Developing Best Practices for Law Enforcement and Dementia

Dementia and Policing: Developing Best Practices for Law Enforcement
Policy Backgrounder
Corinne Alstrom
Placement Student, Public Policy and ProgramInitiatives,Alzheimer Society of Ontario
Preamble
Page 1 of 21 Jan 2013
Preamble
Rationale
The past fewyearshave seenincreasingmediareportsacrossOntarioof people withdementiabeingin
contact withlawenforcementacrossOntario.
The Law Commissionof Ontario(LCO) releasedaFrameworkForThe Law As ItRelatesTo OlderAdults.
As a resultof the Long-TermCare HomesAct of 2007, it is now mandatoryfor long-termcare staff to
report“alleged,suspected,orwitnessed” abuse oranycriminal activitytopolice (Queen’sPrinterfor
Ontario,2011, section98). Thislegislationmayhave ledto more police involvementinlong-termcare.
The presentdocumentexploresthe followingtopicsastheyrelate tolaw enforcement:
 Law enforcementstrategies
 Driving
 Wandering
 Responsive behaviours
Methodology
Methodsof inquiryincludedthe following:
 A literature reviewof articlesandstudiesfrompeer-reviewedjournals;newsstories;andpolicy
documentsrelatingtodementiaandlaw enforcementinvolvement.
 Sixteen KeyInformantinterviewsrangingfromfifteenminutestoone hour. KeyInformants
were soughtfromall overOntario,as well asa few fromthe UnitedStateswithspecial expertise
or experiences.These includedstaff of local AlzheimerSocieties,seniorservices,hospitals,as
well asauthorsof journal articles,researchers,geriatricspecialists,taskforce members,and
specialistsinpolice education.
 A surveyof all local AlzheimerSocietiesinthe Ontariofederation. The surveyclosedJanuary31,
2013, with53 respondentsfrom24of the 38 local Societies;mostwere fromSaultSte Marie
and AlgomaDistrict,GreaterSimcoe County,Belleville-Hastings,andElginStThomas.The
majorityof respondents(approximately67%) identifiedthemselvesasFirstLink,Public
Education,or FamilySupportCoordinators,anddescribed the service areaof theirlocal Society
as a combinationof urbanand rural.
Major themes
Several overarchingthemesbecame prevalentinthe analysisof the dialogue withKeyInformants,and
open-endedsurveyresponses.These included:

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Corinne Alstrom
Preamble
 The importance of proactive intervention.Law enforcementprofessionalsandcommunity
workersbothput forwardthatlaw enforcementinvolvementinasituationisaresultof a failure
of the social safetynettopreventthe situationfromescalatingintoacrisis.Regardless of the
subjectdiscussed,thosewhoworkwithpeoplewhohave dementiastatedthe importance of
planningaheadtopreventcrisesrequiringpolice involvement.Withoutasecure support
system,lawenforcementmaybecome the primaryinterventioninanindividual’slife.
 Ambiguityand inconsistencies.Whenlaw enforcementdoesbecome involvedinthe life of a
personwithdementia,KeyInformantsreported“luck-of-the-draw”services,basedonphysical
location,lawenforcementdivision,andthe specificofficerorotherworkerassignedto
intervene.Whenrelevantlegislationorregulationsare inplace,KeyInformantsreportedawide
varietyof interpretationsof suchpolicies.Some KeyInformantsreportedapolice service that
activelyliaiseswithkeycommunityandhealthcare servicesduringorpriorto a crisis;some
reportedthe opposite.Informantexperiencesrangedfromhorrorstories,tostoriesof liaising
withpolice forexcellentresultsforpeople withdementia.The amountof ambiguitymaycreate
issueswithsystemnavigation:familiesmaynotnecessarilyknow where toturnforhelp,as
everydoorcan leadto a differentoutcome.
Subjects beyond the scope of this paper
 Wanderingisnotdiscussedingreatdepthinthe presentdocumentdue tothe concurrent
developmentof a “wanderingprevention”programbythe AlzheimerSocietyof Ontario. The
Safely Home program,previouslymanagedbythe AlzheimerSocietyof Canada,hasbeenturned
overto MedicAlert,becoming MedicAlertSafely Home.
 KeyInformantsworkingincommunityhousingreportedthatitisnot uncommonforcriminalsto
use the home of a personwithdementiaasa base for illegal activitiessuchassellingdrugs.
Despite the limitedinsightof the tenantwithdementia,discoveryof the illegal activitytaking
place intheirhome may leadtoan evictionrisk,andentryintothe sheltersystem.
 There were referencesinthe literature,andfromKeyInformants,aboutpeople withdementia
makingrepeatedcallsto911 due to the paranoia,hallucinations,anddelusionsthatare often
symptomsof dementia.
 As a resultof time limitations,elderabuse hasnotbeenexploredindepthinthisdocument.
AlzheimerSocietyof Canadahasan extensive literature review onthe subjectof elderabuse,
preparedin2010

Policy Backgrounder
Corinne Alstrom
Law enforcement strategies
A limitedbodyof guidelinesexistsforlaw enforcementprofessionalswhoencounterpeople with
dementiaintheirwork.Forexample,itissuggestedthatpolice officersbe aware of personslivingwith
dementiaintheircommunity,patrol ordivision(ADRDA,1987). Currentlyrecommendedstrategiesfor
reducinganxietyinclude controllingthe tone of one’svoice,removingone’scap,using humour,or
talkingaboutpleasantorfamiliarthings(AlzheimerSocietyof Toronto,2003).
Dependingonthe life experiencesandideologiesof the individualinquestion,contactwithlaw
enforcementmaybe acalmingor upsettingsituation. One KeyInformantreportedthatacommunity
relationsofficer(CRO),whenhe hadtime toprepare,askedlong-termcare staff aheadof time whether
he shouldarrive inor out of uniform.
Doty andCaranasos alsomake a poignantstatementabout bodylanguage:
A primary concernof lawenforcementofficersisthe constantprecautionforlife-threatening
situations.Theyapproacheachsituationmindful of immediate dangerandtheirresponsibilityto
enforce the law.Afterofficersensure safety,theyevaluatethe situation, suchasan assaultor
felony,intermsof authoritytoarrest.A situationinvolvingmemorylosspatients,however,
shouldincorporate conciliatoryprocedures(1990,p 357).
Whenpolice docome intocontact withsomeone whohasdementia,recommendedcommunication
strategiesinclude:speakingslowlyandclearly;usingthe individual’sname;maintainingeye contact;
isolatingthe personfromthe situationinordertoreduce potentiallydistractingstimuli;usingbody
language suchas pointing;repeatinginformationorquestionsif necessary;andstartingbyaskingfor
identification,asthisisoftenremembered (ADRDA,1987). 32.5 percentof respondentstothe surveyof
local AlzheimerSocietieshopedforincreasedcommunicationskillsonthe part of police.
Law enforcement as intervention
Many care partnersof personswithdementiadonotseekhelpfromcommunityservicesuntil some kind
of crisishasoccurred; thus,lawenforcementmaybe usedasa social safetynetwhere otherservices
have failed,ornotyetbeenaccessed(Prattetal,2006 in McAineyetal,2008; Lachs, 2005). Thus there
isa highlikelihood of lawenforcementprofessionals beingthe firstto intervenewith personwith
dementia,eitherpre- orpost-diagnosis. One KeyInformantknew of police whowere oftencalledtoa
the home of a personwithdementia(asa resultof paranoia) usingthe opportunitytocheckonthe
individual’sactivitiesof dailyliving(ADLs).
The AlzheimerSocietyof Canada document“The importance of earlydiagnosis”statesthat fewerthan
25% of cases of Alzheimer’sdiseaseinCanadaare diagnosed(Feldmanetal,2008). Amongthe possible

