A Guide to Driving and Not Driving With Dementia

It’s a question more and more families are being forced to contend with as the age profile of America’s drivers continues to climb. When someone you love, and who may have been driving for more than half a century, has been diagnosed with dementia, how do you get that person to make the transition from driver to passenger?

Doctors and specialists are agreed that an early diagnosis of dementia does not necessarily mean that person must immediately stop driving. However, dementia is progressive and without a doubt, driving skills will decrease with the ultimate result of the person being forced to give up driving altogether.

Dementia symptoms that will certainly affect—even in the very early stages—a person’s ability to drive include:

• Memory loss
• Visual-spatial disorientation
• Decreased cognitive function

For families and caregivers, telling someone they love that it’s time to stop driving can be extremely difficult and upsetting for everyone involved. For the person who has to stop driving, they see it as the ultimate loss of self-reliance and personal freedom. For those that have to intervene, it’s a balancing act between respecting their loved ones dignity and wishes, and looking out for their—and other road users’—personal safety.

Knowing when it’s time to stop

Dementia is without question a progressive condition, but the rate of that progression varies almost universally from person to person. It’s impossible, therefore, to set down hard and fast rules about when a person who has been diagnosed can no longer drive safely.

Experts do agree that for the most part, people with early stage or mild dementia who wish to continue to drive should be allowed to do so only after having their skills assessed by an independent driving evaluator. The DMV can tell you where and how this can be done. Individuals with early or mild dementia who pass an examination will probably have to resubmit to a test every six months. Once the dementia has reached the moderate stage, however, individuals simply should not drive.

The best and safest way for family members to determine whether the person with dementia is still able to drive safely is to watch their behavior outside the vehicle. Watch for the following signs as indicators that it’s time to intervene:

• A loss of coordination
• Difficulty making even simple judgments of distance and space
• Getting lost or disoriented in what should be familiar places
• Difficulty in multi-tasking even simple and familiar things
• Increased memory loss, and particularly short-term or recent events
• Signs of being less alert to things going on in the immediate vicinity of the person affected
• Severe mood swings, confusion and irritability
• Lack of attention to personal care unless prompted
• Difficulty processing even straightforward information
• Troubles with decision-making and solving even simple problems

Comparing the above symptom’s with the person’s ability’s and behavior in each category before the onset of dementia is far easier for family members and close friends than it would be for a doctor or other medical professional. Once the symptoms become obvious, talk about them with other family members, close friends and health care providers to discuss how to move forward.

If the decision is made by all concerned that the dementia doesn’t immediately warrant an intervention, family members and close friends should then carefully monitor behavior behind the wheel. It can be very useful to keep a written log of any incidents of poor driving to share with those who will ultimately be involved in the decision of when it’s time to stop driving. Watch out for and record things like:

• Driving far too slowly
• Stopping in traffic for no reason
• Ignoring traffic signs and signals
• Getting lost, especially on routes that should be familiar
• Experiencing undue difficulty with turns, lane changes or exits
• Drifting into the wrong lane or driving on the wrong side of the street
• Not using signals or signaling incorrectly
• Failing to notice pedestrians, objects in the road or other vehicles
• Becoming sleepy while driving
• Elevated anxiety, frustration or irritation while driving
• Increased numbers of near misses or actual accidents, even minor ones

Making the transition as easy as possible

Sooner or later, family members and caregivers are going to have to make the decision that it’s time for the person with dementia to stop driving. To make the transition as easy as possible, it’s important to discuss with the individual in question how they would feel about not being able to drive. Talking about it usually helps a lot, and there are support groups for both the affected individuals and their families and caregivers, where everyone can hear and be heard.

If the unfortunate person “just doesn’t want to talk about that,” it’s a good idea to ask their doctor to bring up the subject during a regular visit. Then discuss with the person a “bottom line” of behavior that will signal the end of their driving. Start discussions as early as possible, because a sudden and unexpected transition from driving to having the keys taken away can be extremely traumatic for someone who is already going through a very difficult time.

Some ways to make the transition as easy as humanly possible include:

• Work on a gradual reduction in the amount of driving done by the person. Encourage them to:
  • Stay only on familiar roads
  • Avoid heavy traffic
  • Avoid night time driving and poor weather conditions

• Reduce the need to drive as much as possible by:
  • Having things like groceries and prescriptions delivered directly to their home
  • Arranging for barbers or hairdressers to come to the house
  • Inviting friends and family over as often as possible.
  • Organizing friends and family social outings where someone else drives

• Line up practical methods of alternative transportation for the individual, including options such as:
  • Family and friends—do up a list of people that can be called when the individual wants to go to the store, the doctor or a social engagement.
  • Public transportation, provided the affected person is already familiar with the local system. If not, this option may be too difficult and frustrating.
  • Taxis—a good option for those in the early or mid-stages of dementia. If possible, set up a payment account with a designated taxi firm. This will help ensure the taxi is available for both ends of the round trip and eliminate the need for the person with dementia to handle money.

In some areas, the Yellow Pages may list organizations that provide Senior and Special Needs Transportation. These can also be called upon as an additional option.

People with dementia can be as stubborn as…well, as anyone else. In some cases, it will be virtually impossible to convince someone that they have to give up driving. This can be extremely stressful for all concerned and may require methods of last resort such as:

• Hiding the car keys
• Replacing the real car keys with a set that won’t start the car
• Disabling or selling the car
• Moving the car to where the affected person won’t be able to find it

These are extreme measures and may even be considered cruel by some. Certainly, they should only be used when all other reasonable measures have failed. Remember, you may be saving the life of a loved one, as well as those of other innocent road users.

Giving up driving is just one of many areas a person with dementia—and their family, caregivers and/or friends–will have to face in what will admittedly be a very trying and stressful time for all concerned. Personal safety, however, must be of paramount importance.

Letting someone who has dementia drive a car could be considered a negligent act. If someone is hurt or killed by a driver who simply shouldn’t be behind the wheel, for whatever reason, the consequences then become devastating for more than just the family of the person with dementia.

In Oregon, victims of negligent drivers frequently suffer horribly painful and life-changing injuries. If this has happened to you or a member of your family, you should consult a highly experienced Portland car accident attorney to discuss your rights and options. A good personal injury lawyer will clearly explain the best course of action, and the consultation is free, so if you’ve been injured and it wasn’t your fault, make the call.