22: Traveling, Driving, Holidays & Special Occasions

This program will:

  • Teach you how to assess someone’s ability to travel
  • Provide strategies for traveling with or arranging solo travel for someone with dementia
  • Teach you how to recognize the signs of an unsafe driver
  • Provide strategies for getting someone to stop driving
  • Provide strategies for celebrating holidays and other special occasions
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Important to self esteem
  • May pose dangers or difficulties
  • Requires advanced planning

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.

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

  • Sometimes it is helpful to involve a physician in the decision-making process regarding activities and capacities

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

  • Abilities can fluctuate on a day to day basis
  • New surroundings unfamiliar people, and busy settings can cause confusion and stress
  • Make sure the choices match the level of the individual’s capacities

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

  • Consider the person’s capacities and limitations when making special arrangements
  • Escort service at airport
  • Smaller, less busy airport for layover
  • Brother to arrive early at the terminal
  • Transportation pre-arranged
  • Identification, itinerary, boarding pass
  • Important information
  • Emergency contacts (including physician)
  • Medical issues
  • Allergies
  • Medications (dose, schedule, pictures of pills)
  • “Safe Return®” bracelet

Click here to learn more about the Safe Return® Program.

  • Carry-on bag with food, money, mobile phone
  • Ribbon for checked baggage
  • Medication caddy
  • Detailed care instructions
  • Escort security pass
  • Promote autonomy and independence
  • Provide safety and security
  • Make careful preparations
  • Involve family members and the person
  • 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?
  • How does the person deal with negative feelings and impulses?
  • Individualized care based on the individual’s personal preferences, life history, cultural norms, and beliefs

CORE PRINCIPLES IN DEMENTIA CARE

  • Safety and Security
  • Comfort
  • Respect and Love
  • Autonomy
  • Involve the person in the planning process
  • Respect the person’s choices when possible
  • Plan in advance
  • Assess the limitations of the travelers (caregiver and care recipient)
  • Consult travel and health care professionals
  • Negative reaction to changes of environment, people, routines, time zones, noise, or fatigue
  • SIGNS THAT TRAVELING MAY NOT BE A GOOD IDEA
  • Needs assistance with bathing, dressing, and grooming
  • Frequent disorientation, confusion, or agitation
  • Wanting to go home when away for short periods
  • Delusional, paranoid, or disinhibited behavior
  • Teary, anxious, or withdrawn behavior
  • Agitated or wandering behavior
  • Physical or verbal aggression
  • Yelling, screaming, or crying spontaneously
  • High risk of falling
  • Incontinence
  • Unstable medical conditions
  • Trial run
  • Take a short trip using the same type of transport planned for the longer trip
  • Manage unexpected events and challenging behaviors
  • Face stressful situations and lack of sleep
  • Requires patience and flexibility
  • Plan in advance and seek help as needed
  • Plan and prepare carefully
  • Involve the person in simple decisions
  • Keep trips simple and short
  • Travel to familiar, stable, well-ordered settings
  • Make flexible plans
  • Allow plenty of time for everything
  • Travel during the person’s best time of day
  • Do not drive alone with someone who is agitated
  • Take regular rest breaks to meet basic needs
  • Dress in comfortable clothes
  • Do not leave the person unsupervised
  • Avoid crowded, busy, or loud places
  • Look for signs of distress and try to calm and reassure
  • Request transport at airports and travel stations
  • Inform staff of special needs and ask for assistance
  • Inquire about and use services for people with disabilities
  • Try to keep a sense of humor, and enjoy your time

Copies of important documents and information

  • Identification
  • Emergency contact information
  • Doctors’ names and contact information
  • List of current medications, dosages, picture of pills
  • List of drug or food allergies
  • Copies of legal papers (living will, advanced directives, power of attorney, etc.)
  • Insurance information
  • Travel itinerary
  • Provide itinerary to family members and those you are visiting
  • Have the person carry or wear identification at all times Information in a wallet/purse:
  • Name, important phone numbers, medical conditions
  • Enroll in the Safe Return® program. Click here to learn more about the Safe Return® Program.
  • Have person wear a locating device

