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Older Adults and Dementia: Driving Considerations

Driving is a symbol of independence and freedom, especially for seniors who value their ability to stay active and connected to the world around them.

However, for seniors with dementia, driving can be dangerous for both themselves and others on the road.

Can people with dementia drive? The answer depends on dementia severity.

If a senior only has mild dementia, then they still should be able to safely drive themselves around (for the time being). It’s when they can no longer make quick decisions or their cognitive function is seriously impaired that driving can be dangerous for the senior and everyone else on the road.

In this article, we’ll explore the challenges and risks of driving with dementia and the legal and ethical considerations surrounding seniors who drive after a dementia diagnosis.

We’ll also dive into the warning signs that mean the time has come when driving with Alzheimer’s or dementia may be unsafe, along with strategies for coping with the loss of independence that comes with giving up driving.

We’ll even touch on the resources and organizations that provide transportation and other assistance to seniors with dementia who can no longer drive.

What’s The Difference Between Dementia And Mild Cognitive Impairment?

Dementia is a group of symptoms that affects a person’s ability to reason, make sound judgments, and remember.

Alzheimer’s disease is the most common form of dementia. Other common types of dementia are dementia with Lewy bodies, frontotemporal dementia, and vascular dementia.

Although most cases of dementia affect seniors who are 65 and older, those between their 30s and 50s can and do develop dementia.

The signs of dementia are impaired thinking, reduced daily functioning, curtailed social skills, forgetfulness, confusion and disorientation, mood changes, and anxiety and nervousness.

Mild cognitive impairment (MCI), on the other hand, is memory loss in its earliest stages. The cognitive abilities of someone with MCI might limit their spatial or visual perception.

However, for the most part, a person with MCI can still do most things for themselves and, overall, maintain an independent life.

Conversely, someone with dementia will eventually need a full-time caretaker as their dementia goes through a gradual decline.

Those with MCIs are worth keeping an eye out for, too.

According to the National Institute on Aging, up to 20 percent of people with an MCI who are 65 or older will develop dementia within a year.

Does Dementia Affect Driving?

Whether your senior parent or loved one first had an MCI that later became dementia or theirs was always dementia, you worry whether having dementia could affect their driving.

The answer? Absolutely – dementia can affect driving.

Someone with dementia could get in the car and not even remember that they did it. They could be behind the wheel and have no idea where they’re going. Or they may forget what the colors of the traffic lights mean.

In other cases, they can strive to go somewhere, such as to the doctor’s office or the grocery store but forget midway through where they’re going.

They can get lost, even in familiar places or when driving familiar routes.

Dementia patients also struggle to make decisions, which doesn’t bode well when driving.

A person behind the wheel must have good response times and be ready to make sudden stops, change lanes, or turn as a result of the circumstances going on around them.

If older people with dementia hesitate even a second too long, that can sometimes be the difference between causing car accidents and getting away unscathed.

A 2012 publication of the Journal of Geriatric Psychiatry and Neurology reviewed data on the rate of driving incidents by drivers with dementia. Here’s what they found.

Studies have shown that the driver with dementia is at an increased risk to cause traffic accidents. Friedland and coworkers found a 47% prevalence rate of crashes among 30 persons with Alzheimer’s disease (AD) compared to 10% of 20 age-related controls in a retrospective survey over 5 years. Overall, there is probably a 2- to 8-fold greater risk of crashes for elderly drivers with mild to moderate dementia compared to those not demented.

Those numbers are quite sobering and prove that those with dementia absolutely do have a reduced driving ability.

Keeping a dementia patient on the road as their condition worsens makes them an unsafe driver who is even more of a danger to themselves and others.

Legal and Ethical Considerations Of Seniors With Dementia Driving

As dementia progresses, seniors may experience cognitive decline that affects their ability to make sound decisions, react quickly to unexpected situations, and remember driving rules and safety guidelines.

In some cases, this decline can lead to dangerous and potentially life-threatening situations on the road.

For this reason, there are legal and ethical considerations surrounding seniors with dementia driving.

Laws vary by state, but many require that a person with dementia report their condition to the Department of Motor Vehicles (DMV) or take a cognitive and/or physical driving test.

If the test results show that the senior is no longer able to drive safely, their license may be revoked.

Family members and caregivers may also face ethical considerations when it comes to seniors with dementia driving.

They must balance their loved one’s desire for independence with the need to keep them and others safe.

This can be a difficult decision, but it is important to prioritize safety above all else.

