When an individual is diagnosed with dementia, one of the first concerns that families and caregivers face is whether or not that person should drive. A diagnosis of dementia may not mean that a person can no longer drive safely. In the early stages of dementia, some – though not all – individuals may still possess skills necessary for safe driving. Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time. This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving.Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting. Some individuals, recognizing the risks, will limit or stop driving on their own. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk.
Because the progression of dementia varies from person to person, it is difficult to know at what point an individual can no longer drive safely. This fact sheet provides guidelines to help caregivers and persons with dementia decide when and how to limit or stop driving.
Deciding When to Stop
As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Individuals with moderate or severe dementia should not drive.
Observe Behavioral Signs
You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. Following are some signs that a person no longer has the necessary skills to drive safely. He or she:
- Has become less coordinated.
- Has difficulty judging distance and space.
- Gets lost or feels disoriented in familiar places.
- Has difficulty engaging in multiple tasks.
- Has increased memory loss, especially for recent events.
- Is less alert to things happening around him or her.
- Has mood swings, confusion, irritability.
- Needs prompting for personal care.
- Has difficulty processing information.
- Has difficulty with decision-making and problem solving.
It is important to compare present behavior with behavior before the onset of dementia. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. Share and discuss your observations with other family members, friends and health care providers.
Arrange for an Independent Driving Evaluation
The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles (DMV).
Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides.
Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.
Continue to Monitor Driving
If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly in a short period of time. The objective of monitoring is to detect a problem before it becomes a crisis. If there are any doubts about safety, the person with dementia should not be driving.
It is often helpful to keep a written log of each incident of poor driving behavior. Following are some of the common warning signs.
Drives too slowly.
- Stops in traffic for no reason or ignores
- Becomes lost on a familiar route.
- Lacks good judgment.
- Has difficulty with turns, lane changes, or highway exits.
- Drifts into other lanes of traffic or drives on the wrong side of the street.
- Signals incorrectly or does not signal.
- Has difficult seeing pedestrians, objects, or other vehicles.
- Falls asleep while driving or gets drowsy.
- Parks inappropriately.
- Gets ticketed for traffic violations.
- Is increasingly nervous or irritated
- Has accidents, near misses, or “fender benders.”
Discuss any concerns you have with the individual, family members and health care providers. All involved will need to weigh potential risks and decide when the individual needs to stop.
Ask Individual to Co-pilot
You can also estimate an individual’s potential for a traffic accident by taking the person along as a passenger and asking him or her to co-pilot. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. If he or she has difficulty or becomes frustrated easily, it may be time for another in-dependent driving evaluation.
Easing the Transition
Involve Person in Discussions
Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of in-dependence upsetting. Encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive. Support groups provide a good venue for both the caregivers and the in-dividual to talk about their feelings and get advice from others in a similar situation. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.
If the individual is reluctant to talk about driving, ask the individual’s physician or care manager to bring up the subject of driving during health care visits. A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning.
Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will have to find the solutions that work best in their situation.
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