Pack:

  • Water, drinks
  • Snacks
  • Activities to do
  • Favorite items
  • Medications
  • Emergency kit in a watertight bag/container
  • First aid kit
  • Copies of important documents and identification
  • Recent picture of the person with dementia
  • Extra clothing
  • Extra medication
  • Incontinence products
  • Bottled water
  • Food
  • Be sure that your destination has the following:
  • Working smoke alarms and fire extinguishers
  • Non-slip surfaces in the shower and bathtub
  • Adequate lighting in the hallways, bedrooms and bathrooms
  • Remove potential hazards and clutter if possible
  • Check water temperature
  • Be aware of the risk of wandering
  • Keep car keys away
  • Consider a portable door alarm or childproof doorknob cover
  • Lock the door to the room and place a chair in front of it if possible
  • If there are two beds, have the person sleep in the one furthest from the door
  • Requires careful planning and preparation
  • Consider the person’s abilities and limitations
  • Consult a healthcare provider
  • Keep trips simple, short, familiar
  • Make arrangements for services provided to seniors or people with disabilities
  • Pack copies of important documents and information
  • Pack food, water, activities, favorite items, medication, and an emergency kit
  • Have the person carry important information at all times
  • Be prepared for the possibility of wandering
  • Make sure the destination has a safe environment
  • Driving Issues
  • Loss of muscle strength and flexibility
  • Changes in Driving Ability Due to Aging and Alzheimer’s Disease
  • Impaired vision and hearing
  • Decreased spatial perception
  • Diminished attention span
  • Slowed reaction time
  • Decreased perception of traffic lights and signs
  • Disorientation
  • Dementia and older age are associated with higher rates of car accidents and fatalities
  • MEDICAL FACTORS
  • Alzheimer’s disease
  • Parkinson’s Disease
  • Heart disease
  • Alcoholism
  • Diabetes
  • Stroke
  • Arthritis
  • Sleep apnea
  • MEDICATIONS
  • Opioids, benzodiazapenes, tricyclic antidepressants, some antihistamines, glaucoma medications, nonsteroidal anti-inflammatory drugs, muscle relaxants, and painkillers
  • Unsafe driving an average of 11 months after diagnosed with mild Alzheimer’s
  • Older Age
  • Less education

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.

Choice A: Confront Robert and demand that he give up driving, is a possibility, but not a very good choice.

  • Include the driver in the decision-making process, rather than dictating a decision.

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

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

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

  • Getting lost 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
  • Inability to make quick or accurate decisions
  • Hallucinations
  • Confusion when changing lanes or stopping
  • Drifting out of one’s lane
  • Anger, frustrated, or confusion while driving
  • Taking longer to get to places
  • Honking horns or rude gestures from other drivers
  • Tickets for traffic violations
  • New scratches and dents on vehicle
  • Car accidents
  • Trouble with walking, climbing stairs, or performing heavy housework
  • Begin talking early on about when to stop driving
  • Reduce driving gradually over time
  • Have groceries, prescriptions and meals delivered
  • Find reasons why someone else should drive
  • New, unfamiliar route
  • Driving conditions are dangerous
  • Needs to rest
  • Enjoy the scenery
  • Have a passenger distract the person
  • Do not dry drive alone with someone who is agitated or unpredictable
  • Approach the person with your concerns
  • Be prepared to provide information, examples and reassurance
  • Provide options for alternative transportation
  • Involve family and friends
  • Provide options for alternative transportation

