The Role of First Responders and Dementia | Alzheimer's Prevention Registry

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October 5, 2015

The Role of First Responders and Dementia

By Banner Alzheimer's Institute

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Nearly every time you engage a first responder it is because something unexpected has happened.  Whether calling police, fire, or EMTs, something out of our control has occurred and we need help beyond what we are capable of giving.  With this attitude, we try to avoid contact with first responders unless absolutely necessary.   First responders are public servants, but are often an under recognized and underutilized resource in the care team.  They encounter people with dementia in a variety of ways through the initiation of friends and family, or by happenstance.  Regardless of the how, the why is important to consider because, as with most things with dementia, forethought can prevent an escalation or out of control situation.  Read more for some of the most common scenarios in which first responders can be helpful.

 Driving:

Even in the early stages of dementia, driving can become dangerous.  Beyond memory changes, dementia will affect the person’s depth perception, reaction time, the ability to interpret information, and increased likelihood of getting lost - in even familiar surroundings. This is why driving should be cautiously and conservatively evaluated.  While we are always concerned about the safety of our person, driving brings in the added concern of the potential dangers to others on the road. 

Families and other concerned friends need to start the conversation about driving early in the illness as the person may be able to be an active participant in the conversation. Ideally, he/she will decide to discontinue driving.  However, the ideal is not necessarily the norm and taking the keys and vehicle away or making it inoperable becomes the only option for some families.

First responders can help in the risky driving arena in a few ways. A law enforcement Officer can send a Re-Examination Request to Motor Vehicle Division (MVD) asking that the person be brought in and complete a driving test.  Law enforcement typically has to view the person driving and witness their poor driving habits prior to submitting the form. 

A physician, registered nurse practitioner or psychologist may also report a patient to MVD who “has a medical or psychological condition that, in his or her opinion, could significantly impair the person’s ability to safely operate a motor vehicle”.  The Physician Examination Report form must include the name, address and date of birth of the patient. The medical professional submitting the report in good faith is immune from civil or criminal liability for making the report. As a family member, you can ask your medical provider to assist you with this process if they are unfamiliar.

Firearms

Memory, thinking, and judgment as well as physical and behavioral competence issues related to a person's safe operation of a motor vehicle apply to firearms as well. The symptoms of persons with dementia such as memory loss, confusion, personality changes and anxiety affect their ability to safely own and operate a firearm.  Gun availability can pose a particular risk to care partners as families typically have limited legal means to remove firearms from their family members.   If there is a firearm in your home it is best to:

  • Keep it in a locked cabinet (one that does not have glass)
  • Store it unloaded
  • Install trigger guards on all firearms to prevent them from being used
  • Keep all ammunition in a locked fireproof safe separate from the firearm or better yet, rid of all ammunition
  • Keep keys for the trigger guards, gun cabinet and ammunition hidden from the person with dementia
  • Get rid of the firearms; store them at a neighbor’s house, sell them, or take them to the police to be destroyed.  Many local law enforcement agencies will accept firearms for disposal.  Call the agency and an Officer will respond to take possession of the firearm.  You can also bring them to your closest police station BUT leave the firearm in your vehicle and have an Officer meet you at your vehicle to take possession of the firearm.

Wandering

A person with dementia can have disorientation to not only time, but place.  They can also become fixated on getting to a certain location, or become lost in familiar settings which can lead to a very dangerous consequence of dementia- wandering.  The best safeguards are, once again, prevention. However, even with every safety measure in place, a person with dementia can still become lost.  People with dementia can wander on foot, by driving, or using public transportation. With that in mind, every second counts.  First responders recommend contacting them as soon as you notice your person is missing.  With missing person calls, typically, responders want to wait 24 hours before a search begins. However, someone with dementia has specific safety concerns.  Be sure to state this diagnosis when calling 9-1-1.  In addition, Arizona has passed the Silver Alert system which, when certain criteria are met, enables responders to use a broader alert system to try to locate this person as soon as possible. 

Banner Alzheimer’s Institute offers an Information Card that can be filled out in advance which contains detailed pertinent information about the person.  By presenting this card to first responders when your person has wandered, it can save precious moments and ensure this information is transmitted to the appropriate parties.  To obtain your copy of the BAI Information Card, contact: baiinfo@bannerhealth.com

The Alzheimer’s Association offers a Medic Alert- Safe Return (MA-SR) bracelet.  This bracelet or pendent is worn by the person with dementia in case they wander, and there are multiple facets to this program.  First, if the individual is found, first responders know this is a person with dementia and can reunite them with their caregiver.  Second, a caregiver can alert MA-SR if their person wanders, which activates a nationwide community support network to assist in finding your person. Many times scholarships are available to help with the cost of the bracelet.  For more information, visit www.alz.org or call the Alzheimer’s Association 24/7 Helpline at 800.272.3900.

Shoplifting

Here is a common scenario: Mary and John were shopping at a local store one afternoon when, unbeknownst to Mary, John took a candy bar from a shelf.  As they exited the store, they were stopped by a loss prevention officer who had observed John taking the candy bar.

Law enforcement may receive a call of a shoplifting by a person with dementia such as in this story.  The person with Alzheimer’s may not understand or remember that merchandise must be paid for. He or she may casually walk out of the store without paying — unaware of any wrongdoing.  Caregivers can work with the store managers. We suggest explaining the situation to management so they can respond in an accommodating manner.  Perhaps they can snap a photo and keep it on file in case it happens again or you can work something out with management whereby you pay for the item discretely.  Not all store staff will be knowledgeable about the dementia and the shoplifting connection. Thus, they may handle the situation as they would any other shoplifting incident.  If this happens to you don’t hesitate to contact the store management, or enlist the assistance of the local Alzheimer’s Association to address the situation in order to train the store staff.  It would also be helpful for you to carry courtesy cards provided by Banner Alzheimer’s Institute that reads “My companion has a medical condition that affects memory and thinking.  Your patience is appreciated.Or have your loved one carry a wallet-size card that states that he or she is memory-impaired. This may prevent the person with Alzheimer’s disease from feeling embarrassed.

Preparedness is so important for caregivers because in the midst of a traumatic event it is difficult to gather the information necessary to address the issue.  It is better to have a plan in place that can assist the caregiver and first responders. Remember, first responders are here to help you and the person with dementia.