Traveling, Driving, Holidays, and Special Occasions

Welcome to the educational program Traveling, Driving, Holidays, and Special Occasions. This program will teach you how to assess the ability of someone with dementia to travel and provide strategies for traveling (whether you are traveling with the person or arranging solo travel for someone).  It will also teach you how to recognize the signs of unsafe driving and provide some strategies for getting someone to stop driving. In addition, it will discuss some issues associated with holidays and other special occasions, as these are often the times when traveling is needed.

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You may view the topics in order as presented, or click on any topic listed in the main menu to be taken to that section. We hope that you enjoy this program and find it useful in helping both yourself and those you care for. There are no easy answers when it comes to the care of another, as every situation and person is different. In addition, every caregiver comes with different experiences, skills, and attitudes about caregiving. Our hope is to offer you useful information and guidelines for caring for someone with dementia, but these guidelines will need to be adjusted to suit your own individual needs. Remember that your life experiences, your compassion and your inventiveness will go a long way toward enabling you to provide quality care.

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Travel

Traveling has  become a way of life for many people.  It provides opportunities for leisure activities,  reuniting with family and friends, and meeting new people. Holidays  and other special occasions also provide opportunities for people to have fun and enjoy time with family and friends. Being able to manage activities associated with travel and holidays is important to self esteem.  So it can be difficult to give up these activities even when they pose  dangers or difficulties for someone with advancing dementia.  But with advanced planning and adjustments, people with dementia may be able to continue traveling for a long time.

 

Case Study 1

Let’s take a look at a case study involving Mary, who cares for her husband Robert. Robert was diagnosed with early stage Alzheimer’s a year ago. He also suffers from some chronic health issues including macular degeneration, an eye disease that causes loss of vision. He is on several medications for his dementia and other health issues. He is able to manage most of his own personal hygiene, though he faces some challenges because of his vision loss.Robert and Mary are planning a trip to their home town in Kansas for a family reunion. Robert’s high school reunion is taking place the weekend before the family reunion in the same town. His older brother, Paul, plans to attend the high school reunion as well.

What should Mary do?
  • A. Try to persuade Robert not to go, and ask his physician to reinforce her decision.
  • B. Allow Robert to travel alone without special arrangements, as he has recently flown alone.
  • C. Allow Robert to travel alone with special arrangements with the airlines and his brother.

Case Study 1 Answers:

Choice A: Try to persuade Robert not to go, and ask his physician to reinforce her decision, is an option.

If Mary has concerns about allowing Robert to travel alone despite careful preparation, then involving his physician in the decision-making process may be a good option.

His physician can work with Mary to evaluate the progression of Robert’s dementia and his current capabilities. After considering all of these factors, the physician can help Mary make a decision.If they decide that Robert should not be traveling alone, then his physician can help Mary persuade Robert.

If necessary, physicians can advise those with dementia against traveling and other hazardous activities.

Choice B: Allow Robert to travel alone without special arrangements, as he has recently flown alone, is not a good choice.

Although Robert successfully made a direct flight 3 months ago, it is likely that his Alzheimer’s disease has progressed somewhat, and that this longer, more complex trip may be too challenging for him. In fact, people with Alzheimer’s disease can have fluctuations in their abilities on a day to day basis and can seemingly worsen overnight. For Mary to assume that Robert can handle flying alone without special arrangements, because he managed doing it a month ago, would be a mistake. The new surroundings, unfamiliar people, noises, speaker announcements, traffic, and hectic pace of an airport or airplane could overload his senses and cause him to be confused, anxious, and stressed.

When making decisions, it is important to make sure that the choices match the level of the individual’s capacities.Solo travel that was managed in the early stages of dementia may not be an option as the disease progresses, with or without special arrangements.

Choice C:Allow Robert to travel alone with special arrangements with the airlines and his brother, is the best answer.

Mary could agree to let Robert travel alone if he allows her to make special arrangements with the airlines and his brother to ensure his safety and security. Going on this trip will help Robert maintain his self-esteem and his remaining capacities.

Mary should consider Robert’s capacities and limitations when she makes the arrangements.She can also discuss her concerns with Robert’s physician to get his recommendations for the trip. 

Let’s discuss the arrangements Mary can make in more detail.

Solo Travel Arrangements

There are several things Mary can do to ensure Robert’s safety and security.

First, Mary can make sure that Robert will not be left alone during the trip.All major airlines provide senior care services for an additional fee, so Mary can check with her preferred airlines to see what services they offer. She should inform the airline staff of Robert’s medical issues, including his dementia and vision problems. She should provide the staff a list of emergency contacts and his medications, which should include dosages, schedule, and photos of the pills if possible. 