Click here for more information on transportation

  • Involve the person’s physician
  • Ask for a prescription or letter
  • Request that the DMV perform a driving test or revoke the license
  • Some states require a driving test following the diagnosis of dementia
  • Learn about the driving regulations in your state
  • Consider having the person take a driving test at least every 6 months
  • People who have moderate or severe dementia should not be driving
  • Exchange car keys for an unusable set
  • Take away the car keys
  • Have mechanic install a switch that disables the car
  • Disconnect the battery, remove the distributor cap or starter wire
  • Leave headlights on all night
  • Install a car alarm
  • Move car to a different location
  • Have car towed away
  • Get rid of the car
  • Avoid driving at night, dawn, or dusk
  • Avoid driving in bad weather
  • Avoid unfamiliar places
  • Avoid driving long distances
  • Take breaks at least every 2 hrs
  • Avoid expressways
  • Avoid driving during rush hours
  • Try to avoid busy or congested roads
  • Do not use the radio or cell phone while driving
  • Schedule plenty of time to get to destination
  • Avoid driving alone

Click here to learn more about elderly driving programs

  • Walking
  • Public transportation
  • Courtesy shuttles
  • Taxis
  • Friends and family members

Additional Resources:

  • AARP (American Association of Retired Persons)

1-888-227-7669 601 E Street NW, Washington DC 20049. Driver Safety Program

  • Association for Driver Rehabilitation

1-608-884-8833 P.O. Box 49, Edgerton, WI 53534. www.driver-ed.org

  • Driving Safely While Aging Gracefully

Driving Safely Aging

  • Unsafe driving can start in the early stages
  • Watch for the signs of unsafe driving
  • Start talking about restricting driving early
  • Gradually reduce driving over time
  • Involve family members and healthcare providers
  • Approach the person with your concerns and assure the person about driving alternatives
  • If necessary, involve the DMV, disable the car, take away the car keys, install a car alarm, move the car, or get rid of it
  • Modify driving to make it safer
  • Maintain as normal a life as possible
  • Support and utilize their retained capacities
  • Progressively simplify the event
  • Have all of the family members share the responsibilities
  • Holidays and special occasions can provide continuity, elicit happy memories, and celebrate family
  • Caregivers should not be reluctant to accept help when it is offered, or be embarrassed to ask for it
  • Take time to relax and do things that you enjoy
  • Send yourself a gift
  • Let go of any expectations that the holidays will be exactly the same
  • When planning special events, try to involve those with dementia in ways that they can successfully participate
  • Be creative in finding something that they can do
  • Stuffing greeting cards, wrapping presents, or helping to hang ornaments
  • Keep your expectations reasonable
  • Don’t worry if things don’t turn out perfectly
  • Robert’s is in the early stages of Alzheimer’s disease
  • Attending a family reunion
  • Never met some of the family members before
  • Family does not know about Robert’s difficult behaviors and occasional outburst

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.

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

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

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

  • Provide a comfortable, controlled environment
  • Take the person to a quiet place at the first sign of distress or anxiety
  • Plan quiet, alternative activities for the person separate from the main party
  • Provide a comfortable seating area that is away from the main activity of the party
  • Friends and relatives should take turns visiting with the person
  • If the person starts to become anxious, agitated, or inappropriate, the caregiver should intervene and direct the visitors away or guide the person to a quiet place to calm down
  • Redirect with a relaxing activity
  • Have calming distractions prepared
  • Party activities that include young children should be planned to involve minimal chaos and noise
  • Quiet, simple, structured activities are usually most manageable
  • When making introductions, the caregiver can provide orienting information
  • Discuss past events rather than the present or future
  • Put out scrapbooks with clearly labeled photographs and other memorabilia for the person and visitors 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
  • If a home visit seems too stressful, arrange for visits by small groups to the care facility
  • Holidays and special occasions can be an enjoyable with some special planning and organization
  • Keep reasonable expectations
  • Involve those with dementia in holiday planning and invite them to assist with preparations
  • 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 to be redirect the person
  • If inappropriate or difficult behaviors occur, respond with discretion and calmly remove the person from the situation
  • Discuss past events rather than the present or future
  • Put out scrapbooks and other memorabilia
  • Do a trial run of a home visit before the special event
  • Take care of yourself and accept or ask for help when needed