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Corinne Alstrom
reasonsprovided are “lackof time and abilitytoscreenfordementia,lackof knowledgeabout
dementia,lackof symptomrecognition,andbeliefthatearlydetectionincreasespatientand caregiver
distress.”
As a resultof underdiagnosis,lackof caregivingresources,andlackof publicfundingforcommunity
services,contactwithlawenforcementmaybe a the firstindicationof dementiain anindividual,for
themselves ora familymember(ADRDA,1987). Thiscontact may resultfromsuchincidentsas
dangerousdriving,excessivecallstoemergencyservices,indecentexposure (unintentional),wandering,
abuse and othervictimizationsuchastheftor fraud,or perceivedshopliftingdue toanindividual with
dementiaforgettingtopayforan item.Therefore itisimportantforlaw enforcementandotherfirst
responderstolearnhowto interactwithindividualswhohave dementiainorderto avoidprovokinga
response.
Despite thisperceivedtrendtowardincreasedpolice involvement,andapotential opportunitytoplay
an importantrole inearlyintervention,itappearsthatthere isno unifiedpolicyregardinglaw
enforcementinterventionwith personswithdementia.Whenaskedtoname one thingthatshould
“alwayshappen”whenpolice workwithsomeone whohasdementia,42.5percentof AlzheimerSociety
surveyrespondentsexpressedadesire formore training,andforpolice to understanddementiaand
responsive behavioursbetter.32.5 percenthopedforincreasedcommunicationskillsonthe partof
police,and22.5 percentwantedtosee more referralstothe local AlzheimerSocietyoranotherlocal
communityservice.Askedtoname one thingthatshould“neverhappen”whenpolice workwith
someone whohasdementia,61.1percentnotedsome variationonrestraint,arrest,criminal chargesor
imprisonment.13.8percentnoteddisrespectforthe individualwithdementiaandtheirfamilyandcare
partner(s) assomethingthatshouldneverhappen.
KeyInformantsandsurveyrespondentsexpressedconcernsaboutpeople withdementiabeingentered
intothe legal systeminsteadof receivingnecessarymedical assistance.Manyresponsive behaviours
occur as a resultof physical discomfort;thiscouldbe asignof delirium, infection,pain,orothermedical
issues(MAREP).However,itwasreportedthathospital contactswere reluctanttoencourage people
withdementiabeingtakentohospital due toconcernsaboutalternate level of care (ALC).
One KeyInformantnotedanincreasingshifttowardlaw enforcementasfirstrespondersinmental
healthcrises,andexpressedthatthistrendhasbeenof concernto police.Itisseenas a failure of the
safetynetwhena situationoughttohave beenresolvedwithinthe healthcare systemorsocial services
sectoris beingaddressedbythe police.The situationhasbeenallowedtoescalate fromamedical or
mental healthissue toapublicsafetyissue requiring police involvement.The Informantarguedthatthe
aimof policyshouldbe toreduce lawenforcementinvolvementinmental healthsituations,of which
theyconsiderdementiatobe one,byinvestinggovernmentfundsinmedical andmental healthservices,
rather thanin police services.

Policy Backgrounder
Corinne Alstrom
Althoughinterventionwithpersonswithdementia isuptoan individual officer’sdiscretiononacase-
by-case basis. The implementationof mental healthpolicymayprovide some guidance astoappropriate
lawenforcementinterventionsandtrainingtechniques.
Mental health interventions
It notable thatthe sidebarof the TPS webpage regarding“mental healthissues”includesalinkto
Alzheimer.ca. Thissuggeststhat,atleastamongsome law enforcement,dementiaisunderstood within
a mental healthframework.
A TorontoPolice Service (TPS) procedural informationsheetstatesthatinOntario,the Mental Health
Act (MHA) authorizeslawenforcementofficerstodetainan“emotionallydisturbedperson”(EDP) who
isbehavingina disorderlymanner,orthreateningharmtohimself orothers,forexaminationbya
physicianata psychiatricfacility(TPS, 2008). Inpractice,the facilityisoftenanemergencyroom. Due to
hospital overcrowding,itisnotuncommonforpolice tospendan entire shiftwaitinginthe emergency
room witha Form1 (Provincial HumanService andJustice CoordinatingCommittee,2011).
Under the MHA, Form 1, an applicationforpsychiatricassessment,authorizesthe detentionand
assessmentof anEDP for upto 72 hours. The TPS document definesanEDPas “any personwhoappears
to be in a state of crisisor any personwhosuffersfromamental disorder.”Thisdefinitioncould
comprise anindividual withdementia havingcatastrophicresponsive behaviours.
Of surveyrespondentswhobelieve Form1isa successful interventionforpeoplewithdementia,63.6
percentreportedhavingbeeninvolvedinasituationwhereapersonwithdementiawasdetained
througha Form 1. Incontrast, only36.4 percentof those whobelievedForm1is a successful
interventionreportednothavingbeeninvolvedinsuchasituation.Thissuggestsapossible discrepancy
betweenthe understandingof howForm1 is appliedintheory,andhow itisappliedinpractice.
Conversely,the discrepancy maybe betweenhow the MHA isappliedbydifferentindividualofficers,
and indifferentservice areas.Thisharkensbacktothe overarchingtheme of ambiguityand
inconsistencies.
Surveyrespondentsexpressedavarietyof reasonsforbelievingthatForm1 isor is not a successful
interventionforpeoplewithdementia.Reasonsforbelievingitisa successful interventionincluded:a
lack of otheralternatives;the potentialtodiscoveranunderlyingmental healthcondition;the potential
for medical assessmentof the personwithdementia;the opportunityto“getthe ball rolling”toward
furthercommunityintervention;andensuringthe safetyof the personwithdementia,aswell ashisor
herfamilyandcare partner(s).RespondentswhobelievedForm1is nota successful interventiongave
the reasonsof:law enforcementprofessionalsnothavingadequate traininginhow tointeractwith
people withdementia;the potential traumatothe personwithdementia,andhisorherfamilyandcare