She should arrange for an escort through the airline’s customer service department to take Robert to and from his planes at each airport. After each flight, an airline representative can meet him on the plane and escort him to the next gate for his connecting flight or to where his brother will meet him.She should ask the escort service to include a stop at a restroom after each flight.

She can also contact a travel agency or the airline when making the flight reservations to find a smaller, less busy airport for the layover to decrease his risk of over-stimulation and confusion.

She should schedule the flights so that his brother can meet Robert in the terminal and take him to baggage claim. A rental car or other form of transportation should already be arranged so that Robert does not have to wait.

Other things that Mary can do to ensure Robert’s safety and comfort is to make a packet that can be hung in a holder around his neck or on his waist. The packet should contain his ID, itinerary, boarding pass, and a page containing important information about his emergency contacts, including his physician’s office, medical issues, including his dementia and other chronic health conditions, any allergies, and current medications, including dosages, the times they need to be taken, and pictures of the pills when possible. A duplicate packet of information should be placed in his carry-on bag  just in case one gets lost or discarded. Robert can also wear a “Safe Return” bracelet just in case he gets lost or wanders away. 

Mary should prepare a carry-on bag with food to eat on the airplane and during the layover. She can place a white ribbon on his checked bag for easy identification when he arrives in Kansas.

She can give Robert some money in case he needs to make a phone call, or give him a mobile phone with important phone numbers programmed if he is able to operate it.

Mary can organize his medication caddy with enough pills for the trip. She should discuss Robert’s care issues with his brother and include detailed instructions about his special needs and medications. She should ask Paul to call her as soon as he meets up with Robert at the airport.

On the day of departure, Mary should help Robert check his bags and obtain his boarding passes.  She can get an “escort pass” so that she can proceed with him through security and to the departure gate.  If desired, she can request wheelchair service.  At the gate, she should explain his situation to the agent and confirm the escort service between flights.

 

Principles of Solo Travel

As shown in this case study, allowing someone in the early to mid stages of Alzheimer’s disease to travel solo poses many concerns, but it can be accomplished with careful preparation. Being independent, autonomous, and having control over one’s life are important to most people. Loss of independence can result in feelings of worthlessness, and as these negative feelings increase, competence decreases.  Two core principles of dementia care are to support autonomy and independence and to provide safety and security.  Even in the late stages of dementia, every effort should be made to support the person’s retained capacities.  The dilemma is how to support autonomy and independence while at the same time insuring safety and security. The key is in careful planning and preparation, and involving other family members and the person in the process.

Assessing Solo Travel Capacity

When deciding whether or not to allow someone with dementia to travel alone, it is important to assess the person’s capacity to travel solo.

The caregiver can work with the person’s physician to evaluate the status of the dementia and the person’s current capabilities. Questions to consider include, “Does the person become confused or unpredictable under stress,” “Does the person recognize dangerous situations and know to dial 911 or find other ways of getting help in an emergency?” “Does the person sometimes wander or become easily disoriented?” “What is the person’s general mood?”  To be able to make informed decisions, the caregiver must constantly monitor the person’s behavior and emotional stability, taking note of how the person deals with negative feelings and impulses.  The physician and caregiver should discuss all of these factors when evaluating a person’s capacity for solo travel.

Person-Centered Care

The best care for those with dementia is care that is centered on the person.  This is referred to as person-centered care.

 The principle of person-centered care is to individualize the care based on the individual’s personal preferences, life history, cultural norms, and beliefs. It incorporates the core principles of dementia care, which include promoting safety and security, comfort both physically and emotionally; respect and love; and autonomy or control over their lives.

In Robert’s situation, his wife made careful preparations for his trip.  She involved him in the planning process and kept him informed about progress of the arrangements.  Robert was able to speak to his brother on several occasions about the plans, make suggestions about the travel, and confirmed that he felt comfortable with the arrangements.  Though Mary was uneasy about the prospect of his traveling alone, she respected his desire to attend the reunion and made every effort to make it work.

Traveling With Someone With Dementia

Most of the travel for someone in with Alzheimer’s disease will be with a companion, either the primary caregiver or another family member.

Traveling with someone with dementia can be challenging and stressful. However, with careful preparation, it is generally possible to ensure safety, security and comfort. Caregivers need to plan well in advance for travel and carefully assess the care recipient’s limitations as well as their own. It may be helpful to consult travel professionals and healthcare professionals about the best possible methods to travel with the least amount of stress to the person with dementia.

