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Dementia & Driving

By Laurie White

When a relative is experiencing signs of dementia and is still driving, some of the questions families often ask are "Is driving safe?" "When it is time for dad to stop driving?" " How do I talk to him about his driving?" These are not easy questions to answer. Each person’s personality and abilities need to be considered in making the driving decision.

Is Driving Safe?

A diagnosis of dementia does not automatically mean that a person is no longer able to drive. When the diagnosis is made early, many people can continue driving safely for quite a while. Some people with dementia may not be able to drive long distances or in stimulating conditions, but may be able to drive short and familiar distances around home.

If you are concerned about your relative’s ability to drive, ask him to drive you somewhere. Take note of how he is changing lanes and negotiating traffic. Is he using the brake and accelerator appropriately? Is he able to read and interpret signs? Can he follow your directions and get to a familiar location without getting lost? Does he seem to get flustered when traffic conditions change? Is he able to see the cars beside him in the next lane?

If you are not satisfied he is driving safely, bring up your concerns, citing specific errors and incidents that you have observed. Ask him how he feels he is driving. Ask him when he will know it is time to stop driving.

Some people with dementia realize they are not driving as well as they used to and some people may not see themselves as having any problems on the road or recall any ‘near misses’ or accidents. Sometimes it is hard to know if an individual with dementia is denying problems or does not have the insight into how challenging driving has become. Whatever the answer, safety must come first.

When is it Time for the Driver to Become a Passenger?

Since receiving the diagnosis of dementia 2 years ago, Joan 77 years old, has continued to drive her car around town, to classes at the senior center, grocery store and doctor appointments. She has multiple dents and scrapes on her car, "none of which are my fault. They were all caused by other people." When her daughter brings up her concerns about her mother’s driving, Joan says," I am fine on the road. I have not caused an accident in my 65 years of driving. Really, it is all so automatic, I could drive in my sleep."

The number of dents in Joan’s car was a big warning sign that Joan may be a hazard on the road. Although the dents are real and there, Joan does not remember how they got there, clearly and understandably a concern to her daughter. Other signs that may indicate a change in a relative’s ability to drive safely include:

  • Driving tickets
  • Getting lost to and from familiar places
  • Driving too slow or too fast for road and traffic conditions.
  • Braking too late or too soon at stop lights, stop signs, pedestrian traffic
  • Feeling anxious when driving
  • Hitting parked cars or curbs
  • Not being able to park the car appropriately

Joan says that driving is so automatic that she does not have to pay attention to what she is doing. The problem is that driving is not automatic for anyone, but especially for people with dementia:

  • It takes more concentration to pay attention to the conditions, changes and choices on the road.
  • Peripheral vision that is required to see cars in the next lane may be limited.
  • Judging how to negotiate traffic or when to brake and how fast to drive may be impaired.
  • Recognizing the meaning of signs on the road such as "one way" or "do not enter" may be fading.
  • Memory loss may affect a person’s ability to remember how to get from home to another location.

Initially Joan’s daughter was frustrated and stressed that her mother was being so resistant. She soon realized that her mother did not see herself as being a hazard on the road or recall the incidents that caused the car damage. It was not a case of denial; it was a result of brain damage. Joan had lost her self awareness and no amount of talking would convince Joan that she had to give up driving for her own safety and the safety of others. For her mother’s sake and others on the road, Joan’s daughter removed the car. Joan was not happy but gradually she appreciated that her daughter was willing to drive her to places every week. "As long as I can get to do things and see people, I am okay with not driving myself."

When Talking About Driving No Longer Works

Six months ago Tom received his diagnosis of Lewy Body Dementia and Parkinson’s disease. At 68 years old, Tom continues to be active and independent, driving himself to his doctor appointments, grocery shopping, his gym and to see friends. His wife Deborah is very concerned about Tom’s ability to negotiate traffic, and notes that he often misjudges the distances between his car and other cars and people on the road, and is slow to brake. ‘It’s almost like he is in slow motion, which seems like it is more dangerous than speeding. I have talked to him about his driving but he says he is fine and has had no close calls. I know it will be devastating for Tom when he has to give up driving. I do not want to be the one to tell him that he can no longer drive."

Safety was Tom’s wife primary concern, so she made an appointment with Tom’s doctor and talked to him about Tom’s increasing difficulties behind the wheel. At Tom’s next appointment, his doctor told Tom that he did not want him to drive. Although Tom did not like it, he accepted it. Tom continued to talk about ‘getting better and taking the driving test to prove I can drive’. Deborah would encourage him, but say, "in the meantime, we have to do what the doctor says – you are not to drive and I think it is best if I keep the keys until you get better." Eventually he accepted his doctor’s orders and stopped talking about driving.

Doctors often rely on a patient’s family for information on how a patient is caring for himself and managing everyday activities, including driving. When driving becomes an issue and a loved one is resistant to giving up ‘his wheels’ ask the doctor to talk to your relative. Some doctors will even write, "No driving" on a prescription pad to remind a patient that he should no longer drive.

Taking the Matter Into Your Own Hands

A person with dementia can be very insistent that driving is not a problem, when in fact it is dangerous for him to be behind the wheel. If this is the case, talk with other family members and friends about how best to keep your relative safe and off the road. Some families find that it is best to remove the car and tell their relative afterwards. Other families decide to disable the car but leave the car at home. One family member asked to borrow her mom’s car because her car was in the shop. The daughter drove her mom everywhere she wanted to go for a few weeks and eventually her mom forgot about her car being gone.

Most caregivers who are assisting and caring for a relative with dementia have dealt with the driving issue. Talking with other caregivers about how they handled it in their family can be helpful.

For more information on driving and dementia see: At the Crossroads: Family Conversations about Alzheimer's Disease, Dementia and Driving. Published by The Hartford.

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