January 10, 2019
Driving can be an important source of autonomy and self-esteem for those in the early stages of Alzheimer’s disease, providing a coveted sense of independence and connection to the wider community. Deciding when to give up the car keys is an important question for anyone caring for a loved one with Alzheimer’s disease or another form of dementia. Although many people with dementia, particularly in the early stages, can continue to drive safely — driving ability declines as impairments to memory and thinking skills progress.
New guidelines from a group of professional organizations in the United Kingdom offer doctors 10 suggested questions to ask anyone whose driving judgment may be impaired by dementia or mild cognitive impairment, a brain ailment that often leads to full-blown Alzheimer’s disease. They also offer 10 suggested questions to ask family members about a loved one’s driving ability.
The following questions can provide useful information to help doctors and family members assess whether it is safe for someone with Alzheimer’s disease to continue driving:
- Have you noticed any change in your driving skills?
- Have you lost any confidence in your overall driving ability, leading you to drive less often or only in good weather?
- Do others sound their horn or flash lights at you or show signs of irritation?
- Have you ever become lost while driving?
- Have you ever forgotten where you were going?
- Do you think that at present you are an unsafe driver?
- Have you had any car accidents in the last year?
- Have you had any minor accidents with other cars in car parks?
- Have you received any cautions or fines for speeding, going too slowly, failing to stop at a red light, etc.?
- Have others criticized your driving or refused to drive with you?
10 questions to ask family members
- Do you feel uncomfortable in any way driving with your relative?
- Have you noticed any abnormal or unsafe driving behavior?
- Has your relative had any recent crashes?
- Has your relative had near-misses that could be attributed to mental or physical decline?
- Has your relative received any fines or cautions?
- Are other drivers forced to drive defensively to accommodate your relative’s errors in judgment?
- Have there been any occasions where your relative has got lost or experienced navigational confusion?
- Does your relative need many cues or directions from passengers?
- Does your relative need a co-pilot to alert him or her to potentially hazardous events or conditions?
- Have others commented on your relative’s unsafe driving?
Answering yes to any of these questions should spark a wider discussion of whether it is time for someone to stop driving. “This can be a difficult conversation for anyone to have, whether you’re a family member or doctor, because losing the ability to drive can have a significant impact on someone’s independence and wellbeing,” said Dr. John-Paul Taylor of Newcastle University in the U.K., who helped to prepare the guidelines. He notes it is critical to have this discussion because “someone who is no longer safe to drive can be a source of concern for families and loved ones, and may also put the driver and others at risk.”
“While a dementia diagnosis isn’t in itself a reason to stop driving, a decision has to be made as to whether someone is still able to drive safely,” said Tim Beanland of the Alzheimer’s Society in Britain, who worked on the guidelines. “This guidance should give much greater clarity to people with dementia and those supporting them as to what to expect when being assessed for fitness to drive.”
Other experts have noted that it is particularly important that family members look for any signs of mental decline in loved ones and discuss concerns with a physician. Family members and doctors also need to counsel the person with Alzheimer’s disease to prepare them for stopping driving and get them to accept a “no driving” status. Among their recommendations:
Keep It Safe. Some drivers in the early stages of Alzheimer’s may be competent to drive, even if they have been diagnosed with dementia. The decision whether to impose a driving ban should depend on a careful assessment of a driver’s ability. If a driver poses a threat to himself or others, a ban must be imposed.
Engage the Family. Family members should provide the doctor with detailed information about any problems relating to driving as well as memory, judgment, attention and visual and spatial abilities. When appropriate, patients should be included in decisions about current or future driving restrictions.
Perform Regular Assessments. Doctors should perform thorough and regular exams to assess the patient’s skills and abilities and conform to state and local restrictions and laws. A driver rehab specialist can conduct an on-road driving test of an older person with impaired mental functions to assess his or her abilities to continue driving. This specialist should be familiar with the symptoms and nature of Alzheimer’s disease.
Provide Alternatives. Physicians and family members should plan early for those with progressive dementia to use public transport and alternative transportation options, such as buses, taxis, trains, senior shuttles, and rides from family and friends. Your local Area Agency on Aging may also be able to help.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Newcastle University report: “Driving With Dementia or Mild Cognitive Impairment: Consensus Guidelines for Clinicians.” Dec. 2018.