“I’m driving in my car, turn on the radio…” Driving and Dementia

As Bruce Springsteen once wrote, cars have a unique way of imbuing freedom – but how do you know when driving is no longer appropriate when living with dementia?

I wiggled my hips into the seat, tossed my hair about, adjusted the rearview and side mirrors as I’d been instructed and sported a smile that stretched from ear to ear.  I checked over my left shoulder and pulled onto the road for the first time — pure joy!  I had earned my driver’s license that day and my parents were letting me take the car out.  The freedom delivered by a license, a car, and a tankful of gas is priceless.  It’s no wonder driving is a privilege not easily relinquished, even when faced with Alzheimer’s disease or a related dementia.    Questions about driving top the list when patients and families are coming to terms with a new diagnosis of memory loss and adjusting to a life with the diagnosis of Alzheimer’s disease.

How do I know when to stop driving?

This is an important question – and medical experts don’t have a clear answer.

What we do know:

• A diagnosis of mild cognitive impairment or early Alzheimer’s disease or related dementias does not automatically mean driving should be stopped immediately.
• Since dementia is progressive, driving ability will be lost in time, so driving ability should be monitored for decline and decisions made on a person-by-person basis.

So how to decide when to stop?

When certain clues or signs show up, it is time to stop driving.

• Anytime the person driving no longer feels comfortable driving.
• If driving difficulties are noticed such as fender benders, traffic citations or getting lost.
• If a formal driving evaluation notes driving difficulties. Evaluations can be done via neuropsychological testing, interview by skilled professional (occupational therapist or driving specialist) or simulator testing.  Each type of evaluation has research that links impairment with increased risk for accidents compared to individuals without a diagnosis of dementia.

Why does my family member not see that they need to stop driving?

Dementia may impact insight.  Many individuals will feel capable of driving, but family may disagree or worry for safety.  It is important not to limit driving privileges too soon as the loss of freedom brings on isolation and increased rates of depression.

This is where objective testing can help everyone.  My mother underwent testing recommended by her geriatrician.  The request helped alleviate fears my sister was having about my mother’s driving.  The testing noted early difficulties that allowed us to begin putting alternate transportation into place before she had to give up driving completely.  My mother never liked the idea – never.  And she did not agree with the formal assessment, but it gave us a document to point to when the difficult discussion needed to occur.  Many family members ask if I can provide a document for them– when I agree that driving should cease, I will write a prescription for family members to use as a reminder that the recommendation to stop driving came from the doctor.

What do I do for transportation now that I’ve stopped driving?

It may be time to get creative, depending on where you live.  Public transportation is often not possible due to the memory issues or your current living setting (e.g. rural areas or suburbs).

Use the resources in your area to explore alternate transportation.

• Consider whether it is time for a move – living in a community setting (such as assisted living) where a van is available for trips to stores, activities and doctor’s appointments may be a wonderful solution and has the added benefit that it helps maintain socialization and independence.
• Drivers – be creative. Hire a student (call the local college).  Have family take turns being the driver – a week at a time or on a particular day of the week.  Barter with friends – bake a monthly dinner for someone who can take you or your family member to a weekly event.    See if driving is a service offered by the local senior job bank.
• Use the social service department in your town for ideas. In my area, Independent Transportation Network- America (ITN-America) is vibrant and active.  This is a volunteer driving network that provides rides with door-to-door, arm-in-arm service.  Check out their website and see if they may be in your area or explore beginning a network in your area.
• The local Alzheimer’s Association may have leads and has a helpful document for expanding transportation ideas. Find yours right here!

Other considerations

Technology is changing driving.  Cars may be driving themselves soon on “smart roads”.  This may be very good news for those living with dementia as another tool to prolong independence.  But this potential has not yet been reached.  Until then ……

Consider this

• A diagnosis of Alzheimer’s disease or related dementia does not necessarily mean immediate limits on driving.
• Loss of driving abilities can result in isolation – be proactive in creating an alternative driving plan or living situation that supports transportation or socialization.
• This is one of the most difficult topics for families – begin discussions about future transportation plans early for calmer discussions in a non-crisis situation.
• Driving evaluations provide objective data to assist in planning – repeat evaluations should occur approximately every 6 months or with changes in driving status.
• Be creative in exploring transportation alternatives – several resources above are provided to spark your search.