The decision to "give up the keys" is one of the most agonizing issues for patients and families, since it has many emotional and practical implications. The progressive nature of cognitive and behavioral impairments in dementia will eventually result in the patient being unsafe to drive. The physician often takes a pivotal role in this decision and may be asked to tell the patient he/she can no longer drive so that the caregiver will not bear the brunt of the patient’s anger.
To learn more about older driver safety, view the AMA's Physician's Guide to Assessing and Counseling Older Drivers.
Wandering becomes a safety issue when the patient becomes lost or is inappropriately dressed for the weather. Sometimes wandering is agenda-driven (e.g., trying to go home, trying to go to work, trying to catch a bus) or it may be aimless.
- Adaptations for safeguarding the home include camouflaging exits or making them inaccessible. For example, place a stop sign on the door.
- Enroll in Alzheimer’s Association Safe Return Program. An identification bracelet for the patient is recommended and can be obtained through local pharmacies or by mail order.
- Alert local police department to possibility of patient wandering and provide current photograph for identification.
Addressing safety concerns means dealing with the tension between caregiver beneficence and patient autonomy. As patients with dementia gradually lose decision-making capacity, realignment of the weight given to each becomes increasingly important. Even so, there still must be informed consent either by the patient or a designated agent.