Here are some things to keep in mind for traveling with someone with dementia.

Assessing Travel Capacity

Before planning a trip, it is important to assess the person’s capacity for traveling.  People with Alzheimer’s disease often have difficulty with new environments, new people, changes in routines, change of time zones, noise, and fatigue. Therefore it is usually better to travel in the early stages of the disease, as the person is less likely to become disoriented, agitated, or distressed than in the later stages. Someone who requires assistance with bathing, dressing, and toileting will probably have difficulty with traveling, even with short trips.

There are a number of additional signs that may indicate that travel is not a good idea. These include the following:

  • Frequent behavioral problems such as consistent disorientation, confusion, or agitation, even in familiar settings
  • Wanting to go home when away from home, even on short periods,
  • Delusional, paranoid, or disinhibited behavior from the person,
  • Teary, anxious, or withdrawn behavior in crowded, noisy settings,
  • Agitated or wandering behavior,
  • Physical or verbal aggression,
  • Yelling, screaming, or crying spontaneously,
  • High risk of falling,
  • Incontinence of urine or stool,
  • And having unstable medical conditions, such as heart or lung disease.

It may be useful to do a ‘trial run‘ of traveling by taking a short trip using the same type of transport planned for the longer trip, whether it be by plane, train, car, or ship. This trial run will provide a sense of the person’s travel capacity. If the person does not tolerate the shorter trip, it may not be a good idea to travel.

Caregiver Assessment

Caregivers should assess themselves to determine whether they are prepared to travel with someone with dementia. It’s important to have realistic expectations. While traveling, caregivers will need to manage unexpected events and challenging behaviors, sometimes in public. They may face many stressful situations and lack of sleep. They must show patience and flexibility in their plans. If the care recipient is of the opposite sex, the caregiver may need to go into opposite sex restrooms to assist the person. And caregivers must be willing to plan in advance and seek help as needed.   

Guidelines for Traveling

As discussed  earlier, the keys to successful travel for someone with dementia  are careful planning and preparation.  Keep the person informed and promote a sense of control  by offering choices and respecting the decisions. Limit the choices to things that are within the person’s abilities to do safely and successfully.  Here are some guidelines for increasing the likelihood of a successful trip.

  • Keep trips simple and short. It is best to have one destination and return home before making other trips.  Too many destinations with too many airports, hotels, car rides, and activity can be overwhelming for the person. 
  • Try to travel to familiar, stable, and well-ordered settings, such as visiting family or old friends.
  • Build flexibility into the travel plans to give the person time to adjust and rest as needed.
  • Allow plenty of time for everything.  Expect delays and time to make adjustments.
  • Try to travel during the person’s best time of day.
  • If driving, do not drive alone with someone who is agitated. Your safety, as well as that of  the person and other people using the roads, may be at risk.
  • Take regular rest breaks. Check frequently to ensure that all basic needs are met (such as toileting, hydration, nutrition, and rest).
  • Have the person wear comfortable clothes that are easy to disrobe when using the toilet. 
  • Do not leave the person unsupervised, especially in new surroundings. There should be a familiar and reassuring companion at all times.
  • Try to avoid crowded, busy, or loud places, especially if the person is tired.
  • Look for signs of distress and try to calm and reassure the person. Remove the person from the stressful setting if possible
  • The level of activity at airports and travel stations can be confusing or stressful to someone with dementia.  Consider requesting a wheelchair  or motorized transport so that you can getting quickly from place to place.  Inform the airlines, travel, or hotel staff ahead of time of any special needs to make sure that they are prepared to assist you.

Tips for Traveling with Someone with Dementia

Here are some tips for planning your trip with someone with dementia:

When traveling, take copies of important documents and information with you. This should include:

  • Identification
  • Emergency contact information
  • Doctors’ names and contact information
  • List of current medications, dosages, and picture of pills if possible
  • List of drug or food allergies
  • Copies of legal papers (such as a living will, advanced directives, and power of attorney)
  • Insurance information
  • And travel itinerary

An itinerary containing schedules, hotel names and phone #s should be provided to family members and the people you are visiting.

Have the person carry identification (such as an identification bracelet) at all times in case of getting lost. Consider marking their clothing with their name.

Make sure that the following information is carried in a wallet or purse: name, important phone numbers, any medical conditions, including Alzheimer’s disease. 

If the person is at risk for wandering away, consider enrolling the person in the Alzheimer Association’s Safe Return Program and have the person wear the Safe Return bracelet.