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Corinne Alstrom
partner(s),of being forcefullyremovedfromthe home;the factthatthe personwithdementiacannot
rationalize orrememberthe precipitatingincident;the lackof appropriate locationtobringthe person
withdementiato;andthe lack of medical assessmentprovided.
In 2004, the OntarioPolice College,Centre forAddictionandMental Health,andStJoseph’sHealth Care
inLondondevelopedapolice trainingmanual entitled“NotJustAnotherCall...Police Response to
People withMental IllnessesinOntario:A Practical Guide forthe Frontline Officer”(2004).Althoughthe
manual doesnotmention dementia,itdoesdiscussstrategiesandproceduresfordealingwithpotential
manifestationsof dementia,suchasdepression,hallucinations,delusions,andparanoia.Italsodiscusses
relevantportionsof the Mental HealthAct,includingForm1.
One promisingmental healthinterventionisthe Mobile CrisisInterventionTeam(MCIT).Each MCIT
consistsof police,whose jobistoensure safety,andpossiblyapprehendthe individual underthe MHA,
and mental healthworkers,whose jobistoperformapsychiatricassessmentonsite andchoose
whethertobringthe individualtoa hospital orconnectthemwithlocal communityservices.Examples
of MCITs are the CrisisOutreachandSupportTeams(COASTs) operatinginHamilton,Halton,Peel,and
Chatham-Kent.
Despite the potentialbenefitsof regardingdementiawithinamental healthframework,KeyInformants
reportedthatmuch psychiatricinfrastructure isinappropriateforpeoplewith dementia,havingnot
beendesignedwiththe uniqueneedsof peoplewithdementiainmind.Forexample,there existsmuch
potential forvolatile situationsinamental healthcare facility.Staff are nottrainedindementia-care
approachesandmay not be equippedtohandle responsive behaviourssuchaswandering.However,
despite the inappropriatenessof some psychiatricinfrastructure,incidentsinvolvingpeople with
dementiahappentooinfrequentlytojustifythe costof reservingasafe bedsolelyfortheiruse.44.2
percentof surveyrespondentsreportednotknowingof anincidentintheirservice areawhere police
were calledtointervenewithresponsive behaviours. Inaddition,psychiatricinterventionsare designed
for the rehabilitationof apersonwithmental healthissues,whichisnotalwaysthe rightcare model for
people withdementia.
Other current interventions
BehaviourSupportsOntario(BSO) hasrecentlydevelopedBehaviourSupportServices –Mobile Support
Teams(BSS-MST) inmost Local HealthIntegrationNetworks(LIHNs) inthe province.The goal of each
BSS-MST isto provide supportforseniorslivingwithdifficultbehavioural issuesasaresultof dementia,
mental illness,oraddiction.Thisinitiativeispresentedasanalternative tobringingthe seniortothe
emergencyroom,whichmayleadtoAlternativeLevel of Care (ALC) placement.Itsviabilityasan
alternative topolice involvementhasnotbeenevaluated.

Policy Backgrounder
Corinne Alstrom
The PSW ChampionsinitiativeinChamplainLIHN,alsofundedbyBSO,isan example of anintervention
designedtodeescalateincidentsinlong-termcare before police involvementisrequired(BSOQuarterly
Report,2013).
Law enforcement training
55.8 percentof surveyrespondentssaidthattheirlocal Societyisinvolvedinpolice training;those who
identifiedtheirSocietyasurbanwere more likelytohave beeninvolvedinpolicetrainingthanthose
workingina rural or mixedservice area.Of those whowere involved,75percentreportedthattraining
tookplace everyfewyears.The mostcommonsubjectsrespondentsreportedcoveringinpolice training
were dementiabasics(90%),wanderingandmissingincidents(85%),andresponsive behaviours(70%).
Whenaskedwhethertheythoughtanythingimportantwasmissingfromthe survey,37.5percentof
respondentsexpressedadesire forassistance inthe formof atrainingpackage fromASO,or advice on
howto liaise withlocal lawenforcement.
In developingpolice training,itisof utmostimportance tofocusonlyonwhat police absolutely must
know,remainingwithintheirlawenforcementmandate.Trainingtimeisextremelytight.One Key
Informantreportedcomingintoconflictwithagroupprovidingtrainingbecause the groupwishedto
expandthe trainingtoa broadermandate.The standard of trainingissetby the Ministryof Correctional
ServicesandCommunitySafety(MCSCS).Prioritiesare chosenata provincial level,andtrainingmust
applyto all police forcesinthe province.
Some expertshave recommendedthatpolice form“greysquads,”orgroupsof officerswhohave
undergone specializedtrainingingeriatriclaw enforcement. “Police work-particularlyasitoccurs with
olderadults-more commonlyinvolvesthe provisionof advice,guidance,andsympathytothose inneed
than itdoes crime fighting(LiederbachandStelle,2010, p.59).”
The resultsof an unpublishedpilotstudybyDr.LindyKilik,supportedbyQueen’sUniversity,Kingston
Police,andProvidence Care,suggest thatpolice officersinthe field couldpotentiallybe trainedto
detectpossible dementiainasubjectusing ascreeningassessmentcalledthe ShortOrientation-
Memory-ConcentrationTest(SOMCT).Inthe study,officersadministeringthe SOMCTaftera 45-60
minute trainingsession assesseddementiasymptoms withsimilaraccuracy as a registerednurse with
over15 yearsexperience. The SOMCTtakes“a few minutes”toadminister. Dr. Kilik’sfindingswere
presentedinawebinarwiththe DementiaKnowledge Exchange inJune 2011 to 271 participants.
Followingthe successof the pilotstudy,Dr.Kilikiscurrentlycollectingdatafromofficersusingthe
SOMCT in the field.Datacollectionshouldbe completedbyearly2014.
Nusbaumandothersconducteda studyinwhichfirstresponders’(police andfirefighters) awarenessof
eldersatriskof abuse or neglectwasassessedbefore anhour-longeducationalintervention,andthen

