The Delicate Task of Asking for the Keys

One of the most difficult challenges for any family member or caregiver of a loved one who has any form of dementia, is to know when to step in, and when to lend a helping yet unobtrusive hand.


In the early stages of dementia, a gently, but firm hand is often necessary, as personalities start to change, forgetfulness blamed on being tired or denied altogether, and aggressive or paranoid behaviour creeps in ever so slightly.  We figure, as long as they're not really harming anyone or only harming themselves, as we long as we keep a watchful eye, and clean up when necessary, what's the harm? Give them the space they need to adjust, calm down, retreat and start anew.


But most of us who have been through that stage onto the more worrisome and harmful stage of losing sense and awareness of how to complete a basic task, aggressive behaviour that becomes troublesome and hurtful to others, or the inability to follow or participate in a conversation, knows that inevitably, step in you must.


One of the most delicate step ins, is when to ask for the keys of the car, on a permanent basis.  The American Academy of Neurology just issued a new guideline Monday, on when people with Alzheimer's disease or other forms of dementia should cease driving.  


When you review the news release, you quickly get a sense that this isn't a simple blood test or a breathalyzer or an MRI that can definitively pinpoint a time, a symptom or an event.  It does however, strongly suggest that with the doctor's lead, the caregivers or loved ones really must be called on to monitor the warning signals.  In the past, the Grandkids rule has been used, in that if you wouldn't trust your grandkids in the car being driven by the patient with dementia or undetected dementia, then that person shouldn't be driving.


The new report suggests using the Clinical Dementia Rating (CDR) by your physician to test your loved one, with input from the family members or caregivers as to those warning signals:  less miles driven than usual; collisions; aggressive or impulsive behaviour; avoidance of certain types of driving (night-time).  


In the case of my father, when dementia kicked in literally over night, he or we didn't know what had hit us.  It was shocking, terrifying, surreal and literally set us on a course where the learnings came fast and furious.  


But when it came to the car keys, somewhere in his confused, bewildered and scared mind, he sensed that he was a danger to himself and others, and gave up the keys willingly and without hesitation.  Even though I know, that not being able to drive was one of those fears that he lived with from a much younger and healthier age.  Please not me, I'm sure he prayed.


You see, my father Garo, was and continues to always put his loved ones before himself.  He didn't want to be responsible for any of us getting hurt.  The fog of dementia always seems to provide just enough clarity for him when its one of us that's involved.  Then again, that part of my father hasn't really diminished, dementia or not.  It shines through, clear and proud.