Another option to consider is placing a locator on the person, such as a GPS (Global Positioning System), RFID (Radio Frequency Identification), or cellular locator.  These devices come in many forms, such as wristbands, ankle bracelets, necklaces, and handheld transmitters.

Tips for Traveling with Someone with Dementia (Continued)

Remember to pack the following:

  • Water and other drinks
  • Snacks
  • Activities to do while traveling, such as games, puzzles, and cards
  • Favorite items
  • And medications (In addition to the person’s regular medications, consider consulting a health care professional about medications for mood control, pain, stomach upset, diarrhea, or other temporary problems that might arise while traveling.)

Being prepared in case of an emergency is crucial. Put together an emergency kit in a watertight bag or container. This kit should include:

  • First aid kit
  • Copies of important documents and identification
  • Recent picture of the person with dementia
  • Extra clothing
  • Extra medication
  • Incontinence products
  • Bottled water
  • And prepackaged food

Destination Safety

When planning a trip, it is important to consider the safety of the destination environment. Check your destination for:

Working smoke alarms and fire extinguishers;

Non-slip surfaces in the shower and bathtub;

And adequate lighting in the hallways, bedrooms and bathrooms. It is a good idea to take several nightlights and desk lamps just in case.

Walk through the rooms to check for potential hazards and clutter. Unplug or remove the coffee maker, hair dryer, irons, cleaning products, area rugs, and fragile or hazardous objects if possible.

Be sure to check the water temperature  from running faucets and showers. Faucets in new places may be confusing to someone with dementia, so make sure the temperature is properly adjusted.

Be aware that the risk of wandering can be increased by a change in environment. Keep car keys away from the person.  If wandering is a concern, consider using a portable door alarm or childproof doorknob cover.

Place a chair in front of the door if possible.

If there are two beds, have the person sleep in the one further away from the door.

If you are staying in a hotel, inform the hotel management about the person’s dementia just in case there are incidents or the person tries to wander. 

Summary of Traveling Issues

With careful planning and preparation, it is possible for someone with dementia to travel solo or with a caregiver safely and comfortably.

Caregivers should consider the person’s abilities and limitations when making the arrangements.

Consult the person’s healthcare provider to help you assess the person’s capacity for traveling.

Keep trips simple, short, and to familiar settings.

Make arrangements with the travel provider (whether it be an airline, train, bus, or ship) and the hotels for services provided to seniors or people with disabilities.  If the person is traveling alone, arrange for an escort at all times.

Pack copies of important documents and information, including identification, contact information, medication list, and itinerary. Remember to pack food, water, activities, favorite items, medication, and an emergency kit.

Have the person carry identification and important information at all times.

Be prepared for the possibility of wandering while traveling. Consider enrolling the person in the Safe Return program or placing a locating device on the person.

And make sure the destination has a safe environment. 

Driving Issues

Now let’s discuss driving issues associated with Alzheimer’s disease. Difficulty with driving can begin in the very early stages of Alzheimer’s, and caregivers should take action, whether it be to restrict driving or to take the person’s drivers license away.

There are more than 30 million licensed drivers 65 or older according to the National Highway Traffic Safety Administration. As people age, their driving skills begin to diminish. Aging is associated with a decline in motor skills and perceptual and cognitive abilities. In addition, older drivers often have pain, weakness and joint stiffness, which can limit movement and reaction time. A recent study found that the number of severe crashes, driver fatalities, and pedestrian fatalities increase sharply once a driver becomes 65 years old. Driving a car or operating motorized equipment demands quick reactions, alert senses and split second decision-making. Aging is associated with decreasing vision and spatial perception, shorter attention span, slowed reaction time, and declining ability to distinguish traffic signs and lights.

Dementia adds disorientation, confusion, and memory problems to the factors that seriously hinder driving ability. One study found that 30% of drivers with mild to moderate dementia got into an auto accident, and another 11% caused someone else to have an accident. It is very important that those with dementia stop driving during the early stages of the disease before they injure themselves or those around them while driving.

Driving Factors

Aging results in slowed reflexes, worsening eyesight, and hearing loss, which can impair an older person’s driving ability.  Additionally many medical issues increase the risk of car crashes, including Alzheimer’s disease, Parkinson’s disease, heart disease, alcoholism, diabetes, stroke, arthritis, and sleep apnea.

