Driving and Dementia

Anne M. Foerg

Director of Social Work

Driving—it is the ultimate symbol of independence in American culture. As such, having to stop driving can be a devastating loss. Not only can it interfere with our ability to do the things we need to do, such as work, shop, worship, and socialize, it represents losing the freedom to choose what we do and when we do it. A person who is used to being in the driver’s seat, both literally and figuratively, is now often at the mercy of others to meet his or her needs. Many who have had to stop driving describe a feeling of profound powerlessness.

Yet, the reality is that each person diagnosed with an irreversible form of dementia must stop driving at some point, as the progressive nature of the condition will render the brain unable to carry out the myriad tasks required to safely operate a vehicle. A common misconception is that people with dementia can continue to drive as long as they remember where they are traveling or if they have someone to navigate for them.

However, driving requires much more than memory. One must manage multiple tasks at the same time, including pressing the gas pedal, turning the steering wheel, and scanning the environment for potential hazards. One must possess the cognitive capacity to appropriately judge situations and react to them in a rapid manner, such as responding to a changing traffic light, determining when to make a left turn, and allowing emergency vehicles to have the right of way. Multitasking, visuospatial awareness, and reaction times are all impaired for persons with dementia, and to complicate matters further, a person with dementia becomes less aware over time that these skills are becoming compromised.

All of these factors make it unsafe for a person with dementia to continue to drive. Therefore, it is best to start planning how and when this transition from driver to passenger should occur as early in the process as possible, in a manner that balances the independence and safety of the person with dementia as well as the safety of others.

Problems with driving can be an early warning sign of cognitive issues, so if an individual begins to experience difficulty with any of the aforementioned driving-related tasks, a medical evaluation should be scheduled immediately, especially if problems exist with memory and thinking in other areas of functioning. However, if the dementia diagnosis has been made, it is best for a trusted individual, such as a friend, family member, or doctor, to begin the conversation about developing a plan to taper driving with the eventual goal of stopping altogether.

Often, individuals with dementia recognize that some things have become more difficult, such as driving on busy highways or at night, and they will be willing to avoid those situations. They should be assisted in identifying other sources of support that alleviate the need to drive as much, such as grocery and medication delivery services, or a friend or family member who is willing to drive them to social events and important appointments. Equally crucial is identifying other sources of transportation, such as buses, taxis, or senior center vans, that the person can utilize. This maximizes the ability to still travel without having to exclusively rely on another person.

When a person with dementia does not recognize his or her deficits, the conversation can be much more challenging. At this juncture, the intervention of a professional may be useful, as a person may be more accepting of what a doctor or social worker suggests than that of his or her spouse or adult child. Some doctors may “prescribe” the person stop driving or suggest the individual undergo a driving evaluation, a comprehensive assessment of the individual’s visual, perceptual, cognitive and physical abilities, as well as a road test, if appropriate. Taking away a person’s keys, disabling or selling a vehicle, or alerting the Department of Motor Vehicles to an individual’s diagnosis with the goal of having his or her license revoked are options that should only be utilized as a last resort, because it can preclude the person’s involvement, exacerbating the already present feelings of losing autonomy and control.

As with every other element of dealing with dementia, it is not easy to strike the perfect balance between supporting a person’s independence and safety when it comes to driving. Each situation is unique and requires a thoughtful weighing of all the options and implications. As always, CaringKind is here to help. Please call our 24-hour Helpline at 646-744-2900 to speak with one of our professional staff about the issues you are facing related to dementia and driving.

We thank our participants in the Early Stage Center Program for sharing their moments when they decided to stop driving.

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