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Denise220 11-25-2010 09:30 AM

Early stages of mental decline
I’m a new poster and am dealing with issues related to the mental decline of my 84 year old MIL. Looking at the thread on levels of cognitive decline, my guess is that she is at level 3 Mild Cognitive Impairment with some signs of level 4 Mild Dementia. She lives alone in a single family home and will not consider moving. She is quite frail physically. She has stopped bathing because she can’t get in and out of the bathtub; she cleans herself at the sink (an issue for a separate thread). And she is very hard of hearing and won’t consider hearing aids.

My question has to do with allowing her to drive. She does not have a car at the moment and cannot afford to buy one. She’s in deep debt due to runaway spending on credit cards. We have control over her money now. We loaned her a car for a while, but moved it back to our house because she injured her arm in a fall and could not drive. Now after a couple physical therapy sessions, she is looking forward to getting the keys back, based on encouraging words from the therapist.

Apart from whether she is strong enough to turn the wheel, we are questioning whether she should be on the road at all. On the surface, she is fine for her age and can do day-to-day things like food shopping, going to the hairdresser, holding a simple social conversation. Having access to a car allows her to do this independently and would help keep her mentally alert and physically active. In my opinion, a lot of her mental decline is due to being alone and hard of hearing.

On the other hand, she is untrustworthy and repeatedly broke her agreement not to drive on the beltway to visit her sister. She lies regularly, which she has always done, and now it fits into her denial of her physical and mental decline.

If we return the car to her, even with restrictions, it’s a big positive for her physical and mental wellbeing. Just before she fell, we obtained car insurance in her name, so she is insurable. My husband is uncomfortable leaving the car title in our name, because if she causes an accident, liability could extend to us. If we title the car in her name to avoid liability, we then lose control over the car. If we don’t return the car to her, her life becomes even smaller since she lives in the suburbs with no taxi service. There is a county service for the aged that offers low cost rides. We have applied for it, but it is an unknown at this point. And in her mind, it is no substitute for her own car.

My question specifically is whether mental decline is possibly compartmentalized. Is it possible for her not to be able to do a complex task in the house (follow a simple recipe to make deviled eggs) but able to drive safely in an area familiar to her?

Titchou 11-25-2010 09:46 AM

Re: Early stages of mental decline
Yes it is. Not all abilities fade equally. Why don't you just tell her the car is in the repair shop, it has a flat tire, it's in the body shop, you loaned it to Aunt Sue - whatever will make it unavailable. And yes, that is lying but would you rather something more serious happened?

You could also get DMV to call her in for a road test.

Gabriel 11-25-2010 11:12 AM

Re: Early stages of mental decline
If you know she has mental decline, she gets in an accident because you have provided her with a car... That is neglect and a great liability to you. Your hubby is right on that one. Yes, there are normal routine things that they can accomplish because they pull from their long term memory that is still there. She has probably been in her house for years and years and the glasses are in the same place they were 20 years ago. It is the short term memory and judgment that goes first.

My Dad could drive a car, the actually mechanics of turning it on, putting it in gear, driving down the road until well into his dementia. But I would no more trust him on the road than I would a 5 year old. His ability to handle anything beyond sending that car in one direction was completely impaired. Mom was the same way. Yes she could physically drive the car but mentally she was incapable of being responsible for driving.

Mom drove the hour to a doctor's appointment and decided to go shopping. She hit a car in a parking lot, drove off, and went home. Somebody saw her, got her tag number, and it was hit and run. She had no memory of it every happening so those people were "crazy". She constantly backed out of the drive way, into the road, without stopping or looking. The neighbor's new to dodge or stop when she started backing out. She ran over a cute little statue of three children. Crushed it flat, never stopped, and had no idea that it had happened. Just glad that was not three children. There were random dings and dents on the van that she had no idea what happened. Beyond that she got lost a number of times on routes that she knew. As your Mom, she promised not to drive to certain places and she did anyway. The inability to find where they are going causes a problem as well as the fact that they don't remember what they promised you.