Many prescribed medications can also interfere with driving. According to a recent report, older people are more likely to be involved in accidents if they take opioids, benzodiazapenes, tricyclic antidepressants, some antihistamines, glaucoma medications, nonsteroidal anti-inflammatory drugs, muscle relaxants, and painkillers such as aspirin and ibuprofen. If people taking these medications also drink even a glass or two of alcohol before driving, this could make their driving even more risky.

One study found that people who are diagnosed with mild Alzheimer’s disease became unsafe drivers after an average of 11 months. Those who are older and have less education are more likely to become unsafe drivers faster.

Case Study 2

Let’s take a look at a situation involving Sally, a professional caretaker and Mary, who cares for her husband Robert, who was diagnosed with Alzheimer’s disease one year ago.

What should Mary do about Robert’s driving?
  • A. Confront Robert and demand that he give up driving.
  • B. Ask Sally to help deal with the situation.
  • C. Call Robert’s doctor for advice.
  • D. Gather Robert’s friends and family for support and approach Robert with some solutions.

Case Study 2 Answers:

Choice A: Confronting Robert and demanding that he give up driving, is a possibility, but not a very good choice. Because driving is so important for maintaining a sense of freedom and independence, older drivers often get defensive, even irate when others question or  try to take away their driving abilities. To help lessen the confrontation about the subject, it is best to include the driver in the decision-making process, rather than dictating a decision to the person.

Choice B: Ask Sally to help deal with the situation, could be a good choice.

Telling loved ones that they can no longer drive may produce feelings of guilt and anxiety on the part of the caregiver. Mary may not know how to approach the situation of Robert’s unsafe driving due to her feelings about him.  So asking Sally to help deal with the situation may be a good idea, but it does not necessarily mean that Robert will heed Sally’s advice. It will depend on many factors including Sally’s relationship with Robert, Robert’s awareness of his driving abilities, his dependence on driving, and his remaining reasoning abilities.

Choice C: Call Robert’s doctor for advice, could also be a good choice.

Sometimes all the person needs to hear is an order from a physician or other person of authority. It may work for the doctor to simply tell the person, “The medications that you are taking requires that you do not drive a car or any other mechanical equipment.” Some states actually require doctors to report conditions that could impair driving to the department of motor vehicles, which then will retest the individual for driving competence.

Choice D: Gather Robert’s friends and family for support and approach Robert with some solutions, is the best answer.

If persuasion from individuals, including a doctor does not work, you may need to stage an intervention that includes other family members, friends and professionals. When doing this, it is important to work as a team so that everyone understands the hazards and agrees on the plan of action. 

Unsafe Driving

Oftentimes, people with dementia do not recognize when they should no longer drive, and it is often the caregiver, a family member, neighbor, or friend who will first become aware of the danger. Guidelines from the National Institute on Aging recommend that if someone with Alzheimer’s disease experiences one or more of the following problems, it may be time to limit or stop that person’s driving.

The signs of unsafe driving  include getting lost while driving in familiar locations; failure to obey street and traffic signs and signals; driving too fast or too slow; poor judgment; miscalculating speed and distances, slowed reaction time resulting in an inability to make quick or accurate decisions; hallucinations; confusion when changing lanes or stopping; and drifting out of one’s lane.

People’s behavior may also reflect unsafe driving.  The driver may become angry, frustrated, or confused while driving; take longer to get to places; or receive horn honks and rude gestures from other drivers. Other signs of unsafe driving include recent tickets for traffic violations; new scratches, dings or dents on the vehicle’s body or tire rims; and recent car accidents.

Some signs of a person’s inability to drive safely can also show up at home. Older people who have trouble walking, climbing stairs, or performing heavy housework often have difficulty with driving as well.

Caregivers should keep a written record of their observations.  It can be a useful tool when discussing the issue of driving with the person as well as with other family members and health care professionals.

Approaching the Unsafe Driver

Since everyone with Alzheimer’s disease will have to stop driving at some point, it is helpful to begin talking about this early on.  Most people find it easier to adjust to reducing driving gradually over time. For example, a person can start driving only during the day, or start avoiding highways, or drive only in familiar places and for short distances. Reduce the need to drive by having groceries, prescriptions, and meals delivered. Try to find reasons for why someone else should drive.  For example, tell the person that you need to take a new, unfamiliar route, that driving conditions are dangerous, that the person needs to rest, or that she or he deserves a chance to enjoy the scenery. You may also want to arrange for another passenger to sit in the back seat with the person to provide distraction during the drive. Remember that it is not safe to drive alone with someone who is agitated or unpredictable in behavior, especially during the later stages of Alzheimer’s.