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at 3 and 6 monthintervals(2007).Theirfindings suggestthatthe interventiontheydevelopeddidnot
resultinsignificantincreasesinawarenessorprobabilityof doingscreeningsatfirstpointof contact.
Proposedreasonsforthislackof behavioural change includedthe lengthof the intervention,andthe
fact that the interventionwasadministeredbymedical personnel,ratherthanthe firstresponders’
peers.
On the otherhand,Payne and Bergargue thatmultidisciplinarycross-trainingmaybe preferableto
single-professionaltraining,asitmay lowerpotentialobstaclestocollaborationbyraisingsensitivityto
differencesinprofessional values(2003).Burke andothersfoundthat educational interventionsare
more likelytoleadtobehavioural change whentheyincludeelementsof active participation(2006,in
Nusbaumetal,2007).
A trainingprogramimplementedandevaluatedbyDotyandCaranasos wasrated as highlyvaluableby
police officers(1990).The trainingincludedanoverview of dementia;understanding care partner
stressors;coping,communicationandbehavioural techniques;andresourceswithinthe local
community.The trainingalsotoucheduponthemessuchascultivatingempathywithpersonswith
dementia,differentiatingbetweensymptomsof dementiaandintoxicationorotherillness,andworking
withcare partnerdynamics.Real,local case studieswere usedasthe basisforofficerstorole play
appropriate andinappropriate responsestopersonswithdementia.Pre-andpost-intervention
evaluationssuggestedasignificantincrease inknowledge asaresultof the training. KeyInformants
corroboratedthat police respondbettertohands-ontraining,andOntarioPoliceCollegehasfacilitiesto
do hands-ontrainingwithactorsinrealisticlocales.
A potentiallyuseful trainingintervention calledCrisisInterventionResponse Training(CIRT) was
developedin2008 bythe Durham Regional Police inpartnershipwiththe Universityof OntarioInstitute
of Technology.Itisa web-basedtrainingusingmultimediatoolstoguide the trainee throughvariouslaw
enforcementinterventionswithpeople withmental healthissues,andcanbe foundat
http://cirt.uoit.ca/LOs/mainMenu/.
Opportunities moving forward
 Some jurisdictionshave hadsuccesswithdedicatedpoliceofficersservingseniors.Itmaybe
prudenttobeginto developrelationshipswithCommunityRelationsOfficersmovingforward.
However,there are notenoughspeciallytrainedofficerstorespondtoeverycase;therefore,it
wouldbe prudentforall officerstohave basicskillsininteractingwithpeople withdementia.
 Keyinformantsreportedsuccessincludingdementiainmental health/crisisinterventionpolice
training(JB&KR;KS).ThiscouldleadtopartnershipswithCentre forAddictionandMental
Health(CAMH),or CanadianMental Health Association(CMHA) toprovide a“footinthe door”
to police training.

Policy Backgrounder
Corinne Alstrom
 A reportfromthe Provincial HumanServicesandJustice CoordinatingCommittee (PHSJCC)
recommendedthe creationof amemorandumof understanding(MOU) betweenpolice and
hospitalsaddressingthe concernsof fastertriage inhospitalswhenanindividual is“formed,”
and ensuringthatpatientsare connectedwithcommunityservicesbefore discharge.
 The First Linkprogram connectspeople recentlydiagnosedwithdementiatoservicesprovided
by theirlocal AlzheimerSociety.Itmaybe possible tofindamechanismtochannel peoplewith
dementiawhohave police involvement,toensuringconnectionwithaphysician,tolinkage with
AlzheimerSocietylocal programs.Eachlocal Societywouldhave tofindaway.FirstLink
infrastructure isalreadyinplace province-wide;itmaybe prudenttocapitalize onthese existing
resourcesandexpandthe program.
 The current projectprovidesanopportunitytobringall stakeholderstothe table tofindout
whois doingwhat,andhow to interpretregulationsthatare in place.One KeyInformant
identifiedthatamajorhurdle of forminga taskforce wasconvincingall stakeholdersthatthere
was nointerestinfinger-pointing,orblaminganyparticularprofessionforexistingissues. Itis
importantto emphasize thatthe goal istoimprove qualityof life forpeople withdementia.Key
Informantsdescribedavarietyof methodsinwhichdifferentstakeholdersinteract,suchas:
o In NewHampshire,the IncapacitatedAdultFatalityReview Committee (IAFRC) meetson
a regularbasisto examine the positivesandnegativesof the interventionina
challenginglocal case,inordertodetermine bestpracticesinthe future.Professionals
withexpertiseinlong-termcare, emergencymedical services,law enforcement,social
work,home care,domesticviolence,anddisabilityrightsmake upthiscommittee.A
reportwiththeirfindingsisdisseminatedtostakeholders.A local parallel maybe the
OntarioCoroner’sannual review of geriatricdeaths.
o The Alzheimer’sAssociationof SoutheasternWisconsinconvenedaChallenging
BehavioursTaskForce that meteveryothermonthfora yearto discusslegal
interventions,lawenforcement,psychotropicmedications,andtraining.Examiningthe
innerworkingsof multiple systemsprovidedthe TaskForce withabetterunderstanding
of them.
Questions moving forward
1. What wouldbe the goalsand underlyingprinciplesof adementiastrategyforlaw enforcement?
2. Where else mightlawenforcementmental healthinterventionsbe adaptedforuse withpeople
withdementia?
3. How oftenare personsdetainedunderthe MHA laterfoundto have dementia?
4. What dementiatrainingtoolscanbe adaptedforuse withpolice?
5. How wouldthe successof an educational interventionforlaw enforcementbe measured?
6. Whendo lawenforcementprofessionalsfeel itisappropriate forthemtobe involved?