If you are able to keep the car away from here I would absolutely do it. Yes, it is one of the two hardest things you will have to do. The other is taking her out of the house for her own safety. But with the car, it is not just an issue of her safety. It is an issue of the safety of every other car around her. Just recently we had an 90 year old that killed a family of three because she was going the wrong way on an express way. She passed car after car with them honking, dodging, and waving at her... and she never seemed to realize that there was a problem... just speeding down the express way into oncoming traffic. Yep, she had early to mid stage dementia. It only takes one time to fill a lifetime with regrets.

Please talk to the physical therapist and tell her not to encourage the driving. If Mom insist then take her to a driving evaluation. You can find those though your department of motor vehicle or through the Alzheimer's Society. Let them evaluate her physical and cognitive abilities. They will tell her whether she is capable of driving or not and the monkey will be off your back.

Just know that this is the hardest but the most important step you need to take at this time. Yes, it does lesson their independence and makes their world smaller but it can save them... and others. Will she fuss.. UH HUH!!! My dad griped and complained and yelled and cursed and on and on for three years. I actually put his van keys in the casket with him so he would leave the angels alone about it :) Mom called 911 and reported the van stolen... by her girls!! They fought us every step of the way for 3 years but never got their van back. There is a wonderful single mother with three kids that is enjoying it now :) Not easy, but necessary!!

Keep posting... most of us have been where you are and know the pitfalls. Hate you need to be here but glad you found us.... Welcome!!!

Love, deb

meg1230 11-25-2010 04:18 PM

Re: Early stages of mental decline
For her safety, for your safety, for my children's safety, for my grandchildren's not let her have a car.

As Deb said, the hardest thing for us to do was to take my mom's car away from her but it was our responsibility to protect her..and all the rest of us.

No amount of rationalizing equals the dangers of her driving.
She doesn't have it now so make it easy and keep it away...not easy but much easier than giving it back to her and then having to figure out how to get it away again.

We have been where you are, so we understand...stick with us and we'll get through this together.

And like Deb did with her dad, we will send my mom off to the great highway in the sky with her car keys.

Love, Meg

Denise220 11-28-2010 09:50 AM

Re: Early stages of mental decline
If I may ask those of you who have gone through this, what stage of mental decline was your parent at when you made this decision for him or her? Had he or she been professionally evaluated at that point?

Gabriel 11-28-2010 11:58 AM

Re: Early stages of mental decline
When you have a doubt about their ability to drive, it is time. Mom had been diagnosed through a memory assessment research service which was part of a local university's psychology department. This can be done by a neurologist or other professional that specializes in dementia and geriatric care. It is not a diagnosis that you need to trust to your general physician. There are those professionals that do specialize in this disease and they understand it much better than those without the specialization.

As for the driving, if you are in doubt then make sure. If you will call your local Alzheimer's Association they can give you the contact information for someone who can do a cognitive driving evaluation. Then you can have your love one go through the testing. That will give you an unbiased evaluation based on Mom's ability without the emotional entanglement that we have. If your loved one is still capable of driving then you will know it for sure... and if not then they will be the ones to deliver the news to your loved one. That will take you off the bad list with your loved one :) Blame it on the professional who carry more weight in this situation than you do.

What level is your loved one? Have they been officially diagnosed yet? I will say for me, getting the diagnosis was the first step in being able to deal with Mom and Dad's condition. It's not something you want to know but something you MUST know. It is what gives you the ability to move forward with the hard decision to come. It gives you the validation that you are doing what is necessary. It take away the doubt that lingers :)

Love, deb

PS... if you do have any doubt please go ahead and have the necessarily legal and financial arrangements done NOW. You will need a durable power of attorney to deal with their financial and legal needs as well as a medical power of attorney and living will do deal with their medical needs. You also need to get yourself added to their HIPPA assigment at all medical institutions... including insurances. It is nice to have your name on their checking accounts as well. These are not optional but a necessity. With these papers you can handle everything except social security and military retirements or other federal agencies. If necessary, you can deal with these easily with a declaration in inability which can be obtained from the social security office and military retirement administration. It is not a declaration of incompetency that takes court order. It is just a statement that they are unable to deal with their own financial affairs. I had to do this with Mom and Dad and it was simple.

meg1230 11-28-2010 03:03 PM

Re: Early stages of mental decline
My mom had been diagnosed. She should have lost driving priveleges long before she did but she was still with her husband...he had control. We didn't. He would tell her..."Now, be careful when you drive and stay calm" and she would say, "ok, yes, I will". Then she go on her way...and God only knows what all was going on other than what we saw!! She would stop..jsut STOP in the middle of a road...she would drive through stop signs..she had dings all over her car. It took her hours to get home when what would normally be a 20 minute drive. But once my step dad died we swooped in and that was it...her driving privleges were gone! It truly broke her heart but it was necessary!

