Several factors make driving dangerous for people with any form of dementia. Confusion, impaired vision and hearing, poor judgment, difficulty making decisions, slower information processing, and delayed reaction times — these driving behaviors put everyone on the roads in harm’s way.
If your loved one has been diagnosed with Alzheimer’s disease, this decline in their driving skills is inevitable. Does your family feel prepared to support your loved one when they can no longer safely operate a vehicle and provide their own daily transportation?
Two dementia experts share advice for caregivers and family members navigating driver safety and Alzheimer’s disease. This article helps caregivers decide when driving is no longer safe for a loved one and offers a four-step approach to easing the transition when the time comes.
When is driving no longer safe for someone with Alzheimer’s disease?
According to Dr. Dung Trinh, founder and owner of the Healthy Brain Clinic, there is no general rule for when people with dementia should stop driving; instead, it should be decided on a case-by-case basis.
“A doctor will usually assess the individual’s mental and physical abilities to determine whether they are still safe to drive. Factors such as the severity of dementia and its effects on daily life should be taken into consideration when making this decision,” he says. “Ultimately, it is important that people with dementia take all necessary precautions while driving and stop if they are unsafe. When in doubt, a person with dementia should undergo a DMV driving and written test to reassess their driving ability.”
Dr. Trinh adds that caregivers, family, and friends play a role in assessing and protecting their loved one’s safety by observing their driving behaviors. Once they’ve observed warning signs of unsafe driving, caregivers can initiate the conversation with their loved ones and begin making a plan.
Use these four steps — observe, evaluate, discuss, support — to navigate your loved one’s transition away from independent driving and help them adjust to their new lifestyle.
Observe: Identifying warning signs of unsafe driving
“In my experience, families, and caregivers are often reluctant to pull the plug on driving because they love their loved ones and want them to live as independently as possible,” says Amber Dixon, a dietician, geriatric nurse, and CEO of Elderly Assist, Inc. “That’s why it’s important to look for signs that indicate a loved one is no longer safe behind the wheel.”
Dr. Trinh adds that signs of unsafe driving and when they present vary depending on the progression of each individual’s condition. However, it is generally accepted that when certain red flags appear, it is time to discontinue driving and consider other transportation options.
Observe for signs of disorientation, confusion, or other changes in mood or behavior while your loved one is driving. Red flags of unsafe driving may look like this:
- Difficulty focusing on the road, concentrating on surroundings, or following directions/GPS guidance
- Getting lost while driving familiar routes to commonly-visited places and taking longer than usual to run errands
- Inability to remember the rules of the road or understand traffic signs and signals (e.g., running stop signs and lights, illegal passing, wrong turns, etc.)
- Difficulty judging distance between objects (e.g., parking, changing lanes, observing pedestrians and oncoming traffic, etc.)
- Erratic steering, excessive speeding, or sudden stops
- Confusing the brake and gas pedals
- New dents and scratches on the car
- An increase in traffic tickets, parking citations, accidents, or car insurance premiums
- Comments from friends and neighbors about driving
If your loved one’s driving abilities are an imminent threat to the safety of themselves and others on the road, take immediate action to prevent them from driving:
- Hide the car keys
- Move or cover the car
- Take out the distributor cap
- Disconnect the battery
“Caregivers and families can plan for the transition by making sure their loved one knows that driving is not going to be an option anymore,” says Dixon. “When possible, take away your loved one’s keys before they are even asked to give them up, like when their car is in need of repairs. But if you see them approaching a busy intersection without slowing down, it’s time to remove the keys from their possession.”
Evaluate: Seeking medical and driving assessments
Dr. Trinh urges caregivers and family members to schedule an appointment with their loved one’s doctor as soon as they recognize signs of unsafe driving behaviors.
“At this appointment, they can discuss changes in their loved one’s driving abilities and decide whether or not continuing to drive is safe. The doctor may order cognitive tests and do a physical assessment of the patient’s vision, hearing, and reaction time.”
Caregivers can also work with their physician to explore the possibility of a medical driving evaluation, which Dr. Trinh says may provide more insight into whether it is safe for a person with dementia to continue to drive.
“A driving evaluation for an Alzheimer’s patient is an important tool in planning for the transition to stop driving because it provides a comprehensive assessment of the individual’s current abilities and risks,” he explains. “The evaluation can help determine if the person has any physical or cognitive impairments that could pose a risk on the road and how those might be managed. It can also provide an indication of how the disease has progressed and what kind of challenges may lie ahead.”
Overall, a driving evaluation helps caregivers and family members make informed decisions about driving privileges. It offers clear guidance on if or when to transition from a personal vehicle to alternative transportation options.
The American Occupational Therapy Association maintains a national database of driving specialists, and you can also refer to your state’s Department of Motor Vehicles. It’s best to get a professional driving evaluation; however, there are several online caregiver- or self-assessments.
Discuss: Sharing concerns with your loved one and explaining why driving is no longer safe
Caregivers and family members should openly discuss their concerns about their loved one’s driving abilities. “Approach the conversation from a place of love and concern,” Dixon says.“You don’t want to make your loved one defensive, and you don’t want to come across as an authority figure.”
She suggests starting by saying something like: “I’m worried about your driving because I care about you. Can we talk about it?”
If your loved one is receptive, continue with more questions: “What do you think is going on with your driving? How do you feel while you’re behind the wheel? What do you think we could do together to improve your situation?”
If your loved one isn’t receptive, try again a few days or weeks later with a different approach: “I’m worried about what happened when we went out last weekend. Can we talk about it?”
Some people with memory problems decide on their own not to drive, while others may deny their driving is unsafe. If your loved one is resisting the idea, utilize driving assessments and medical advice to help them understand that driving is no longer safe.
Dr. Trinh urges caregivers and family members to discuss the potential risks associated with driving, such as an increased risk of car accidents or becoming lost, to help your loved one understand why giving up driving is for the best.
Support: Helping your loved one navigate a transition that may feel like a loss of independence
Both Dixon and Dr. Trinh remind caregivers that people with dementia may perceive giving up driving as a significant loss of independence.
“They are no longer able to do something they once took for granted: getting around independently,” Dixon says.
“Driving is often associated with freedom, and for many people, it is an important part of their daily routine,” Dr. Trinh explains. “For someone living with dementia, the ability to drive can provide a sense of control and purpose that is lost when they have to give up the activity. Giving up driving can lead to feelings of isolation, as it can be difficult to access social activities or medical appointments without a car.”
Dr. Trinh adds that encouraging your loved one to be involved in the decision-making process is also important, as it can help them feel more in control of their situation. This means working together to find other ways that your loved one can get around on their own and maintain a sense of independence.
“Caregivers and families can help make the transition less difficult by providing alternative forms of transportation, such as public transit, rideshare services, or rides from friends or family members,” he says.
The National Institute on Aging advises caregivers to contact the local Area Agency on Aging or Eldercare Locator for information about transportation services in the area, like free or low-cost buses, taxis, or carpools for older people. Some churches and community groups have volunteer-run transportation.
“I think it’s important to remember that people with dementia are still the same person they always were, and that means they can make their own decisions,” says Dixon. She maintains that it’s important to give your loved one as much autonomy as possible, but only within reason and as long as they aren’t risking the safety of themselves or others by driving.
“If you feel like your loved one is a danger to others, I recommend taking away their keys and considering assisted living or long-term care facilities. The most important thing is keeping them safe and comfortable so they can continue enjoying life!”