Policy Backgrounder
Corinne Alstrom
Responsive behaviours
The Murray AlzheimerResearchandEducationProgram(MAREP) now referstothe responsive
behavioursas“personal expressions.”Some behavioursthatmayoccur as a resultof dementiamaybe
classifiedascriminal acts.Forexample,apersonwithdementiamayundressinpublicbecause theyare
overheatedorneedtouse the toilet;thisbehaviourmayappeartobe publicindecency.Shopliftingmay
be suspectedwhenapersonwithdementiaforgetstopayforan item, orleavesastore forgettingthat
theyhave an itemintheirpossession(Alzheimer’sAssociation,2006).
Because dementiaresultsinthe lossof a person’scapacitytocope withstressors,includingthe
behavioursof otherresidents,researchhasfoundincidentsof residentslashingoutatothersdue to the
otherresidents’dementia-relatedbehaviours.ResidenttoResidentElderMistreatment(RREM) isthe
mostcommon reasonforpolice beingcalledtolong-termcare settings(Lachsetal,2007).
Whenaskedwhatinterventions,otherthanpolice,theyknew people toseekoutwhenfeelingunsafe
arounda personintheirlife whohasdementia,48.6 percentof surveyrespondentsnamedfamily,
neighbours,friendsorclergyasamongthe primarysupports.43.2 percentciteda medical professional
or dementiaprofessional suchasthe local CCAC,BSO,COAST,or GEM nurses.27 percentcitedthe
emergencyroom,and13.5 percentsaidtheyknew of familymembersorcare partnerswhowouldleave
the personwithdementiaalone,despite the safetyrisk.
Examples of incidents; risk factors
In a 2010 Winnipegcase,JosephMcLeod,apersonwithdementia,wasarrestedafterpushinghiswife
and primarycare partner,Rose.Rose maintainsthatherhusbandwasunable torecognize heratthe
time.She wasinjuredinthe altercationandrequiredstitches. Local police arrestedJoseph,andhe
spenta monthin jail separatedfromhisprimarycare partner,as she wasconsideredavictimof
domesticviolence (Picard,2010). Monthslater,afterbeingmovedtoa long-termcare facility,Joseph
shovedanotherresident,resultinginafatal head injury.He wasbroughtto a psychiatricfacilityand
chargedwithmanslaughter.
Testifyinginthe UnitedStatesSenate,researcherDonnaCohen,anoriginal founderof the Alzheimer’s
Association,liststhe followingantecedentriskfactorsforhomicidal behaviourinpersonswith
dementia:
 Historyof previousviolence or"other-directed"behaviors
 Historyof alcohol abuse
 Active paranoiaandotherpsychoticsymptoms
 Psychoticdepression
 Vasculardementia

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 Historyof catastrophicreactions
 Traits suchas lowfrustrationtolerance andaggressivity
 Military/lawenforcement/firefighterhistory(USSenate 2004, p 51).
The bestpredictorsforviolence are previousviolence,active paranoia,andpsychoticsymptoms(U.S.
Senate,2004).
Conflicting interdisciplinary frameworks
Whenpolice have “reasonable grounds”tosuspectdomesticviolence,acharge will be laidagainstthe
aggressor.Thischarge is laidregardlessof whetherthe victimiswillingtoattendcourt,or whetherathe
officerbelievesaconvictionislikelytobe made (TorontoPolice Service Procedure InformationSheet).
The allegedperpetratorinadomesticdispute isremovedfromthe presence of the victim(through
arrest) inorder to give the victimtime andspace forlegal decisions,safetyplanning,andfindingshelter,
withoutthe threatof furtherviolence.
Thistype of domesticviolence policyisaresultof feministlobbyingsince the early1960s forrecognition
of the greatrisk facedbyvictimsof domesticviolence.Whatwasonce seenasa private familyissue
became a criminal offence.Violence orothertypesof abuse withinintimate relationshipswaslookedat
as a systemicissue regardingmen’suse of powerandcontrol (Botrill andMort,2003).
The societal contextwithinwhichperson-centreddementiacare standardsdevelopedisentirely
different.Responsive behavioursshownbypeople withdementiawere,inthe past,knownas
“challengingbehaviour,”“combativeness,”andotherpotentiallydehumanizingterms.The current
terminologycame abouttoframe these behavioursdifferently.Itisknownthatresponsivebehaviours
become more intense andfrequentasa response tosomethingunwantedorupsettinginthe
environmentof the personwithdementia.Therefore,bycallingbehavioursresponsive,the focusis
shiftedtothe livedexperienceof the personwithdementia.Whenbehavioursoccur,modifyingthe
environmentinordertoreduce the behavioursisnow consideredbestpractice (MAREPetal,2005).
Some of the interdisciplinarysimilaritiesandpotential conflictspresentwhenworkingwiththese
seeminglyincompatible frameworksare summarizedinthe table below:

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Corinne Alstrom
Domestic Abuse vs. Responsive Behaviours: Conflicting Frameworks
Domestic Abuse Aggressive Responsive Behaviour
SIMILARITIES
Victim’s safety may be at risk Victim’s safety may be at risk
Aggressor may deny behaviour
Aggressor may deny behaviour (because
they do not remember)
Victim tries to excuse behaviour; fears
separation from aggressor
Victim tries to excuse behaviour; fears
separation from aggressor
Victim blames self for incident Victim blames self for incident
CONFLICTS
Result of lobbying for rights of victims of
violence
Result of lobbying for rights of persons
with dementia
“It’s not your fault” (No victim blaming)
“What are you doing to cause the
behaviour?”
“There is no excuse for violence”
“Any harm is excusable because the
individual with dementia did not know
what they were doing”
Focus on wellbeing of victim
Focus on wellbeing of person with
dementia
“Nobody deserves violence” (No mention)
“Aggressor should be punished” “Aggressor should be advocated for”
Emphasis on development of safety plan
for victim
Emphasis on preventing future incidents
by modifying care
Aggressor is culpable for actions Aggressor may not be culpable for actions

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Corinne Alstrom
It iseasyto see how,ina situationwhere aggressionisasymptomof dementia,expertsworkingfrom
differentframeworksmaynotsee eye toeye regardingappropriate interventions.Inthe
aforementionedcase of JosephMcLeod,forinstance,the domesticviolence frameworkwouldfocuson
ensuringthe safetyof hiswife,Rose.However,withinthe dementiacare framework,emphasiswould
firstand foremostbe onmodifyingJoseph’scare environmentandroutine inordertopreventasimilar
incidentinthe future.An examinationof the relationshiphistorybetweenJosephandRose mayyield
verydifferentinterventions.
Interestingly,of the surveyrespondentswhoreportedknowingof anincidentintheirservice areawhere
someone washarmedbythe behavioursof apersonwithdementiaandpolice werecalled,55.6 percent
saidthat the resultinginterventioninvolvedsafetyplanningforthe personwhowasharmed.Anequal
amountreportedthatthe resultinginterventioninvolvedachange inthe care routine of the personwith
dementia,ormedication,orhospitalizationof the individual.Thiswouldsuggestthatinpractice,the
twotheoretical frameworkscancoexist,andperhapsevencomplementone another.
Aftertwolocal incidentswhere peoplewithdementiawere arrested afterphysicallyassaultingtheir
spouses,The AlzheimerSocietyof SaultSte.Marie andAlgomametwithlocal police andformeda
Communitydiscussiongroup(Kelly,2012).Eventually,thiscame toa stalemate because the local police
were unwillingtoconsiderarrestalternatives,suchasa twenty-fourhourmobile crisisunit,ina
situationwhere apartnerisharmed,norwere theyinterestedinlearningtouse abrief screeningtool.
In a discussionpaper,BotrillandMort furtherexamine the conflictsraisedbythese diverging
interdisciplinaryframeworks(2003).Theynote thataggressive responsivebehaviours of people with
dementiatendtobe conceptualizedasbeingsymptomaticof diseasewithina dementiacare
framework.Ananalysisof powerandcontrol issues,suchaswouldbe usedwithinadomesticviolence
framework,maybe lacking.Theyargue thatthere exists adangerof care partnerrightsand safety
beingoverlooked, inthe haste toadvocate forpersonswithdementia:
Issuesof responsibilityandsafetycanbe blindedorignoredwithinthe contextof notionsof
caring forthe personwithdementia –Who shouldandcan care for olderpeople andwhatwill
happenif theydonot care? Doesitchange the assessmentandresponse if the violence/power-
and-control issuesexistedinthe relationshipbefore the onsetof dementia(p.6)?
Botrill andMort alsonote that the over-65cohort islesslikelytohave beenaffectedbythe societal shift
inconsciousnessregardingdomesticviolence thatresultedfrom feministconsciousness-raising(for
example whatconstitutesabuse andthatnobodyhasto tolerate abuse) the way youngerpersons would
(Morgan DisneyandAssociates,2000, inBotrill andMort, 2003). They cite research suggestingthatpre-

