Dementia and driving

Driving is something most people take for granted.

It gives us freedom, flexibility and independence. While we will all need to step out from behind the wheel one day, conditions such as dementia can mean that the decision to stop driving needs to be planned for and made much earlier than expected.

Driving can seem like an automatic activity. However, it is a complicated task that requires complex thought processes, manual skills and fast reaction times. Dementia can cause loss of memory, limited concentration, and vision and insight problems. This affects a person’s judgement and ability to drive safely.

A diagnosis of dementia does not always mean that a person has to give up driving straight away. Because the condition involves a gradual decline in cognitive and physical ability however, they will need to stop driving at some point.

The experience of giving up driving can be very difficult for many people, and the sense of grief and loss can be ongoing.

For quality of life and wellbeing, it’s vital to think about and plan ways that a person living with dementia and their families and carers can keep mobile, active and socially connected in the transition to non-driving.
 

Table of contents:

• Licensing requirements
• Individual responses
• Signs dementia is affecting driving
• Where safety is an immediate concern
• Starting conversations about driving
• Alternatives to driving
• Information and resources
  • National
  • Information for health professionals

Licensing requirements

All drivers are required by law to tell their local licensing authority of any medical condition that might affect their ability to drive safely. Dementia, diabetes and some heart conditions all need to be disclosed because they may affect a person’s driving ability.

Once notified, the licensing authority will ask that the driver’s doctor makes an initial assessment of the driver’s medical fitness. After this, a formal driving assessment may be required. Based on the results of these assessments the licensing authority will decide if the person can continue to drive.

If the person with dementia can continue to drive they will be issued a conditional licence. Conditional licences are valid for a maximum of 12 months; after that the driver will be reassessed. Sometimes restrictions are also placed on the licence holder. These restrictions might be that the person can only drive close to home, at certain times, or below certain speed limits.

If a person with dementia continues to drive and they have not notified their licensing authority, or if they continue to drive after their licence has been cancelled or suspended, there can be serious consequences. If the driver is in a crash they could be charged with driving offences or be sued. In addition their insurance company may not provide cover.

Keep in mind that licensing requirements for drivers with dementia and for assessing fitness to drive vary across different states and territories.

Individual responses

For people living alone or in rural and remote areas it can be especially difficult to manage without driving. People may feel a loss of independence or identity when they can no longer drive. For someone in the early stages of dementia making the decision to give up driving can be very challenging.

Some people will recognise their declining ability; others may not, or may simply forget that they are no longer safe to drive. For others it will be a relief to no longer have the responsibility of driving.

Signs that dementia may be affecting a person’s driving

Changes in driving behaviour may have been occurring for some time without being noticed. Consider the following driving warning signs:

• Vision – Can they see things coming straight at them and from the sides? Can they see and respond appropriately to traffic signs and signals?
• Hearing – Can they hear the sound of approaching cars, car horns and sirens and respond appropriately? Do they pay attention to these when in the car?
• Reaction time – Can they turn, stop or speed up their car quickly?
• Problem solving – Do they become upset and confused when more than one thing happens at the same time?
• Coordination – Is their coordination affected? Do they get the brake and accelerator pedals mixed up?
• Alertness – Are they aware and understand what is happening around them?
• Can they tell the difference between left and right?
• Do they become confused on familiar routes? Do they get lost or take a long time on familiar journeys?
• Do they understand the difference between Stop and Go coloured lights?
• Are they able to stay in the correct lane?
• Can they read a road map and follow detour routes?
• Has their mood changed when driving? Some previously calm drivers may become angry or aggressive.
• Are there new bumps and scratches on the car?

Where safety is an immediate concern

If you have concerns about a person’s ability to drive, try speaking to them or to their doctor. You can also contact your local licensing authority to discuss your concerns. The licensing authority may contact the driver and advise that a medical and driving test is necessary.

You can also contact Dementia Australia to discuss any specific concerns or situations that you are facing.

For someone in the early stages of dementia, actions such as hiding the keys, taking away a license or disabling the car could seem disrespectful or hostile.

These actions may not even succeed as the person may continue to drive without a licence, fix their car or even buy a new one.

Starting conversations about driving

Some suggestions for when and how to raise concerns about driving:

• Start discussions as early as possible after diagnosis, and at a time when everyone is calm.
• Where possible, have discussions when there have been changes in medications or health status, rather than during or after a driving incident.
• Have short and frequent conversations, rather than one long discussion.
• Concentrate on the person’s strengths and the positive aspects of other options.
• Acknowledge that giving up driving is hard to do.
• Normalise the situation - everyone will have to stop driving at some point.
• Focus on the nature of the disease - many people with dementia have very safe past driving records, but this has no bearing on their safety as a driver with dementia in the future.
• Focus on the financial benefits of selling the car.
• Be respectful and try to understand how the person with dementia will be feeling.
• Consider what driving means to the person. Owning a car and driving can mean more than just mobility to a driver. It can be a sign of status, a hobby and even a job. Think about ways that this relationship to the car and driving might be addressed in other ways.

Alternatives to driving

You can support drivers by helping them to reduce the need to drive and find alternatives for getting around.

Things to try:

• Offer to support the person by driving them to appointments, social gatherings and to access shops and services.
• Encourage the use of buses, trains or taxis when possible.
• Encourage walking when possible. You may find GPS technology can be helpful.
• Investigate community transport available in your area. Check with your local council.
• Encourage the use of home delivery services for food, medical prescriptions and your local library.
• Ask family and friends to assist with transport, either by driving the person or accompanying them on other transport.

When people stop driving they often stop making social trips, like visiting friends, family, attending functions or participating in hobbies. It is important that social contacts are maintained, try to continue these trips wherever possible.

Some people find benefits from no longer driving, such as less stress, reduced costs and enjoyment of the journey.

 

National information and resources

Dementia Australia Driving Policy Statement

Dementia Australia has an important role in ensuring that the issue of driving is appropriately and sensitively handled. Every individual has the right to mobility. Driving as a means to this mobility should not be challenged if drivers have the functional ability to do so without risking the safety of their passengers, other road users and pedestrians, and themselves.

Help sheet on dementia and driving for people living with dementia

Help sheet on dementia and driving for family and carers

 

Information for health professionals

Information about dementia and driving - for health professionals

Find information about the role of health professionals with patients or clients who are driving; fitness to drive assessments; the licensing pathway tool for patients with dementia and tips for starting conversations about driving.