Naomi was hopelessly lost. As she drove, absolutely nothing looked familiar. She noticed a fluttering in her stomach. She had to admit that she was in a lovely area, with large shade trees and a lovely lawn, but there were no houses where she could stop to ask directions. And the road seemed so narrow. She was starting to feel confused again. And there was nowhere to turn around. So she stopped the car and placed the gearshift into park.

Some time passed before a groundskeeper noticed the car on the golf course cart path. He called the police. A patrolman checked Naomi's identification and called her husband. The police officer then notified the state driver's licensing authority that Naomi should be retested.

Knowing when and how to take away the keys to the car is one of the most troublesome issues facing families who have a loved one with the illness. As we age, our eyesight and hearing may worsen. Depth perception plays tricks. Our reaction time slows. These elements of normal aging may interfere with our ability to drive a motor vehicle safely. For someone with Alzheimer's disease, these normal processes are complicated by additional symptoms related to the disease's effect on the brain. In fact, studies show that a person with Alzheimer's disease has twice the chance of being involved in a motor vehicle accident as a driver of the same age without the illness.

While a person in early stages of Alzheimer's disease may retain the ability to drive a motor vehicle, as the disease progresses, the time is likely to come when he or she is no longer safe behind the wheel. At the same time, the person with Alzheimer's disease will cling to whatever sense of independence he or she can.

The American Psychiatric Association says that some Alzheimer's patients with moderate impairment and all severely impaired patients pose unacceptable risks to themselves and others behind the wheel of a motor vehicle. Even those in early stages of the disease may be unable to drive even short distances safely. Depending on the individual, family members and others have a responsibility to assess the situation and, when necessary, step in and take away the keys.

Warning Signs

How do you know when to restrict driving privileges in a person with Alzheimer's disease? Trust your instincts. If you feel uncomfortable riding with him or her-or letting your children ride along-you may have unconsciously decided that the time has come. Another indicator is the person's inability to follow a recipe or perform simple household tasks. These types of activities require some of the same mental abilities necessary for safely operating a motor vehicle.

Deterioration in the ability to concentrate, as well as impairment of judgment seen in people who have Alzheimer's disease, add to the concern about such patients driving motor vehicles. According to the Alzheimer's Association, some things to watch for include the following:

1. Getting lost.

Anyone can get lost in an unfamiliar area. Those with Alzheimer's disease may become disoriented and be unable to find his or her way in familiar locales.

2. Ignoring traffic signals.

Failure to notice or obey stop signs, traffic lights or other highway markers may mean the driver didn't notice them. In addition, the driver may have lost the ability to associate the sign with its meaning. He or she may see the sign, but not know what it means.

3. Lack of judgment.

Inability to estimate the speed of oncoming traffic, deciding whether to stop for a yellow light or slide through the intersection, or becoming confused at a four-way stop sign are some examples of poor judgment while driving. Being slow to make decisions-or making poor ones-when driving can result in accidents that can harm the driver, as well as others on the road.

4. Driving too fast or too slowly.

Erratic driving at inappropriate speeds can indicate a lack of concentration, as well as poor physical coordination. It may also indicate poor judgment.

5. Anger and confusion.

You don't have to have Alzheimer's disease to experience road rage. Frustration during driving can make anyone flustered or angry. If the driver has Alzheimer's disease, however, watch for frequent occurrences of anger or confusion, as well as inappropriate or exaggerated reactions, while driving.

Taking Away the Car Keys

If your family member's ability to drive is impaired, you have a moral responsibility to take action to keep him or her off the road. However, accomplishing this goal may not be easy. Any suggestion that car keys be relinquished could be met with resistance, frustration, anger, or hostility-especially when it comes from a family member who may already be providing care by assisting with activities of daily living like bathing, dressing, and meal preparation.

Ask the Doctor

Many Alzheimer's families turn to the loved one's physician for help with the issue. Your loved one may more easily accept advice not to drive from a health care professional he or she has an established trust relationship with. For one thing, a doctor is often seen as an authority figure. For another, such a third party can discuss the situation objectively and dispassionately with less chance of offending your loved one on a personal level. Many doctors understand the need for this intervention and will be willing to comply with requests of this nature from family members. In some cases, doctors will write the words "Do Not Drive" on a prescription slip. In others, you may need to ask the doctor to file a request for re-examination of your loved one's driving abilities by the state driver's licensing authority.

Contact the State Licensing Authority

All states have a system in place to require retesting of persons with mental or physical impairments. However, state laws and re-examination processes vary. They may include medical evaluation, as well as written and road tests. Laws also vary concerning who is authorized to request re-examination. They may include police officers, judges, state's attorneys, physicians, family members, neighbors, friends, or other drivers. In some states, all older drivers must take driving tests for annual renewals. Check with your state's driver's licensing authority to see what rules and procedures exist for revoking driver's licenses for impaired drivers.