Policy Backgrounder
Corinne Alstrom
morbidabusive orviolentbehaviourinpeoplewithdementiaismore predictiveof aggressive
responsive behavioursafterdisease onset,thanis anindividual’s degree of cognitive impairment.
One studyfoundpremorbidaggressionanda “troubled”relationshipwiththe primarycare partnerto
be predictive of aggressiveresponsive behavioursinpeople withdementia. Aggressionalsotendedto
be predictive of the discontinuationof home care andentryintolong-termcare (Hamel etal,1990).
Botrill andMort suggestthatinterventionsshouldcentre onthe subjective experience of the care
partner(2003). AnAustralianstudy theycite foundthat72% percentof care partnerscontinuedto
assume theirrole ascarers until a time of crisis,usuallyathreatto theirsafety (GilbertsonandBull 1997,
inBotrill andMort, 2003).
KeyInformantsreportedmakingsafetyplanningpartof theirproactive,pre-crisisplanning.58.3percent
of surveyrespondentswhoreportedhavingbeeninvolvedinanincidentinvolvingpolice,saidthatthey
alsodidsafetyplanningwiththe individual whohadbeenharmed.
 MeetwithOACPand leadersof AlzheimerSocietiestodiscussalternativestoarrestingaperson
withdementiawhenafamilymemberorcare partner isat risk.Thisissue mustbe dealtwithon
a provincial level becausesome police servicesclaimthatdomesticviolence policiesprevent
themfromconsideringalternativestoanarrest. Thisraisesthe potential forgreatrisktothe
personwithresponsive behaviours,becausetheymaybe at riskof deliriumoranothermedical
emergency.
 Utilize assetsinthe anti-violence-against-womencommunitytoteachsafetyplanningforcare
partners.The non-victim-blamingapproachundertakenbyanti-violence expertsmayprovide
opportunitiestochange the waywe advocate for bettercare for people withdementia.Itwas
recommendedbyaKeyInformantthatdomesticviolence advocacygroupsbe involvedinthis
processfromthe beginning,inordertopreventendingupinconflictwiththem.Domestic
violence protocolswere developedforuse withabuserswith“fullmental capacity,”andwere
neverintendedtopunishthose whose behavioursare causedbyillness.The OntarioWomen’s
Directorate andthe AssaultedWomen’sHelpline maybe goodplacestostart.
 SenecaCollege partneredwithpolice tocreate apublicservice announcement(video) on
domesticviolence.The budgetwasreasonable because the PSA wascreatedaspart of the
students’course work.A similarpartnershipmay be possible.
1. How docare partners,employeesandfamilymembersexperience aggressionorviolence from
people withdementia?

Policy Backgrounder
Corinne Alstrom
2. “How muchof that whichiscurrentlyidentifiedasa behaviourorsymptomof dementiais
actuallydomesticviolence thatpredatesthe onsetof disease (Botrill andMort,2003, p 21)?”
3. How mightitdomesticviolence protocol be enforcedwhenthe allegedoffenderisdependent
on the victim?
4. How doesone reconcile the personwithdementiaasthe agentof theirownlife,withnotseeing
themas responsibleforviolence orabuse? How isthisrelatedtothe conceptof “vulnerability”?
5. What constituteshumane/person-centredtreatmentof perpetratorswithdementia?
6. At whatpointintheircognitive decline isapersonwithdementianolongerresponsible fortheir
actions?
7. What intervention(s),policeorotherwise, docare partnersseekat timesof crisis?
8. Can police ensure safetyof the victimwithoutarrestingthe aggressor?
9. To what degree isthe needforbehavioural geriatricunitsunmet?
10. If an aggressorwithdementiaisbroughttohospital foremergencyassessment,how mightthey
be preventedfromALCplacement?
11. Can certainaggressors(forexample,withdementia) be exemptfromdomesticviolence protocol
withoutdiminishingthe gainsof the feminist/domesticviolenceframework?

Policy Backgrounder
Corinne Alstrom
Wandering and missing incidents
As a resultof changesinthe brain causedbydementia,six of tenwill gomissingatsome point.When
someone withdementiagoesmissing,theirchangesof returninghome safelyreduce drasticallywithin
24 hours (Alzheimer’sAssociation,2006).Thus itis importanttotreat searchas an emergency.A
numberof effortsare currentlyunderwaytoassistlaw enforcementprofessionalsinsearchingfor
personswithdementiawhogomissing.
Search and rescue programs
Both the AlzheimerSocietyof Canadaandthe Alzheimer’sAssociationinthe UnitedStatesrunprograms
that assistsearchand rescue personnel whenapersonwithdementiagoesmissing.Canada’sprogramis
nowknownas MedicAlertSafelyHome,andinthe U.S.,MedicAlert+ Safe Returnrunsnationwide. Both
programsmake use of the MedicAlertdatabase.Whenamissingregistrantislocatedbylaw
enforcementoracivilian,MedicAlerthelpstonotifyfamilymembersandreunite them(Lachenmayret
al,2000).
The AlzheimerSocietyof Peel,usingfundingreceivedfromtheirLIHN,openedarespite facilitycalled
Nora’sHouse in2005. A personfoundwandering,whohasbeenassessedbypolice aspotentiallyhaving
dementia,wouldbe broughttoNora’sHouse forfurtherassessmentbystaff until hisorherprimary
care partneris located. AlzheimerSocietyPeelandPeel Regional Police are inthe processof developing
an online communicationtool tofacilitatethisprocess.
Tracking devices
ProjectLifesaver,currentlyusedbyOntarioProvincial Police andYorkRegional Police,usesa$300
wristbandembeddedwitharadiosignal tolocate at-riskpersonswhohave gone missing(forexample,
people withdementia,autism, Down’ssyndrome,ortraumaticbraininjury).The rationale forthe
technology isthata radiosignal requireslessbatterypowerthanGPS,andso needstobe changedonly
monthlyfora fee of $10 (Agrell,2001).GPS alsohas trouble trackingpeople whoare indoorsornotin
an uprightposition.VolunteerscheckinonProjectLifesaverclientsmonthlywhentheirwristband
batteryischanged. The FBILaw EnforcementBulletinclaimsthat“inover1,800 searches,noserious
injuriesordeathshave beenreportedandrecoverytimesaverage lessthan30 minutes(Bryant,2010).”
SafetyNetinthe UnitedStatesalsousesradiotechnologytolocate missingat-riskpersons.Theirservice
costs $99 to enrol and $30 monthly(Moran,2011).
ProjectS.O.F.T.(SatelliteOptionFindingTechnology) isapilotprojectcurrentlyunderwayinmajor
municipalitiesinNovaScotia.It involvesthe use of GPSbraceletsthe size of a large watch to track
wanderingseniors.Fundingforthisprojectissetto endinFebruary2013, at whichpointitwill be
evaluated(Tucker,2012).

