Health – Dr. Robert Kohn

When Driving Becomes Part of Alzheimer’s Care Planning

When a person receives an Alzheimer’s diagnosis, one of the first questions they and their family members have is should they immediately stop driving. But this diagnosis doesn’t always answer the driving question on the day a doctor gives it. Some people may still drive familiar routes for a time, while families may begin to notice changes that raise concern. Care planning means deciding what monitoring, medical review, support, and transportation changes the person may need as Alzheimer’s affects daily function.

Alzheimer’s disease affects the brain over time. It can change memory, thinking, behavior, judgment, perception, and the ability to manage daily tasks. Driving matters in this context because it is a complex daily activity, not just a familiar routine.

A driver needs to notice and comprehend signs, judge distance, react to other cars, stay in the correct lane, remember the route, and adjust when something unexpected happens. A person with Alzheimer’s may struggle with one part of that process before driving appears unsafe. That is why families should look beyond forgetfulness alone and pay attention to how the person handles real driving situations.

Families may notice warning signs during ordinary trips. A driver may get lost on a familiar road, react slowly in traffic, miss traffic signs, drift between lanes, drive unusually slowly, stop for no clear reason, or become confused at intersections. New dents, minor crashes, parking trouble, tickets, unpredictable braking, or sudden acceleration also deserve attention.

Families can evaluate the concern more clearly when they track events over time. Bad weather, heavy traffic, an unfamiliar route, medicine side effects or combinations, or illness can affect driving safety. The concern grows when problems occur repeatedly, become more serious, or appear on routes the person once handled without difficulty.

Families can help by documenting facts before an appointment with the doctor. Useful notes include the date, location, route, what happened, who saw it, whether anyone was at risk, and how the driver responded afterward. These details give the doctor more than a general statement such as the person “seems unsafe.”

Those observations become part of the medical review. The doctor may ask about recent confusion, sleepiness, vision, falls, movement, alertness, other illnesses, and changes in daily function. The doctor may also review prescription medicines, non-prescription medicines, and combinations that can affect judgment, reflexes, or alertness.

A formal driving evaluation may become useful when the answer remains unclear. A driving evaluation is a structured review of whether a person can still drive safely and what limits, training, equipment, or transportation changes may fit. It may include clinical checks, vision or thinking tasks, behind-the-wheel assessment, and an on-road review by a trained driving rehabilitation professional.

The driving conversation should include safety and independence. Driving may connect the person to errands, appointments, social visits, volunteering, and familiar routines. Families can keep the discussion focused on specific driving events instead of treating the change as a punishment. At the same time, families, clinicians, and caregivers still need to respond when repeated safety risks appear.

Families can turn a driving limit into a workable care step by planning transportation. They can discuss rides from relatives, taxis, ride-share services, public transportation, and senior transportation programs. They can also discuss grocery delivery, meal delivery, prescription delivery, and home visits from a barber or hairdresser when available. Planning these options before a crisis can reduce conflict when driving changes become unavoidable.

As Alzheimer’s progresses, the driving question may need more than one conversation. Families can keep tracking incidents, clinicians can reassess health and safety factors, and caregivers can adjust transportation plans before the risk increases. That ongoing review helps the person stay connected to daily life without waiting for a ticket, dangerous near miss, crash, or injury.

Treating Older Adults With Long-Term Mental Illness as Needs Change

An older adult may live with a mental illness for many years before a new concern changes what care must address. A hospital stay, new medical diagnosis, reduced mobility, loss, limited transportation, or reduced support can disrupt routines that once felt stable. The main question, especially when care depends on several people and services, is whether current care still matches daily life, safety, and available help.

Long-term mental illness means a psychiatric condition that has required treatment, monitoring, or support over many years. Some clinicians define serious mental illness as when symptoms cause significant functional impairment and limit major life activities. Aging can add new support needs even when the original diagnosis remains the same.

Physical health can change psychiatric care in specific ways. Physical pain, poor sleep, chronic illness, reduced mobility, or substance use can affect mood, attention, and follow-through. A psychiatrist may need to know about new medical diagnoses because physical symptoms can affect sleep, alertness, anxiety, depression, and treatment response. That context helps connect mental health treatment with overall health.

Daily function shows how changes appear outside an appointment. Function means how the person manages routines, responsibilities, personal care, transportation, and instructions, not only how symptoms sound during a visit. Missed appointments, difficulty using transportation, trouble following discharge directions, or declining personal care can reveal a need for more support. Function matters most when symptoms begin affecting safety or basic needs.

Medication safety deserves a focused review when an older adult is on several medications. A psychiatrist, primary care doctor, or pharmacist may need to review prescription and nonprescription medicines for dose, caution, side effects, interactions, or kidney-related concerns. The same review can compare recent medication changes with new confusion, sleepiness, or other symptoms. The goal is safer decision-making, not stopping medicine without clinical guidance.

Family members and caregivers can improve clinical decision-making by bringing concrete observations. They may notice withdrawal, appetite or sleep changes, missed routines, unsafe choices, or problems functioning before the older adult describes a change in an appointment. Their role is to report examples, not replace the person’s own account. The clinician should also confirm whether the older adult wants relatives included in care planning.

Transitions between care settings can create confusion when communication breaks down. A hospital discharge, new medication prescriber, or change in outpatient follow-up can leave different people relying on different information. The risk grows when no one clearly tracks follow-up, warning signs, transportation, appointments, or community services. Clear handoffs help each clinician understand what has changed and who is responsible for the next step in treatment.

A clinician may need to review memory, judgment, and planning during reassessment. The goal is not to assume Alzheimer’s disease or treat every thinking change as dementia. The visit may include questions about whether the person remembers recent directions, pays attention, makes decisions, and recognizes unsafe situations. Those answers can show whether the change may be temporary, medical, neurological, medication-related, or part of a longer care need.

Families and care partners do not need to decide whether aging, illness, medication, or the psychiatric condition caused every new problem. They can ask for reassessment when one change begins affecting meals, transportation, personal care, appointments, medicine routines, or safe decisions. That review helps the clinician separate a temporary disruption from a care need that requires a specific next step. A careful reassessment helps everyone work from the same plan when new concerns affect daily care.

2020 Study in BJPsych Contradicts the Stress Inoculation Hypothesis

Just as an inoculation against a viral infection prevents sickness by introducing a controlled amount of virus into the body, an inoculation against stress exposes an individual to a controlled and measured level of stress, which in turn helps them build up psychological resilience against future traumatic experiences. At least, this is the basic idea behind the stress inoculation hypothesis.

Published in the peer-reviewed British Journal of Psychiatry in 2020, the study “Assessing the relationship between psychosocial stressors and psychiatric resilience among Chilean disaster survivors” produced findings that definitively contradict the stress inoculation hypothesis. The researchers analyzed post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) testing data from survivors of the historically powerful earthquake that struck Chile in 2010.

Comparing PTSD and MDD test results before and after this disaster, the study’s authors found that those who had experienced multiple stressors before the Chilean earthquake were more susceptible to stress related disorder from the quake compared to those with fewer stressors. These conclusions indicate that an “inoculation” of stress doesn’t decrease vulnerability to PTSD or MDD, but instead increases it.