When is it time for a person with dementia to stop driving? New research and recent recommendations offer some insights.
After decades of freedom and independence, many people with dementia are reluctant to stop driving. But the decline in cognition found in people with conditions such as Alzheimer’s disease often makes them unsafe drivers. For example, people with dementia are about three to five times as likely as others their age to be involved in a car crash.
Although experts agree that those with moderate or severe dementia should not drive, the data on people with very mild or mild dementia are not as clear. Evidence shows that people with very mild Alzheimer’s disease are no more likely to cause a car crash than a young person who just obtained a driver’s license. And new research is beginning to clarify when patients with dementia are fit to drive and when they should give up the keys.
Signs and Signals of Problem Driving
Some people with dementia might seem like safe drivers in familiar traffic conditions, but they actually have underlying deficits that prevent them from reacting appropriately to unanticipated events. So what problems can family members look for?
According to a study from the Journal of the American Geriatrics Society, the first driving skills to go are judgment, awareness of how one’s driving affects other drivers, and speed control.
Other behaviors that indicate that someone’s driving skills may be deteriorating include the following:
- braking often or unexpectedly;
- not obeying traffic signs and signals;
- becoming aggressive or angry while driving;
- trouble staying in one’s lane;
- difficulty navigating through familiar locations.
A report from the journalNeuropsychology, which reviewed the results of 27 studies, found that deficits in visuospatial skills (those abilities that allow a person to relate their visual perception to concrete spatial relationships) and, to a lesser extent, attention and concentration were the best predictors of which people with early dementia had problems with driving. Visuospatial deficits in people with early dementia are “red flags” indicating that their driving skills should be evaluated carefully, the researchers conclude.
What the Experts Recommend
Guidelines from the American Academy of Neurology (AAN) say that people with mild or more severe dementia should not drive because of an increased crash risk. However, while noting that people with very mild Alzheimer’s disease have an elevated crash risk compared with age-matched controls, the AAN explains that this elevated risk is no different from that in other acceptably “impaired” drivers: 16- to 21-year-olds and people with a blood alcohol content below 0.08%. Therefore, the AAN says that people with very mild Alzheimer’s may still be able to drive.
When and How To Restrict Driving
Although some people with very mild or mild dementia may retain the ability to drive safely, they should restrict their driving to nonchallenging situations, such as driving only in familiar areas, during the daytime, in good weather, for short distances, and in light traffic. They should never drink any amount of alcohol before driving.
Also, family members need to ascertain that these drivers maintain skills necessary for driving: a quick reaction time; the ability to make decisions appropriately and rapidly; an alertness to what is going on in the environment; and good coordination, vision, and hearing. Eventually, the time to stop driving will come to every person with dementia.
Yet a loved one with dementia may have a strong desire to keep driving and little awareness of his or her deficits. How can you get someone with dementia to stop driving if asking isn’t enough? Experts recommend that you ask the person’s doctor to tell the person not to drive, or even ask the doctor write a “Do Not Drive” prescription.
Health care professionals in some states must report to the motor vehicle division that a person in their care has a medical condition that interferes with driving ability. The state may then revoke the person’s driver’s license. If the person still insists on driving, caregivers can take more drastic measures. These include hiding the car keys, parking the car where the person can’t see it, or selling the car. A mechanic may be able to show you how to disable the car temporarily by removing the distributor cap or disconnecting the battery.
The Bottom Line on Driving With Dementia – “The Grandchild Test”
Determining when a person in the early stages of dementia can no longer drive is not always easy. Enlist the help of doctors, lawyers, therapists, or the department of motor vehicles when difficult questions arise. But above all, patients, caregivers, and family members should let common sense be their guide. A good rule of thumb may be the “grandchild test”: If you would not feel safe having the person with dementia drive his or her grandchild in the car, you should talk to the person about not driving.
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Posted in Memory on April 12, 2006
Reviewed June 2008
