At what point do you start being seriously concerned about cognitive decline?

[IShouldNotCoco]

My mum is 78 and lately I’ve noticed that she’s very suddenly gone from being a good driver to one who drives in the middle of two lanes and seems unable to realise when it’s her right of way or not. Yesterday, she was waving her fists at another driver even though it was clearly their right of way - the give way line was on her side. She can’t reverse out of spaces now either - I had to take over and do it.

I think if I told her she should stop driving, she’d be aggressive towards me about it. She’s very upset atm because apparently she did an NHS cognition test which revealed she’s in the bottom 30% for her age.

She’s angry a lot of the time, lately as well. How concerned should I be about this? Any advice about how to handle it?

I’d be concerned, especially with the change in behaviour. Has she had an eye test recently? My DM was a similar age when we noticed a sharp but inconsistent decline in her driving, some days she was great, others she was awful. Her macular degeneration was getting much worse. Thankfully she’s now given up driving!

It's a difficult one but she shouldn't be driving. I'd suggest a GP as first port of call for some tests, assuming the cognitive test she did was generic one and not conducted by a medic. Older people (like me) will usually listen to advice from the experts but can balk at being given advice by family. however well intended. I had to give up driving because of glaucoma 3 years ago and wasn't happy at all but once the DVLA have notified you that you're not allowed to drive you have no choice. She will be angry because she knows that she's not as mentally capable as she used to be but I'm sure it's not directed at you but just at how her life is progressing. I hope you get things sorted for your own peace of mind.

Thank you for your responses. I am not sure about her eye sight but her hearing definitely isn’t great. She has the TV on 100 volume, constantly and when I suggest she should get a hearing test she tells me to shut up.

She has always reacted angrily to any type of perceived criticism so that isn’t exactly new.

But yeah, I’ve noticed a very sudden change in how she drives.

How would I get her to see the doctor about these things given how she has always got disproportionately angry about perceived criticism?

Hearing loss is one of the biggest precursors to dementia. I had to wait until I was mum's POA and had access to her money before I insisted she went to Boots and bought a private hearing aid that was catered more towards her profound hearing loss than the successions of NHS aids she'd had previously thst clearly weren't up to the job.

Oh no that’s so concerning. But thanks for highlighting this for me - I had no idea.

Im an only child so I have to deal with this alone.

I agree with @HangryBrickShark re hearing loss and dementia. Your first port of call should be the GP for a checkup and memory test for mum.

I've been also dealing with this as an only child with my Mum the past eight years and she passed away almost a month ago with Altzeimers. She died peacefully in her sleep.

It's a horrible condition but there's a lot of support out there. Social isolation, lack of mental stimulation and lack of exercise are also risk factors.

I saw Mum three times a week in the last 7 months of her life, because i was fortunate to live right by her. Before then i was visiting daily so we had some quality time together. She was at a carehome for the past 14 months and had been widowed 7 yrs and lived in her own home until the age of 87 so had done well really. She'd been fully mobile until falling, breaking her hip and ending up in care.

Her funeral is next week.

Feel free to pm me if you need a chat. I'm feeling a bit down at the moment so it would be nice to chat x

You need to be concerned now, before she kills herself or someone else on the road.

Has she been referred to memory clinic? Had a recent eye test?

You can report anonymously to the DVLA on line.
And phone her GP to share your concerns and get them to call her in for 'a checkup'.
The cognition test should also be reported to her car insurance.

Unfortunately if you leave it to her nothing will happen as she doesn't recognise she has a problem. This is why she is so angry- the world has suddenly got confusing to her, she doesn't know why and it must be because of other people.

My Dad started showing signs of decline by way of confusion, getting really angry about things, and it seemed to really accelerate. It turned out to be something way more serious than age related (liver failure due to cancer), and I'm so glad that I pushed him into an appointment. Please don't assume it's "just" old age or the slow onset of dementia. Get them to the GP, and as soon as you can. Not saying this to scare the crap out of you, but it's easy to assume.

You do have some responsibilities but it’s not all on you. It’s actually a drivers responsibility and there can also be professionals involved.

I learned to be blunt but specific. ‘You need to stop driving’ isn’t your responsibility or job, plus she can dispute it. ‘I think your driving has changed. I’m really worried.’ is specific and about your view on things. ‘I think you should see your GP’ isn’t also your view.

If she won’t, inform the DVLA anonymously. Write to the gp with your cognitive concerns. Then try to stop worrying.

‘I think you should see your GP’ IS your view.

