Driving with Dementia - when and how to start the process
- Marian Engelbrecht
- Oct 23, 2024
- 6 min read
Updated: Nov 4, 2024
The community where I live have a large elderly population, with many retirement villages and old age homes, so quite a large part of the clients that are referred to me tend to be older drivers. Over the years I have been in many conversations with family members that have loved ones with dementia or Alzheimer’s disease. There has always been a common thread in the questions being asked in terms of driving. I hope to provide some information about dementia, how it can affect driving and also how to navigate this challenging journey. I will also share some resources and links to other websites where you can find more information.
What is dementia?
There are different types of dementia and it affects people differently. Alzheimer's disease is also classified as a type of dementia, with dementia being the umbrella term. Because of the way that dementia affect people differently, no two people will present in the same way and therefor recommendations and assessments for driving may vary. People also have different driving habits and needs where some may only drive to a few shops and places and others are on the road frequently. This is often quite a difficult and tricky population group to work with and I will discuss some of the reasons why and ways to manage the different challenges.
Changes in daily functioning
Referrals to an occupational therapist for a driving evaluation will often come from family members or from a medical professional. Concerns about driving are usually identified when there are declines that become more apparent in other areas of daily life.
This can include:
Changes in how the person functions at home.
The person may become more disorganized
Struggles with short term memory that affects daily functioning
Struggles to manage medications and appointments and/or
Self care and being able to look after themselves and keep themselves clean, neat and organized as they used to. An example can include wearing the same clothes everyday, or clothes being dirty.
Concerns about driving
When these concerns are being identified, family members will often consult a medical professional like a neurologist, psychiatrist or their GP and often either early on in the dementia journey or later on people might start asking the question about driving.
Family members may become concerned due to observed scratches and dents on the car, or when driving with the person and noticing errors, poor judgement or missing vital information.
A referral to an occupational therapist is then often the next step.
Sometimes these concerns are amplified due to a sudden crisis situation that resulted in a near miss or a crash and so the bigger concerns about driving presents itself. This usually necessitates quick action in terms of assessment due to safety concerns and risks.
How can dementia or Alzheimer's disease affect driving?
Dementia or Alzheimer's disease can affect cognitive, visual and motor functions that progresses over time. The progression of dementia can also be different depending on the type of dementia and the age of the person when they are diagnosed. Therefore, trying to determine prognosis and rate of progression can influence future planning in terms of the driving journey and eventual driving cessation.
Cognitive impairments that can significantly affect driving include:
Executive functions
Attention (being able to maintain focus on the road)
Alternating attention (being able to attend to multiple things at once)
Short-term memory (getting lost in familiar areas)
Orientation to time and place - this refers to knowing the day and date and knowing where you are.
Reasoning and decision making (quick decision making and taking appropriate action)
Judgment (manaaging hazards and navigating other road users safely)
Processing ability and speed of processing of information (slower reactions and responses)
Insight - (being aware of own impairments in driving and noticing errors on the road)
Changes in executive functions raise the biggest concerns, especially when a person's ability to judge safety on the road becomes impaired. Cognitive changes also affect abstract thinking, and becomes more concrete and focused on the present, resulting in an inability to think further ahead or consider the consequences of actions and decisions being made. Limited insight or awareness often lead people to say things like, "My driving is perfectly fine, I'm functioning well, I have no problems or concerns". On the other hand, the family is extremely concerned.
There is a mismatch between how the person perceives their own functioning and how they are perceived by their next of kin and loved ones.
The person may struggle to understand and comprehend feedback about their driving, and receiving feedback after an assessment may elicit strong emotions. It is important to anticipate this and to be prepared. The occupational therapist can provide support for the family and the client during the feedback session.
The family needs to navigate the person's need for independence and self-identity in driving, with their and other's safety and this can be difficult to balance and navigate.
When is it still safe for a person with dementia to drive?
It is possible for people in the earlier phases of dementia to still continue to drive. Many people start limiting their driving and cut down on driving as they get older, or their health declines. People might drive in their local area to a few places like shops, church or community centers and also start limiting how often they drive. However some still continue to drive on highways and busy roads without realizing the inherent risks. As dementia progresses, driving may thus become unsafe and an evaluation by an occcupational therapist or a family conversation with the person may need to be the next step. Recommendations may include limiting driving or driving cessation and needs to be considered carefully.
Examples of warning signs
Family members should drive with the person in their vehicle and observe them on the road in order to identify warning signs. Warning signs to look out for may include some of the following:
Getting lost in familiar areas
Bumps and scrapes on the car
Becoming disorienated and flustered
Struggling with judging safe gaps in traffic
Impulsive behaviour
Risk taking behaviour
Struggling to manage intersections safely
Sudden stops in the middle of traffic
Missing important information e.g. pedestrian, uncoming car or road sign.
For more information including a checklist with warning signs, the Driving with Dementia Roadmap is a very useful resource.
As dementia progresses, driving may become unsafe and an evaluation by an occcupational therapist or a family conversation with the person may need to be the next step.
Driving retirement - who should have the conversation?
As dementia progresses, at some point driving retirement may be indicated. This can be facilitated by the occupational therapist to help determine timing for driving retirement. This can include an assessment, future reassessment, or family education. If you are planning to have the conversation, do so when you start noticing any of the warning signs. Follow some of the guidelines provided in the Hartford handouts.
Transportation planning for driving cessation
Statistics show that driving cessation can lead to depression and isolation, and therefore negatively affect the person's health and well-being. It is extremely important to have a plan in place when driving retirement is recommended, so that alternative options are available.
It is not a question of if, but of when the person with dementia will retire from driving.
Often when the person needs to retire from driving, they will need assisted transportation options like a family member, a friend, a carer or companion to assist and accompany the person when they go out. One of the benefits of using alternative transport is that this can potentially open up new opportunities and avenues for the person to be engaged within their community, and in a safe way. The family's involvement in the planning process is extremely important. The therapist will guide the family through identifying relevant and appropriate options for alternative transportation. I have found in my community over the years that there are more and more options becoming available, making it increasingly viable for people to navigate without a car.
The way that feedback and future planning is navigated is extremely important so that the transition to non-driving can be as gentle and painless as possible.
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