And yes, follow your gut ..if you think it is time then I will bet it is time.

Love, Meg

Denise220 12-09-2010 08:54 AM

Re: Early stages of mental decline
I thought I would give an update. My MIL has not been driving for a few months – doctor’s (orthopedist) orders because of a rotator cuff tear that cannot be surgically repaired. She accepted that, feeling it was only temporary until she was finished with physical therapy. We sent word to the orthopedist about her overall physical and mental weakness (both of which are obvious) and warning that she would be asking about driving. At the final appointment with him, she asked if she could resume driving and he was extremely clear with her, saying that he felt she was too weak to drive and directed her to her personal physician and an “adaptive driving” program at a local hospital.

During her physical therapy, she asked the PT if she could drive and he apparently said she should try. So that combined with the overall positive reinforcement the PT gave her, she was taken aback by the doctor’s response. Now the second guessing has begun. She wants to go back for another appointment with the orthopedist and “have some questions answered.”

It’s hard to separate what she doesn’t understand from what she doesn’t hear from what she doesn’t want to hear. She wants to talk endlessly about this, repeating herself a dozen times in the same conversation. And at the end of the conversation, it doesn’t appear she has made any progress in understanding/accepting because it starts all over again at the next conversation.

She doesn’t have the money to take the driving program, and we have taken the car away. Things are settled as far as we are concerned, but she doesn’t see it that way.

Gabriel 12-09-2010 10:51 AM

Re: Early stages of mental decline
And she may never Denise... or at least not until her cognition reaches the point where she doesn't remember any more. Sad, but true. Some accept it easily and some fight it right on and on.

If you can blame it on the doctor then do so. I would be having words with the Physical Therapist as well. Let everybody know that the decision has been made and don't encourage her.

Dad lost his privileges long ago and was ok with it at first because he didn't know he was not allowed. We just beat him to the steering wheel. If he had a meeting we arranged somebody to pick him up. He though they were so nice. The problem came when mom, who was doing all the driving, lost her privileges. She threw the fit and stirred Dad up as well. I listened to woes of that van for three years. They even called the police to report it stolen... by their daughters :) Dad was ok with just the keys in his pocket unless Mom was on one of her Van Rants. When Dad died last March... I sent him to heaven with his van keys!! Mom's general physician told her she just needed to "focus" a little more :eek: And of course I was in the conspiracy with the diagnosing doctor to take away her privileges. But that is now all a thing of the past because she has no memory of driving left.

Taking away those privileges is only second to taking them out of the home as being the most difficult things we have to do. You have done good and stick by your decision :) That is a huge hurdle. Just keep playing up the arm issue and keeping the car impounded!

Love, deb

meg1230 12-09-2010 03:37 PM

Re: Early stages of mental decline
Before you let anyone talk with your mother, make sure they understand to NOT tell her anything positive about any possibilities of her ever driving again. Good grief. Sometimes some people in the medical community are clueless.

My mother lost her driving privileges 3 years ago and just a few months ago said she wanted a jeep! Huh??? So I told her we would get her one next summer. That's what I tell her about everything. She can barely walk and could no more drive than man a rocket ship but they hang on to it as long as their mind allows it. It has been much less of an issue as the time goes by. It maybe lasted a year and a half..the mourning of losing her driving priveleges. She even threatened to call the police on the doctor who did the deed. She said he didn't have a legal right to do that! She was right but we didn't tell her that.

The worse is over...he car is taken away and a doctor ahs told her she can't drive. Now you jsut have to reinforece it with the reason of the day.
The oil needs changing.
Have to get tires.
Your arm isn't well enough yet. and so on and so on......

Love, Meg

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