Warning Signs That A Senior With Dementia May Be Unsafe To Drive

It can be challenging to determine when a senior with dementia should stop driving. However, there are warning signs that may indicate that it’s time to give up driving.

These signs include:

  • Difficulty staying focused on the road
  • Forgetting how to get to familiar places
  • Getting lost on the way to familiar places
  • Failing to follow traffic signals and signs
  • Difficulty judging distances and speed
  • Difficulty with parking and reversing
  • Increased aggression or confusion while driving
  • Dents, scrapes, or other signs of accidents on the car
  • Increased citations or warnings from law enforcement

If a senior with dementia exhibits any of these signs, it may be time to consider alternative transportation options.

What Is A Cognitive Driving Test?

Depending on whether your senior parent or loved one’s condition, you might not be willing to take any chances.

So, before they get back in the car to drive themselves anywhere, you want them to take a cognitive driving test, also known as a cognitive driver assessment.

This independent driving evaluation determines a driver’s reaction time, visual and auditory perception, attention span, time perception, manual dexterity, and ability to determine speed and distance.

Cognitive driving tests aren’t solely recommended for dementia patients, but also for those with reduced eyesight, balance issues, and other medical conditions.

Depending on the organization that administers the road test, it can go very in-depth or only somewhat.

For example, CogniFit offers an Online Cognitive Assessment Battery for Driving test that creates a cognitive profile and reviews neurological factors, the driver’s well being, and psychometrics.

The goal is to create a complete profile on the driving fitness of those who pay to take the online test.

Of course, whether you opt to pay for the CogniFit test or you go with a less complex assessment, a cognitive driving test can only provide advice on whether it’s safe for a person to drive.

The assessment does not replace or supersede the advice of your senior’s doctor or health care providers.

That said, you can bring the results of the test to your senior’s next appointment and discuss them to see what their doctor says.

It is worth noting that if there are no cognitive driving tests available in your area, look for an occupational therapist (OT) who has special training in driving rehabilitation.

The OT can do a comprehensive assessment of the driving skills of older drivers, along with evaluation of their visuospatial skills and physical ability to drive (such as turning their head, looking over their shoulder, etc).

Lastly, AARP has an online Fitness-To-Drive screening tool that could provide some insight.

At What Point Should Someone With Dementia Stop Driving?

The Alzheimer’s Society states that “a diagnosis of dementia is not itself a reason to stop driving.

We agree, as dementia has multiple stages that are characterized by the worsening of symptoms. The keyword there is worsening.

Dementia currently has no cure. Even if your senior parent or loved one is receiving the best medical care, their dementia will still eventually become more advanced.

When is dementia too advanced to continue driving?

When your senior begins experiencing the following signs of unsafe driving regularly, they shouldn’t drive anymore.

They Get Tickets All The Time

You probably remember when your parents proudly boasted about their perfect driving records.

My dad drove for a living and was extremely proud of never having gotten a ticket in his life. (He also loved getting discounts from his car insurance company!)

These days, your senior loved one seems to get pulled over all the time. They’re constantly coming home and griping about the latest ticket they’re issued.

Since their dementia is getting worse, you may have been taking care of paying their fines or even going to court (if you can) to testify on your senior’s behalf.

You can’t keep it up for much longer, though, because each new ticket seriously mars your senior’s record.

They’re Constantly In Fender Benders

Your senior’s car is practically unrecognizable these days, as it’s that dinged up.

Each time you see your parent, there’s another new dent or scuff in the car’s fender or a streak of paint that doesn’t belong to their vehicle.

Sure, for now, your senior is only getting in fender benders, but how much longer until they have a serious, possibly even life-threatening accident?

They Can’t Drive Anywhere Without Getting Confused Or Angry

Listen, you can understand the case for being angry when you’re stuck in bumper-to-bumper traffic and you’re already late for work. Your senior parent or loved one constantly gets upset, though.

You can’t even go 10 minutes in the car with them before they launch into a tirade about other drivers.

If not anger, then perhaps your senior always experiences confusion when behind the wheel.

This can be dangerous, especially when driving alone, as the disorientation can leave them lost and unsure where to go.

They Can’t Maintain The Speed Limit

You’re sure your senior parent or loved one can read the street signs, yet they never seem to drive the speed limit.

They’re either way under the limit, crawling at a snail’s pace, or they’re driving like a speed demon.

Both scenarios are very risky, which we’re sure we don’t have to tell you.

When driving under the speed limit, other cars can hit you more easily. They also have to go out of their way to get around you, which is dangerous.

Driving at too high a speed makes the impact of a crash that much deadlier.