If someone with dementia shows signs of unsafe driving, try to involve the person in the decision to stop driving. Approach the person with your concerns about safety. Be prepared to provide information and reassurance. Use specific examples that demonstrate the person’s unsafe driving.  Keeping a written record of incidents can be useful for this.  Provide supporting data about car accidents and injuries among those with dementia if you feel it is appropriate.  Consider enlisting the support of other family members in your discussions. 

Provide options for alternative transportation and assure the person that you will do your best to find transportation if she or he needs to get somewhere. Family and friends can be a big help with this. They can provide rides for the person or help in planning other forms of transportation, such as taxis, shuttles, or public transportation.

Information on transportation for the elderly may be obtained from the local Agency on Aging and the National Transit Hotline. 

Click here for more information on transportation

Getting Someone to Stop Driving

If your attempts to get the person to stop driving are unsuccessful, involving a healthcare provider can be an effective strategy. Ask the physician to speak to the person and write a prescription saying “do not drive.”  The physician can also write a letter stating that the person should not drive.  You can show this letter to other family members or to the Department of Motor Vehicles (DMV). By saying that, “The doctor said that you can’t drive anymore,” it takes the blame off of the caregiver and the family.

Another approach is to request that the DMV perform a driving test on the person. Or write  a letter to the DMV requesting that the driver’s license be revoked, because Alzheimer’s disease has made driving hazardous for that person.  The DMV may ask for a supporting letter from a physician. The physician can also notify the DMV directly.

Some states actually require physicians to report a diagnosis of Alzheimer’s to the health department, which then reports it to the DMV to have them test the person’s driving skills.  Some DMV’s have special tests set up for people with dementia.  You can contact the DMV or local Alzheimer’s Association to learn about the driving regulations in your state.

Some experts recommend that people with dementia have their driving skills tested at least every 6 months.  If the person’s driver’s license is revoked, have it replaced with a photo identification card, so that the person can still have a form of identification. 

Keep in mind that people who have moderate or severe dementia should not be driving at all.

Taking Immediate Action

If you must take immediate action to prevent the person from getting behind the wheel of a vehicle, you can try several tactics.  Try exchanging the car keys for a set that is not usable.  Or take the keys away from the person and hide them. 

Ask a mechanic to install a switch in the car that will prevent the car from starting.  Or disable the car by disconnecting the battery or removing the distributor cap or the starter wire.  Leave the headlights on all night to drain the battery. 

Install a car alarm and keep the alarm remote away from the person so that “sneaking” away with the car is impossible. 

Move the car to a location that is beyond the person’s control, or have the car towed away.  If the car is not needed, put it into storage until you can sell it or donate it. Alerting your favorite mechanic and other service people that your loved one has Alzheimers disease is also a good idea.

While some of these actions may seem drastic, they can save the lives of drivers and pedestrians as well.

Adjustments for Safer Driving

Completely removing the person’s driving privileges may not necessarily be the best approach. There are some programs that help elderly drivers adjust their driving to changes in their physical condition. The American Association of Retired Persons,(or AARP) sponsors the 55-Alive Mature Driver Program, which helps older people deal with issues such as compensating for vision problems caused by aging. In addition, there is the Association for Driver Rehabilitation, which offers referrals to specialists who teach people with disabilities, including those associated with aging, how to improve their driving. The most common adjustments that elderly drivers make are to avoid driving at night and if possible, at dawn and dusk. They can try to avoid driving in bad weather and driving to unfamiliar locations. If long distances must be driven, they can take frequent breaks, and not drive for more than two hours at a time and no more than a total of six or seven hours a day. When driving locally, they should try avoid expressways, especially during rush hour traffic.  They should also try to avoid very busy or congested roads.  The car radio should stay off, and mobile phones should only be used while parked in a safe location. Always schedule plenty of time to get to the destination so no one feels rushed.  Elderly drivers should also avoid driving alone. This final suggestion is especially important for people who have a disability such as arthritis in the neck or shoulder and may not be able to turn their neck well enough to look in all directions. They should have a partner driver who can help with backing up, checking blind spots, and keeping an eye on traffic signs and signals.

Click here to learn more about elderly driving programs.

Driving Alternatives

Some solutions for giving up driving privileges include walking, using public transportation, and special shuttles for seniors. Most cities offer special discounts for seniors on buses, trains, and shuttles. Senior centers and community service agencies can help to find special transportation alternatives. Some businesses, like grocery stores and health care centers, have vans or shuttles designated for seniors in the area. Another suggestion is to sell the car and use the money for taxis and shuttle services. You can also simply offer to drive people wherever they need to go, but never leave them alone in the car with the keys.

