Driving and Dementia: When and How to Have the Talk
Taking away an elder’s driving privileges is one of the most dreaded challenges that adult children, or spouses of people with dementia, face. The ability to drive oneself to a chosen destination is often the ultimate sign of independence. Conversely, being forced to stop driving is generally viewed by elders as a major loss of independence. Yet, an unfit driver is a potential killer. When should a person quit driving, and how do we convince our loved one that he or she must give up this independence?
A story in the January edition of the Mayo Clinic newsletter focuses on the dementia and driving problem. The article points out that while memory is an issue, a person with Alzheimer’s or another dementia may have trouble prioritizing visual cues which could have even more of an impact on driving safety. Even a person without a cognitive disorder can momentarily hesitate when making a decision about how to respond to a dog running across the street or a children playing near a curb. Then there are traffic signs, brake lights on the vehicle ahead of the driver, confusing lane changes – we all know these challenges. When a person has dementia, it’s simply harder to process these abundant cues and to respond appropriately. This inability can make the person a dangerous driver.
The challenge for families
My dad never had strong eyes and as he aged he naturally had more vision problems. After a close call where he could have had an accident, Dad voluntarily gave up driving. That was before he had surgery that left him with severe dementia.
After dementia took over Dad’s cognition, he went through many stretches where he angrily demanded that he could drive and that I was supposed to buy him a car. He no longer remembered that he’d wisely given up driving at an earlier time because it was the right thing to do. There was no use in my pointing out that at this time he had trouble even using a walker and he couldn’t see well enough to dial a telephone. He was sure he could drive and that was that. Those were heartbreaking times which we just had to weather until we could get him re-focused on some other issue.
Expert opinions vary on when people who’ve been diagnosed with dementia should quit driving. The National Alzheimer’s Association says that for some people, it’s easier to give up driving earlier while they can still understand the danger of driving while impaired. Yet, other sources say that people can drive in a limited range during the early stages, as long as they stay in familiar territory.
That being said, the National Alzheimer’s Association gives these guidelines for families to follow when deciding when it’s time to get an elder with dementia to quit driving:
- Difficulty navigating to familiar places, changing lanes or making turns
- Confusing the brake and gas pedals
- Failing to observe traffic signals
- Making slow or poor decisions
- Hitting the curb while driving
- Driving at an inappropriate speed
- Becoming angry or confused while driving
I like the National Alzheimer’s Association’s bottom line, which is to ask yourself if you would feel safe allowing your children or grandchildren to ride with this person. If the answer is “no,” then it’s time to get serious about driving cessation.
Starting the conversation
- Do your homework about alternatives to driving. Offer to drive parent or spouse to medical appointments and other events, but also look into senior ride services so that your loved one will have some independence. Most communities of any size have a senior center that likely has a van service one can call for a ride. My community also has a para-transit bus service that makes regular stops at senior housing and private homes to take people to the grocery store and other places. Again, this makes the elder less dependent on the family for transportation. Make sure your elder understands these alternatives.
- Ask the doctor to “prescribe” driving cessation. Get a letter from the clinician to show your loved one that the doctor says to stop driving.
- Talk about your concern for the safety of the driver, but also stress the safety of others. Using children as examples of people who could be hurt or killed by your elder’s driving can be effective in these situations.
- Let your elder know that you understand that driving cessation is extremely difficult for most people and that their initial resistance is understandable. Again stress the need to be responsible. Be patient and loving, but also firm.
- Consider an evaluation by a driving school or instructor. Our local clinic has a driving program where people can be evaluated. This takes some responsibility off of the family.
- If necessary, contact your state’s DMV and ask them to send a letter to your elder stating that a driver’s test needs to be given. A letter from the doctor may be needed. Help your elder follow through.
- Don’t expect one conversation to make everything okay. If your elder fights hard, watch for sneaky behavior such as having extra car keys made. People with dementia are still smart. They just have trouble processing their thoughts. I’ve heard of very creative ways around the no driving rule.
Dig in for the long haul, watch for chances to have friendly talks before the situation demands immediate cessation, and look for help from the doctor and DMV if you need it. For your own sake, remember that the time may come that you can laugh about this tough time. One woman’s husband, who had Alzheimer’s, was sly enough to talk a car dealership into bringing a car over to the nursing home for him to try. He succeeded twice (not in driving, but in fooling the dealership). The nursing home staff still gets a chuckle out of that.
For more information, see driving and dementia located on The Hartford website. This site is recommended by the National Institutes of Health.
Mayo Clinic Newsletter. (2013, January) Alzheimer's: When to stop driving
National Alzheimer’s Association Dementia and Driving Resource Center (2013)
The Hartford. (2013) Understanding Dementia and Driving