Policy Backgrounder
Corinne Alstrom
 MaintainrelationshipswithstakeholdersatOntarioPolice College andthe OntarioAssociation
of Chiefsof Police,aswell asotherhigh-rankinglaw enforcementofficials,aboutthe current
“wanderingprevention”program.
1. How muchtrainingdo lawenforcementofficersrequireinsearchandrescue of people with
dementia?
2. What are police officers’experienceswithSafelyHome andMedicAlert+Safe Return?
3. What are some of the benefitsanddrawbacksof trackingdevicesforpeopleatriskof going
missing?
4. For whatreasonsmighta personwithdementiaora primarycare partnerchoose notto register
witha program like SafelyHome orMedicAlert+Safe Return?(Forexample,are the related
costs prohibitive forpeople withlow incomes?)

Policy Backgrounder
Corinne Alstrom
Driving
Driving
In Ontario,itisrequiredfordriverstorenew theirlicence atthe age of 80. The renewal processtakes
place everytwoyears,andincludesavisiontest,a group educationsessionwithotherseniors,anda
writtenorverbal,untimedmultiple-choice test.If aparticipanthastrouble followingthe group
discussion,orhasrecentdemeritpointsontheirdrivingrecord,adrivingcounsellormaychoose tohave
the personundergoa road test. However,nearly37000 Ontariomotoristswithpotentialdementia
(calculatedfromlocal prevalence rates) are underthe age of 80; moreover,dementiainmotoristsover
the age of 80 maynot be detected,asthe licence renewal processisnotdesignedtodetectsymptoms
of dementia(Hopkinsetal,2004).
Healthy driving
In one study,lawenforcementofficersinterviewedweremore likelythanotherstakeholderstosupport
immediate licence revocationupondiagnosisof dementia(Perkinsonetal,2005). The researchers
recommendededucationalinterventiontoincrease awarenessof dementiaprogressionamonglaw
enforcementofficers.
Conditional orrestrictedlicensing(forexample,requiringa“co-pilot”,orbanningnightdrivingand
highwaydriving) hasbeensuggestedasone wayto assistseniorswithandwithoutdementiato
maintaindrivingmobilityaslongas possible (CanadianCouncil of MotorTransportAdministrators,
2007). There is some evidence thatrestrictedlicensingdoes reduce the incidence of crashesamong
motoristswithmedical impairments(Marshall etal,2002).
Evaluation methodology
The majorityof surveyrespondentswhoreporteddiscussingdrivingwithclientsreportedthatthey
wouldadvise someone withdementiawhohadconcernsabouttheirdrivingtospeakwithadoctor
(82.6%). In Ontario,as well asmostother Canadianprovinces,aphysicianisrequiredtoreporttothe
Ministryof Transportationif theybelieve apatientisunsafe todrive (Rapoportetal,2007). However,
there isstill muchdisagreementinthe literatureregardingthe bestwaytoevaluate whenapersonwith
dementiaisnolongersafe todrive.PracticesvaryacrossNorth Americanandthere iscurrentlyno“gold
standard”evaluationpractice inuse (Korner-Bitenskyetal,2006, inCarr and Ott,2010; Ott etal 2005).
Thismay explainwhy,inone study,45.8% of physicianssurveyedreportednothavingconfidence in
theirabilitytoassessdrivingabilityintheirpatients,and88.6% believedthat“educationabout
evaluatingfitnesstodrive wouldbe beneficial (Jangetal,2007, p. 534).”
The CanadianDrivingResearchInitiative forVehicular Safetyinthe Elderly(CanDRIVE) recommendsthat
motoristswithdementiahave theirdrivingabilityevaluatedeverysixmonths.Otherresearchsuggests

Policy Backgrounder
Corinne Alstrom
Driving
that a full neuropsychological testeverysixmonthswouldbe the mosteffective waytoevaluate driving-
relatedabilitiesinpeoplewithdementia(Adleretal,2005; Carr andOtt, 2010).
A possible screeningtool forphysicians,knownasthe Screenforthe Identificationof Cognitively
ImpairedMedicallyAt-RiskDrivers,A Modificationof the DemTect (SIMARDMD) wasdevelopedatthe
Universityof Albertain2010. Since thenthe SIMARD MD has beenactivelypromotedbyitsdevelopers;
however,analysisfromCanDRIVEresearcherssuggeststhatthe testhaslow validity,producingan
unacceptable percentageof false positivesandfalse negatives(Hogan&Bédard,2011).
KeyInformants andsurveyrespondentsreportedthatDriveABLEtestingisavailable intheirservice area;
however,itwascharacterizedasbeingprohibitivelyexpensive formanypeopleatriskof losingtheir
licence.Itwasreportedthatsome people whodisputetheirdoctor’sreportsimplycannotafford the
testto have theirlicense reinstated.
The Ministryof Transportation(MTO) hastakenan interestinthe resultsof the studyledbyDr Lindy
Kilik,regardingthe SOMCTtestbeingusedbypolice inthe field.SOMCTscoreswouldprovide officers
withan objective reportif apersonwithdementiaisfounddriving.Thiswouldreduce the challenge of
the officertoneedingtoarticulate whytheyare reportingadriverto the MTO.
Discussing driving
Many Key Informantscharacterizeddiscussionsaboutdrivingashighlyemotional,andamongthe most
stressful partsof workingwithpeoplewithdementia. The lossof drivingabilitywasreportedtobe one
of the firstandmost traumaticlossesof a dementiadiagnosis.Attimes,the revocationof the person’s
license comesinthe same appointmentashe or she isdiagnosedwithdementia;thiswasdescribedas
“like beingslappedinthe face twice.”Of respondentstothe surveyof local Societies,86.7percent
reporteda client’sfearof losingtheirindependence asanissue.Responsestoopen-endedquestions
made mentionof otherchallenges encounteredwhendiscussingdrivingwithclients,suchasthe family
or care partner(s) beingconcernedaboutapossiblenegative response tothe suggestionthatthe person
withdementiamaynotbe safe to drive,andthe role of the physicianindrivingassessment.
Informants talkedaboutthe stressputonthe clinical relationshipbetweenapersonwithdementiaand
hisor her doctorcausedby the doctor’s dutyto report.Some KeyInformantsfoundthatdisclosingthe
possibilityof license revocationgoesbetterif rapporthasbeenbuiltinadvance.Some people wantto
be warnedinadvance that theirlicense maybe revoked;others mayavoidseeingadoctor,or decline
consentto be assessedfordementia,forfearof havingitrevoked.
Although adementiadiagnosisisnotnecessarilyacause forimmediate drivingcessation, driverswith
dementiashow trendstoward “more at-faultcrashes,crasheswithinjuries,andcrashesinwhichthe
officeronthe scene citedfailure toyield (Carretal,2000).” KeyInformantsreportedthatpeoplewith
dementiamayhave small drivingincidentsthatbringthemtothe attentionof law enforcement,before