For additional resources, you can contact the following agencies.

The AARP (formerly the American Association of Retired Persons) offers the highly recommended Driver Safety Program for older people.

The Association for Driver Rehabilitation offers referrals to professionals trained to help people with disabilities, including those associated with aging.

The USAA Educational Foundation, AARP, and the National Highway Traffic Safety Administration developed a very informative booklet, “Driving Safely While Aging Gracefully.” It describes many of the physical changes associated with aging, and includes tips on coping with them so that older people can remain safe drivers.

Summary of Driving Issues

In summary, unsafe driving can start in the early stages of Alzheimer’s diseaseCaregivers need to watch for the signs of unsafe driving.Start talking about restricting driving privileges early in the illness.Gradually reduce driving over time. Involve family members and healthcare providers in the decision to restrict or stop driving.Approach the person with your concerns and assure the person that driving alternatives are available. If a person refuses to stop driving, involve the DMV, disable the car, take away the car keys, install a car alarm, move the car, or get rid of it.Lastly, look into programs that teach older people how to modify their driving to make it safer.

Planning for Holidays and Special Occasions

Now let’s discuss some issues and strategies for managing holidays and special occasions.  These times often require travel and special caregiving strategies.  The hurried pace and busy activities of the holidays can be stressful for just about anyone, but for someone with Alzheimer’s disease, the change in routine can be especially disruptive and confusing. To make sure that these times are enjoyable for all, some advanced planning is necessary.

The guiding principles in planning for holidays and special occasions with a person with dementia are to maintain as normal a life as possible, to support and utilize their retained capacities, to progressively simplify the event, and to have all of the family members share the responsibilities with the primary caregiver.

Celebrating holidays and special occasions need not be abandoned because a family member has Alzheimers disease.  In fact, observing holidays and special events can provide continuity of traditions for someone with dementia.  If carefully planned, these times can elicit happy memories, renew relationships and celebrate family. 

Caregivers should not feel that they need to take on the responsibilities of special events as well as the caregiving duties alone. Do not be reluctant to accept help when it is offered, or be embarrassed to ask for it. Be honest with friends and family about the limitations that you are facing, and remember that caregivers need to celebrate as well. Take time to relax and do things that you enjoy. Send yourself a gift and pretend that your loved one sent it, as she or he probably would have if able. Keep in mind that holidays and special occasions are opportunities to show love and appreciation to the important people in our lives.

Holidays Planning Tips for Caregivers

Caregivers should begin by letting go of any expectations that the holidays will be exactly the same as always, because Alzheimer’s disease greatly reduces a person’s ability to deal with stimulating, unfamiliar activities. Holidays and special occasions are very different from normal, daily routines. They can involve loud conversations, bright or blinking lights on ornaments, excited children running about, and special foods served at different times in different settings from regular meals. Someone with Alzheimer’s will probably feel overwhelmed in this kind of environment, and can feel more confused, anxious or irritable. 

When planning special events, try to involve those with dementia in ways that they can successfully participate.  All people enjoy feeling appreciated and needed and want to make valued contributions to activities.  So consult them in holiday planning and invite them to assist with the preparations.  Be creative in finding something that they can do, such as stuffing greeting cards, wrapping presents, or helping to hang ornaments.  Keep your expectations reasonable and dont worry if things dont turn out perfectly, as even the effort can provide pleasure and a sense of accomplishment. So relax and enjoy things as they are. 

Case Study 3

Let’s consider an example with Mary and  Robert, who is in the early stages of Alzheimers disease. They plan on attending a family reunion in another state. There will be about 25 people at the reunion.  Robert has never met some of them before, such as new grandchildren and spouses. The family knows that Robert was diagnosed with Alzheimers a little over a year ago and that he still socializes, but they do not know about Roberts difficult behaviors and occasional outbursts.

What should Mary say to the family about Robert’s dementia and occasional difficult behaviors?

  • A. She should write to everyone in advance to tell them about Robert’s behavior.
  • B. She should not say anything to anyone about his difficult behaviors.
  • C. She should wait until the need arises and then say something.

Case Study 3 Answers:

Choice A: She should write to everyone in advance to tell them about Roberts behavior, is a possibility, but not the best answer. 

At this early stage, Robert still attends to his own personal care and can easily speak with people, though with some hesitation and sometimes about unrelated topics. Because Roberts difficult behaviors are rare, it probably isnt necessary to inform everyone about it.