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

21: Environment Issues: The Human Environment

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion
  • Aging Parents and Elder Care. (2009) When to Put the Brakes On Elderly Drivers. Retrieved on December 28, 2008 from http://www.agingparents-and-elder-care.com/Pages/Checklists/Elderly_Drivers.html
  • Alzheimer’s Association. (Nov 2007). Travel Safety. Retrieved on May 22, 2008 from http://www.alz.org/national/documents/topicsheet_travelsafety.pdf.
  • Alzheimer’s Association. (Jan 2008). Driving Safety and Alzheimer’s. Retrieved on December 28, 2008 from http://blogs.mysanantonio.com/weblogs/alzheimers/2008/01/driving-safety-and-alzheimers.html
  • Better Health Channel. (Nov 2007). Dementia and traveling. Retrieved on May 22, 2008 from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dementia_and_travelling.
  • Blue Cross Blue Shield. 2008. Driving and the Elderly. Retrieved on December 28, 2008. http://www.ahealthyme.com/topic/srdriving.
  • California Department of Motor Vehicles. (2009). Dementia. Retrieved on December 28, 2008 from http://dmv.ca.gov/dl/driversafety/dementia.htm.
  • Carr D. 2000. The older adult driver. American Family Physician. 61(1):141-8.
  • Carr DB, Douche JM, Meuser TM, Morris JC. 2006. Older adult drivers with cognitive impairment. Am Fam Physician. 73(6):1029-34.
  • Deniz Erten-Lyons. 2008. When should patients with Alzheimer disease stop driving? Neurology. 70:e45-7
  • Evans L. 1988. Older driver involvement in fatal and severe traffic crashes. General Motors Research Labs. J Gerontology. 43(6):S186-93.
  • Hall GR. Travel guidelines for people with dementing illness. University of Iowa. Retrieved on May 22, 2008 from http://www.centeronaging.uiowa.edu/archive/pubs/Newest%20Versions%20-%20pdf%20format/Travel%20Guidelines.pdf.
  • Herrmann N, Rapoport MJ, Sambrook R, Hébert R, et al. Canadian Outcomes Study in Dementia (COSID) Investigators. 2006. Predictors of driving cessation in mild-to-moderate dementia. CMAJ.175(6):591-5.
  • Lucas-Blaustein MJ, Filipp L, Dungan C, Tune L. Driving in patients with dementia. J Am Geriatr Soc. 1988;36:1087-1091.
  • Moxley J. (1996). Totebag and Toothbrush: Travel Tips for the Alzheimer’s Caregiver. Winston-Salem, North Carolina: Piedmont Triad Alzheimer’s Association.
  • National Institute on Aging. (2007). Driving. In: Home safety for people with Alzheimer’s disease. http://www.nia.nih.gov/nia.nih.gov.
  • Netzer WJ. Alzheimer’s and the Holidays . (Dec 2, 2004). Alzinfo.org. Retrieved on December 27, 2008 from http://www.alzinfo.org/newsarticle/templates/archivenewstemplate.asp?articleid=87&zoneid=6.
  • Spitz K. How to Help Alzheimer’s Patients Enjoy Holidays: Easy Changes Can Make Season Enjoyable, Despite Illness. (Nov 11, 2008).Suite101.com. Retrieved on December 27, 2008 from http://seniors-healthmedicare.suite101.com/article.cfm/alzheimers_patients_can_enjotnehow_to_aalzhhow#ixzz0BH6ac9Mk
  • Stong C. Driving with dementia—what is the physician’s role? (2002). Neuropyschiatry Review; 3(4). Retrieved on December 27, 2008 from http://www.neuropsychiatryreviews.com/may0/npr_may02_demdrivers.html.
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