Normally, when formulating my blogs, I ponder the ethics involved and make judgments based on my present knowledge; and while I may feel strongly about a certain point of view, my emotions rarely get involved. However, a recent New York Times article, Safety: When to Ground Alzheimer's Drivers, found me on a personal level.
This article interested me because my grandmother was diagnosed with Alzheimer's many years ago. In general, the disease has gradually taken away her "personhood". However, recently, she has gone downhill rather quickly. She doesn't recognize herself in pictures, and the depression/anger has begun to set in.
My family got lucky with my grandmother; she voluntarily took herself off the road many years ago. However, what if that was not the case? Figuring out when to take the keys away poses a problem for doctors and families. With so much already taken away from her, mentally and physically, how could we take away her freedom and mobility without much thought?
A new study reports that a series of cognitive tests may help doctors determine which early Alzheimer’s patients are likely to pose a danger behind the wheel. The researchers said the findings could prove valuable as an aging population results in more drivers with dementia on the road.
I was eager to read on to find out what is being done to protect Alzheimer's drivers and other drivers on the road; however, I soon found that the study did not meet my expectations.
For the study, researchers asked 40 drivers with probable Alzheimer’s disease and 115 elderly drivers who were healthy neurologically to undergo a battery of cognitive, visual and motor tests. They were also asked to take a 35-mile driving test with a research assistant in the car and cameras recording their performance.
First of all, I have a problem with the lack of numbers in this study. With only 40 test subjects and 115 control subjects, how can these data be generalized to the actual population with any power of confidence?
Not only are the populations too small, but why are they unbalanced? Why would researchers compare 40 to 115? It seems like the study design is a bit biased and any results would embellish differences between the two groups.
Now, for the actual study results, the Alzheimer’s drivers made about 25 percent more mistakes than the other drivers. This may be an expected result; however, the actual number of mistakes was not given. How can a statistically significant difference be stated on percentages alone?
It is obvious that, from my personal experience, concrete predictions cannot be made as to when an Alzheimer's driver should be grounded. The progression of the disease varies to such a degree, even in the individual, that judgments must be made on a continual basis. I feel that to make a generalization from a small-scale, biased study would be unethical on multiple levels.
It is one thing to administer driving tests for teenagers; it is a prize and a right of passage. However, testing Alzheimer's drivers has a completely opposite connotation; it means you are no longer fit to take care of yourself or to make your own decisions. Autonomy is definitely at stake, and it should be a conjoined effort among all involved, not a set point based on one study.
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2 comments:
The AARP will never allow any legislation that forces every elderly person of a certain age to begin a process through which they may lose their driving privileges. The AARP is definitely one of the most powerful lobbying organizations in America.
That being said, I consider Alzheimer’s to be the most insidious of conditions. Loved ones see the victim die twice. On top of that, the behavior of the victim begins to crowd out the good memories that loved ones have of the victim. In a way, it eventually almost starts to seem if the "real" person may have been imaginary.
You ask some good questions. Few people advocate that when people reach a certain age, they lose their rights (including the right to not have to periodically submit to tests to prove their own basic competence to function in society).
Well, Lisa, this subject actually hits really close to home for me, too. In my case, we had to take the keys away from my father, and it was really painful. Seeing my father reduced to a shell of what he once was and then taking away his independence, which he'd had since grade school when he had to drop out of school to help support his family, made the situation worse. In our case, the doctor made the decision that it was time to take the keys away from my father, and although we knew he was right, it was difficult for us to decide when to do it and who would do it.
We chose one of my brothers to have the talk with him and take away his keys. He didn't react well, but his disease progressed so rapidly that thankfully, he didn't remember (no pun intended).
I think that taking the keys away should be a decision made by the family and the physician, because only those involved with the person's every day care know the situation better than anyone else.
I, however, believe people at a certain age must submit to a driving test because their reflexes are slower and their memory is not as good as it use to be.
And, on a side note, why is it that the older you get, the bigger your car becomes? Why do so many older people drive huge cadillacs of which they can't see over the dashboard? Yet another reason older people should be tested again.
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