state has rescinded about 30,000 licenses for medical reasons.

The Memory and Wellness Center at Florida Atlantic University in Boca Raton has

one of the few South Florida programs to evaluate older drivers through computer

and road tests. Program Director Sparks is seeing more referrals from

neurologists and hopes the care guidelines will encourage other doctors to deal

with driving.

The fact that Medicare and most private insurance does not cover the $275 test

battery keeps some away. " A lot of rehabilitation centers don't do driving

evaluations because it's not profitable, " said Sparks.

Diane Lade can be reached at dlade@... or .

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