@IShouldNotCoco How would I get her to see the doctor about these things given how she has always got disproportionately angry about perceived criticism?

Try to get her in on some innocuous pretext - medication review, blood pressure check, and alert the GP beforehand. They will take it from there.
Agree that it is concerning, OP. Sending good wishes - this is not easy.

It’s also worth finding her an alternative, locally we have an elderly taxi service they can sign up to, the driver will help them load their shopping and bring it into the house. They’ll time medical appointments so they can get them home too. It’s often as much about wanting to maintain a level of independence as getting annoyed at criticism for their own failings.

Report anonymously to DVLA.
If she injures someone you will feel dreadful. Sympathies re getting her to see a GP and to cooperate.
Do your best but don't beat yourself up .
If she won't accept her decline there's not much to be done.
Even if she does see a GP there's no guarantee that she'll keep any health appointments or referrals eg to a memory clinic.
I speak from experience.

Sorry about your mum @HangryBrickShark . She had a great long life mind and you did all you could for her. It often seems to be a fall that precipitates the final illness. Perhaps low blood pressure or hearing loss a factor there?

Are you listed as next of kin with your DM’s GP surgery? If you are then you could discuss directly with the GP. Otherwise, you can email the GP with your concerns so that they can bring them up at your DM’s next appointment.

We did this with my DM, who was similarly a dreadful driver but refused to stop - eventually there was a diagnosis of late stage heart failure that had to be reported to the DVLA, who removed her licence.

So sorry to hear what's happening OP. It's awful to feel you are going behind their back, but if they won't co operate there's really no other way.

Agree with approaching her GP as the first port of call. We just contacted MILs GP via the usual messaging service.

Explain the signs and symptoms, (with particular focus on the risks re driving!) and ask them to perform a Cog test the next time they see her. Does she have medication reviews or other regular appointments? If not they may think up a reason to call her to arrange an appointment.

If you can, try to arrange for your mum to agree to allowing the GP to speak with you about her health matters, MIL had Alzheimer's and we were completely frozen out of her healthcare as she had never given permission for the GP to talk to us.

Report her to the DVLA. If your mum hurts herself or someone else in the road you will feel responsible if you don’t act now.
Suggest an opticians appointment to your mum, her eyesight may be failing which could be an explanation for her poor driving.

No, my dad is. But unfortunately he isn’t in any better shape than she is. He doesn’t drive any more by choice as he has bad legs.

I spoke to my mum this afternoon and have convinced her to have a hearing test next week. So we’ve booked that. I could also email our GP but the problem with that is that our GP service isn’t very good and they ignore people as long as they can. But I will try.

I highlighted my concerns about her driving and she kept saying ‘there’s nothing wrong with my driving - I’m a better driver than so and so’. But she did manage to take on board my concerns without getting angry so thank goodness for that.

@IShouldNotCoco I could also email our GP but the problem with that is that our GP service isn’t very good and they ignore people as long as they can.

As well as emailing, I would bring a note in to the Surgery and slip it to the desk surreptitiously whilst mum is in the waiting area.

Definitely still worth emailing the GP and highlighting all of your concerns.

Make a list of all the issues you can think of. Does your DM remember how to do everyday tasks or does she randomly forget things? Is she motivated to do basic tasks such as getting breakfast Does she have short term memory issues??

We presented it to DM as just getting a baseline check, although she told the GP that she didn’t want one so they were a bit limited in what they could do, but at least were aware of our concerns.

If for example your mum got a urine infection, which can send people completely over the edge, it’s really important to have what you’ve noticed on the record. Even if they don’t do anything about it now, a note to them describing the suddenness of her decline could really help.

I think the time is to act now, as I've had relatives whose cognitive decline worsened fast in their 70's.

My uncle had a car crash, luckily injuring no one else but himself. It was noticed not long after this time he had CD. I don't know if it could have been picked up earlier as I didn't live with him, not being a closer or first line relative.

Within 2 years he was in a specialist dementia nursing home.

I came across this video recently and found it very helpful. At 5m20s she suggests a way of addressing the driving issue without riling the person.

One of the early signs of my stepmother’s diagnosis was with her driving. She lost all sense of spatial awareness and would drive down a road perilously close to parked cars. She then drove so close to a roundabout that she ended up half on it. That was the point at which her daughter took her to the GP.

I think the early signs can be things like behaviour/mood change. With my stepmother (in addition to the poor driving), she lost any sense of empathy. She’d always been a really empathetic person before that.