Policy Backgrounder
Corinne Alstrom
Driving
a major incident. However,anindividualofficermaynotfeel thatthe incidentissufficienttorequire a
charge.Theyletthe personoff withawarning,whichmaybe forgotten.One informantreportedan
occasional strategyof usingpolice authoritytoconvince apersonwhose license hasbeenrevokedto
cease driving;forexample,sendingthe officerovertodiscussitwithpersonandtheirfamily.
Ethical considerations
The conflictbetweenthe independenceandwell-beingof peoplewithdementia,andtheirsafetyand
that of other motoristsandpedestrians,producesanethical dilemma.Researchsuggeststhatdriving
cessationinelderlypersonsmayleadtosocial isolation,depression,andreductionof out-of-home
activitiesincludingmedical appointments(Freemanetal,2006). Elderswhostop drivingmayoptfor
withdrawal fromout-of-homeactivitiesratherthandependence andperceivedburdenonanother
motorist(Taylor& Tripodes,2001; CanadianCouncil of MotorTransport Administrators,2007).One
studyfounda positive correlationbetweenbeinganon-driverandearlierentrance intolong-termcare
(Freemanetal,2006).
For these reasons,astudyfounddriverswithdementiaunlikelytoself-regulate drivingcessation;only
27% of studyparticipantsoptedforvoluntarydrivingcessationbefore the occurrence of acrash
(Friedlandetal, 1988). Anotherstudyfoundthat80% of studyparticipantscontinuedtodrive forupto
three yearsfollowingacrash (Cooperetal 1993, inBreenet al,2007). In anotherstudy,seniorswithout
dementiareportedthatonlyacrash or near-crashwouldcause them tovoluntarilystopdriving
(Rudmanetal, 2006).
Transportation alternatives
Individuals livinginareaswithlowpublictransitaccess,suchasrural and northernareas,aswell as
some urbanareas, are leftwithouttransportationoptionsuponcessationof driving(CanadianCouncilof
Motor Transport Administrators,2007).In small orrural areas,drivingmightbe necessaryinorderto
pickup one’smail at the postoffice.Of surveyrespondentswhodescribedtheirservice areaasrural,
81.8 percentreportedalack of transportationalternativesasa majorissue,comparedto68.9 percentof
all respondents.KeyInformantsreportedthatsome transportalternativesare onlyformedical
appointments.Asfarassocial and leisure activities,anindividual whoselicense hasbeenrevokedas
veryfewoptions,especiallyinarural setting.
Transportation optionsthatnon-driversare able toaccess,such as WheelTransinToronto,orvolunteer
drivingservices,lackspontaneityandmustbe plannedinadvance.Thisleadstoa feelingof
dependence.KeyInformantsalsoreportedWheelTransbookingdifficulties.One informantreported
beingputon holdforup to an hour whenbookingWheelTransforclients.The alternative,anonline
bookingsystem,wasreportedasbeingdifficultforseniorstouse.If a WheelTransusermisseshisorher
pick-uptime,forexamplebecause adoctorisbehindschedule,he orshe maynot have othermeansof
returninghome.

Policy Backgrounder
Corinne Alstrom
Driving
 The upcomingfull reportfromDr SamirSinhamay addressa possible solutiontothe stressof
license revocationonthe doctor-patientrelationship.If all individuals80and overwere to
require medical certificationtodrive,thiswouldrelievethe pressureonbothdoctorsand care
partners to place themselvesinoppositiontoa personwithdementiaoranyotherimpairment
that may make themunsafe todrive.Thusinsteadof the revocationseemingassuddenand
punitive,itbecomespartof a healthcare check-up.Additionally,thisapproachmay leadtomore
diagnosesof dementia,aswell asothermedical issues,atanearlierpoint.
 One KeyInformantputforwardthe ideaof a “pre-charge”fordangerousdriving.When
someone hasa minorincident,insteadof lettingthemoff withawarning,which theymay
forget,police wouldinformthemhave done somethinginconflictwiththe law,andrequire a
follow-upwithacrisisteamandphysicianwithinthree days.If the individual doesnotfollowup,
the police will initiateafollowup.
 The At-RiskDriverProgrambeganwithAlzheimerSocietyDurhamRegionandhassince been
adoptedbyotherlocal AlzheimerSocieties.The programregistersanindividual withdementia
whose license hasbeenrevokedintothe CPICdatabase.If the personcontinuesdriving,andis
stoppedbypolice,the contactinformationof afamilymemberorcare partneris available inthe
CPICdatabase.Thiscare partneris responsible forthe car.The local AlzheimerSocietyprovides
ongoingsupport,information,andreferrals.Few people are registeredforthisprogramandit is
not heavilypublicized.
1. Is itpossible fortestingof motorists80and overto reveal signsof cognitive impairment?If so,
can individualswhoshowthese signsbe referredfortesting?
2. What interventionsare inplace if amotoristwithdementiaorpossibledementiaisstoppedby
police?Cantheybe referredfortesting,forexample throughthe FirstLinkprogram, ora
memoryclinic?
3. What viewsdolocal lawenforcementholdregardingmotoristswithdementia?

Developing Best Practices for Law Enforcement and Dementia

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