If your loved one's driver's license is ultimately revoked, he or she should get a state issued photo identification card to use for check cashing, air travel,

Protecting Insurance Coverage

Even with a doctor's advice not to drive, or a driver's license revocation, a person with Alzheimer's may still get behind the wheel. He or she may forget that driving is no longer allowed. Or, stubbornness, anger, or frustration may encourage him or her to grab the keys and hit the road. If that happens and an accident occurs, serious consequences-beyond the risk of personal injury or death to the driver, passengers, or others-may result.

For example, although some state laws require insurance companies to honor claims involving insured motor vehicles, even if driven by an unlicensed driver, an insurance claim can be challenged. Insurance coverage may be cancelled. And future applications for motor vehicle insurance can be denied. In some states, insurance companies can cancel policies if a driver's license is revoked, regardless of whether an accident has happened or not. Should a driver without coverage become involved in a motor vehicle accident, his or her assets will be at risk from claims by accident victims for property damage or personal injury.

These issues are particularly important for an unimpaired spouse of a person with Alzheimer's disease. Insurance cancellation will jeopardize the spouse's insurability. Acceptance under a new policy may be difficult because of the spouse's older age. And the new policy may cost much more than the previous one. State insurance laws vary, and some states have regulations pertaining to such situations.

One option is for the impaired driver to exclude himself or herself from the policy, enabling the unimpaired spouse to continue insurance coverage. But if the excluded driver drives anyway, a claim for personal injury or property damage to the driver's car may not be honored to the full extent of the policy's limits. (Liability claims by others would likely be paid, however.) If that happened, the policy would most likely be canceled.

Action Steps for Family Members

Depending upon your loved one's abilities and desire to drive, regardless of driver's license status or doctor's orders, family members can take steps to prevent an impaired driver from operating the car. Here are six steps you can take: 1. Sell the car. If the car won't be driven, it makes sense to sell it. However, Americans love their cars. Some even name them the way they would name a pet dog or cat. If your loved one is attached to his or her motor vehicle, your suggestion to sell it may meet strong objection, even if the impaired driver seems to understand that driving is no longer allowed. If the loved one wants to keep the car, or is comforted by seeing it in the garage or driveway, you can disable the car so it can't be driven. 2. Hide the car keys. If the car remains in the family, someone must control access to all copies of the keys. Lock them in a safe place unknown to the impaired driver. 3. Replace the car key. If the impaired driver resists or refuses to hand over his or her set of keys, quietly replace the car key with one that looks like it, but that doesn't work in the vehicle. 4. Remove the tires. Removing the tires will disable the vehicle, but in some residential areas, parking a car on blocks is not allowed, except-perhaps-in an enclosed garage. Check with your local jurisdiction before taking this step. 5. Disable the vehicle. Ask a mechanic to show you how to disconnect the car's battery or how to disconnect the coil wire between the coil and distributor. If a spouse or other household member needs to use the car, reconnecting them is relatively easy. 6. Park the car elsewhere. Park the car down the street, around the corner, or out of sight in a neighbor's garage to make it inaccessible.

Look for Alternatives

A person who has been driving for decades and who takes pride in his or her independence will likely resist attempts to restrict driving privileges. That independence is difficult to give up, especially in neighborhoods without good public transportation systems. The person may not want to burden friends or family to get where he or she wants to go.

In modern American culture, driving is important. For many, it involves self-esteem and status as well as mobility. For these reasons, those who have Alzheimer's disease are unlikely to admit difficulties they are experiencing when driving. So, family members and physicians must balance the person's convenience with the safety of the driver, as well as passengers and other drivers on the road.

When restricting driving privileges becomes an issue, you can ease the transition by investigating alternative methods of getting from place to place. Here are some choices you can make available to your loved one in place of a personal motor vehicle.

1. Friends and family.

Are you willing to provide all or part of your loved one's transportation needs? What about other family members? If friends say, "let me know if I can do anything to help," suggest they give your loved one a ride to the grocery store, hairdresser, or doctor's appointment. You can also ask for volunteers at your place of worship.

2. Public Transportation.

Gather information about bus routes, train schedules, and taxi services. See whether they offer discounts for older individuals or those with disabilities. Calculate round-trip fares from your loved one's home to frequently visited locations, such as the grocery store, doctor's office, barber shop, or library.

3. Government ­funded transportation.

Investigate availability of government-funded transportation for people with disabilities. Inquire about how to qualify for such programs.

4. Delivery Services.

To reduce the need for trips outside the home, look for pharmacies, office supply stores, restaurants, and other businesses and organizations that deliver goods and services to the home. Find a courier service that operates in your area, or see whether a taxi service will perform that function. Look into the Meals on Wheels program in your area.

William G. Hammond, JD is a nationally known elder law attorney and founder of The Alzheimer’s Resource Center. He is a frequent guest on radio and television and has developed innovative solutions to guide families who have a loved one suffering from Alzheimer’s. For more information you can visit his website at www.BeatAlzheimers.com

support@Alzheimers-Resource-Center.com