In the early stages of Alzheimers disease, individuals seem to be able to pull themselves together in social situations, so that people who do not have daily contact may not be aware of their illness.  Informing everyone in advance could take away Robert’s dignity and control, which would go against one of the core principles in dementia care. 

Choice B: She should not say anything to anyone about his difficult behaviors, is another possible answer but not the best one.

People in the early stages of Alzheimer’s can get confused and respond with agitation or inappropriate behavior.  If Robert gets into a situation during the reunion in which he gets confused or distressed, it may be wise to let people know about his condition to avoid embarrassment or reactions that could worsen the situation. 

Choice C: She should wait until the need arises and then say something, is the best answer in this situation.

If Robert gets confused or responds inappropriately to someone, Mary can help orient and calm Robert, and then say a brief word at a discrete moment to involved family members. If  Robert becomes very disruptive or inappropriate, Mary can calmly remove him from the situation and take him to a quiet place to calm down.  She can also redirect him by offering a relaxing, alternative activity. 

Party Planning

By planning celebrations to provide comfortable, controlled environments for those with Alzheimers, it will increase their chances of doing well and enjoying the festivities. Here are a few strategies for planning holiday parties and special events. 

When planning a party or special event that includes someone with Alzheimers disease, it is important to remember that a lot of noise and activity can distress that person. The caregiver should take the person to a quiet place at the first sign of distress or anxiety.  Another possibility is to plan quiet, alternative activities for the person separate from the main party.

Once at a party or special event, the person with Alzheimer’s should be settled into a comfortable seating area that is away from the main hustle and bustle of the party. 

People with dementia can have trouble focusing when several people are talking together. It’s easier for them to talk to one person at a time, so friends and relatives should take turns visiting. If the person starts to become anxious, agitated , or inappropriate during a visit, the caregiver should intervene and direct the visitors away or guide the person to a quiet place to calm down.  Sometimes redirecting the person by offering a relaxing activity can be effective. Have calming distractions prepared just in case the person needs to be redirected.  For example, have relaxing music or a fun movie ready to enjoy in a quiet room.

Party activities that include someone with Alzheimer’s and young children should be planned to involve minimal chaos and noise. Quiet, simple, structured activities are usually most manageable for those with Alzheimers. The person might enjoy decorating holiday cookies or making a decoration with a few grandchildren, rather than trying to sustain a conversation or participate in unstructured play. Again, if the person starts to become anxious or agitated during an activity, the caregiver should intervene and guide the grandchildren or the person away.

Party Planning (Continued)

Depending on the day or hour, a person with Alzheimers may or may not remember certain relatives and friends. When making introductions, the caregiver can provide orienting information by saying something like, Robert, your grandson Matthew wants to wish you a Happy Thanksgiving. Say hello to your grandson, Matthew.

Others attending the party can help the person feel less confused by discussing past events, rather than talking about the present or future. People with Alzheimers often maintain good long-term memory, so they will be able to enjoy reminiscing about old memories. One idea is to put out scrapbooks with clearly labeled photographs and other memorabilia for everyone to enjoy together.

If a family member lives in a long-term care facility, do a trial run with a short visit home before the special event. For many with Alzheimer’s, being removed from familiar surroundings can be disorienting and distressful.  So if a home visit for a special occasion seems too stressful, arrange for visits by small groups to the care facility.

Summary of Holiday and Special Events

In summary, holidays and special occasions can be enjoyable for everyone with some special planning and organization, but it is important to keep reasonable expectations.

Involve those with dementia in holiday planning and invite them to assist with preparations that use their retained capacities.

At gatherings and special events, provide a comfortable, controlled environment in an area with less noise and activity. Plan quiet, structured activities that are separate from the main party. Have calming distractions prepared just in case the person needs to be redirected away from a negative situation. Take the individual to a quiet place or reduce the surrounding noise and activity at the first sign of distress or anxiety. If inappropriate or difficult behaviors occur, respond with discretion and calmly remove the person from the situation.

Discuss past events that are likely to be remembered rather than talking about the present or future.  One way to promote this is to put out scrapbooks and other memorabilia.

If a family member with dementia lives in a long-term care facility, do a trial run of a home visit before the special event.

Lastly, caregivers should remember to take care of themselves and to accept or ask for help when needed.

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Written by: Catherine M. Harris, PhD, RNCS (University of New Mexico College of Nursing)

Edited by: Mindy J. Kim-Miller, MD, PhD (University of Chicago School of Medicine)

 

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