My father had early dementia and he scared me several times when I rode with him towards the end of his driving days.

He started to drive slower and slower and I had to prompt him to pick up his speed.

Also, he didn’t seem to register the change in traffic lights until the last minute, forcing him to make hard stops.

Once, he pulled out very slowly in front of a car that was clearly going above the posted speed limit and the driver had to swerve to avoid him.

After seeing these warning signs become more frequent, my sister and I made the decision to have a family intervention and ask for his car keys.

Their Decision-Making Has Gone Seriously Downhill

The person’s judgement and ability to make quick decisions when behind the wheel is all but gone now.

As we mentioned earlier, one’s ability to decide something as they drive can be the difference between an accident and driving off in one piece.

They Drive Poorly

Sitting in the passenger seat of your senior parent’s car is giving you heart palpitations lately. When they drive, they’re all over the road, weaving in and out of lanes.

They bump curbs frequently. Sometimes they mean to hit the gas and press the brake or vice-versa.

When they see traffic signs like slow down or stop, your senior just keeps going. You know it’s only a matter of time before they cause or are involved in a serious crash.

How Do You Tell Someone They Can’t Drive With Dementia?

The best course of action in a situation like that is to have a conversation with your loved one about their dementia and driving abilities.

You’re going to ask them to stop driving outright, which is not going to be the easiest conversation to have.

Here are some pointers for getting through this difficult situation.

Ask If The Senior Even Wants To Drive Anymore

Sometimes, a older person might recognize their own worsening dementia during lucid moments and not want to drive anymore.

However, they don’t know how else they’ll get around, so they don’t want to say anything.

Broach this conversation by asking if the elder is interested in driving. If they say yes, then that’s one thing. However, if they’ve been looking for an out, this is officially it.

Provide Alternate Transportation Options

One of the reasons a senior might be reluctant to give up their driver’s license is the resulting loss of independence.

They have no idea how they’ll get to and from their medical appointments, to see family and friends, to the grocery store, etc.

You should have a transportation plan for your senior ready to go before you have the conversation with them.

Maybe you or another adult child or family member agrees to take the senior wherever they need to go.

Perhaps they ride with rideshare services like Uber or a taxi. If so, you should download an accompanying app so you can monitor your senior’s rides.

Organizations and community centers sometimes offer transportation services, so you could take advantage of those for your loved one.

Your neighborhood might have senior transportation services.

You don’t want to leave your senior to get on a bus or a train, as this can be very confusing for them as well. They could get lost, ending up at the wrong stop and with no idea how to get back home or even where the bus is.

Get A Medical Opinion (Or Two)

If your senior parent or loved one won’t listen to you and other family members, then it’s time to bring out the big guns.

As we mentioned before, requesting that your parent undergo a cognitive driving test is the perfect opportunity for family caregivers to bring up the results with the senior’s doctor.

If their family doctor feels strongly about your senior driving, get a letter of recommendation from them that you can present to the senior. It might help sway them!

Take Away The Car If Necessary

That said, some particularly stubborn seniors won’t be moved by their doctor and family imploring them not to drive. They’ll still want to get behind the wheel anyway.

For these seniors, you might have to resort to drastic measures. For example, you might have to take their keys or even revoke access to the car.

In some states, the senior driver’s doctor can report their concerns to the Department of Motor Vehicle and request the revocation of the person’s driving license.

If you can’t tow the car away from their property, then you can always disable the vehicle so the senior can’t drive it. Selling the vehicle is another option as well.

Coping With The Loss Of Independence After Giving Up Driving

Giving up driving can be a difficult transition for seniors with dementia, as it means losing their sense of independence and control. It can be a blow to both their self-esteem and quality of life.

However, there are strategies that can help them cope.

One way is to encourage them to stay connected with their community. This can include participating in social activities, volunteering, and staying in touch with family and friends.

These types of activities will help the person feel valued and connected, even if they are no longer able to drive.

Another strategy is to explore transportation options that can provide seniors with mobility and independence.

This can include public transportation, ride-sharing services like Lyft or Uber, and specialized transportation services for seniors.

In addition, there are a number of non-profit organizations that offer transportation services to seniors, such as Meals on Wheels or the American Red Cross.

Senior centers and community organizations also may have transportation services specifically for seniors, so check with a couple of the ones near your parent to explore their options.

If they don’t offer these services, they may be able to direct you to a nearby organization that does,

By finding the options that work best for them, your loved one with dementia or Alzheimer’s can maintain their independence and mobility, even if they can no longer drive themselves.

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