Driving and transportation
Driving a vehicle is a complex activity that requires several abilities and skills, such as:
- Quick reactions
- The ability to divide your attention (e.g., watching a traffic light and pedestrians, while keeping your foot on the brake)
- Good judgment
- An understanding and ability to recall the rules of the road
- The ability to find a destination
- Adequate eyesight and hearing.
Driving also represents freedom, independence and mobility. Although driving is a privilege, some people view it as a right.
Alzheimer's disease and other dementias cause changes that affect a person's ability to drive a motor vehicle safely. A diagnosis of dementia, however, does not automatically mean that a person is incapable of driving. Some people may be capable of driving safely for some time after the diagnosis, depending on when in the disease progression the person has been diagnosed and the rate the disease progresses. Eventually, however, people with Alzheimer's disease must stop driving, as it will no longer be safe.
A) While the person with Alzheimer’s disease is still driving
For people who have been driving for many years, driving may feel mostly automatic. But driving is a complex task that requires quick reactions, thought processes and dexterity.
If you think the person with Alzheimer’s disease may be having difficulty driving, watch for these signs:
- Traffic violations
- Getting lost
- Misjudging distances
- Forgetting the rules of the road
- Slow response times
- Taking too long to reach a destination.
A diagnosis of dementia does not mean automatic denial of insurance. If you have been diagnosed with dementia, talk to your doctor about the progression of the disease and your driving abilities. Consider contacting your car insurance provider to share the information received from your doctor. Your provider will determine your car insurance coverage based on your specific situation. Failure to disclose a diagnosis could impact your insurance policy.
What you can do:
Plan ahead for the time when driving must stop. Talk with the person with Alzheimer's disease to find out when driving is needed most and why. For example, is it for keeping medical appointments, shopping, entertainment, meeting with friends? Or is it perhaps more a form of escape or relaxation?
Once you’ve found out the person’s driving needs, talk about other ways of getting around. These can include:
- Public transit
- Rides provided by community organizations
- Lifts from family members and friends.
Look into special testing to assess the driving abilities of a person with dementia. This could be a driving simulation test and/or a road test, carried out by someone with experience in testing drivers with cognitive problems.
If this type of driving assessment is not available, ask a doctor to determine if and when the person is no longer able to drive. The doctor may ask the person and family members questions about:
- Driving patterns (when and where the person drives)
- Any differences noticed in driving skills
- Any unsafe or abnormal driving behaviour
- Traffic tickets (for going too slowly, too quickly, improper turns, failing to stop)
- Crashes, fender benders or near-misses
- Instances where the driver has been lost
- How comfortable the person or family members feel about the person's driving abilities.
Throughout the disease, the person with dementia, family members and a doctor or other health care professional should monitor the person's driving ability. When appropriate, the person should stop driving.
If you are the person with Alzheimer’s disease, here are some things to consider:
- Ask someone you know if he or she has noticed changes in your driving.
- Arrange for driver testing.
- Ask family members and friends to drive you where you need to go, or use public transit and take taxis.
Here are some tips to minimize the risks while the person with Alzheimer’s disease is still driving:
- Take short drives and keep to familiar roads.
- Drive at quiet times of the day.
- Be aware of the timing of medications that might affect the ability to think clearly or to see.
A) When to stop driving: broaching the subject
Sometimes the person with Alzheimer’s disease is relieved to stop driving. Perhaps she was feeling a lack of confidence when she drove. She might have been worried about an accident or confused about how to get places. Even someone with this awareness, though, will need support and sensitivity around the subject of giving up driving, as it still can represent a loss of independence.
Family members and caregivers: When a person is unable to recognize or admit that he is losing his ability to drive, family members and caregivers often have to deal with the issue. Their concerns may include the risk to the person, the risk to the public and the risk of liability in the event of an accident. Within families, there may be disagreement about when the person with Alzheimer's disease should stop driving. Some family members may believe that the person should stop driving immediately upon diagnosis. Others may be inclined to overlook some risky driving behaviour in favour of maintaining the person's sense of independence. They may fear that bringing attention to the person's loss of abilities and the need to stop driving may create difficulties in the relationship.
By the time the person should give up driving, the disease may have affected his ability to understand the reason why. Discussing the situation openly in a trusting environment may help the person accept the loss more easily.
The Dementia and Driving Resource Center, created by the Alzheimer’s Association, provides advice on how to talk about driving with a person who has dementia. It includes four videos detailing different methods to broach the subject of driving and how the person with dementia may react.
Doctors: People often approach their family doctor to help determine when a person should stop driving. However, doctors may not have full information to be able to assess the situation. They see people for a limited time, during visits, not when they are behind the wheel. They may not have proper training to assess driving abilities. They rely on information from individuals and family members who may not always be objective or reliable. As well, doctors may be concerned that telling people they must stop driving could harm the doctor/patient relationship.
Doctors are bound by professional ethics, and in some provinces by law, to report medical conditions that could impair a person's ability to drive. They may also be held liable if a person in their care is involved in an auto accident and they have not reported the person's driving problems to provincial licensing authorities.
If you are the person with Alzheimer's disease:
Giving up driving may be one of the most stressful events you experience, but, in the end, you have to weigh this against your safety and the safety of others. Recognizing and admitting the loss of abilities needed to drive is difficult for some people, while others freely give up their licence.
C) Giving up driving
Driving must be stopped immediately if safety is at risk. Signs that a person's driving abilities are declining include:
- Slow response times
- Traffic violations
- Taking too much time to reach a destination
- Not reaching the destination at all.
People vary in their reactions to driving restrictions. They may immediately accept the idea or may strongly resist it. It may be easier for them to accept the decision if it comes from someone objective.
Acknowledge that it may not be an easy decision to make. Offer alternatives right away, such as looking at the bus schedule together or looking online at websites that offer products or services needed, such as online banking. Point out the benefits:
- Money saved on parking and gas
- Less worry and stress about remembering how to drive places
- Increased exercise if the person plans to walk sometimes instead of drive.
If the person refuses:
Some people may refuse to accept losing their driving privilege. Or, they may simply forget that they are no longer able to drive. In these instances, family members should ask a doctor or other health-care professional help them raise the issue. Be careful, however, that this process does not interfere with the individual’s care. This may happen if the person becomes angry with the doctor and fails to return for future appointments.
If open discussion does not result in the person accepting the need to stop driving, it may be necessary to use other means to prevent the person from driving, such as removing the keys to the vehicle.
More extreme solutions might involve:
- Asking a police officer to intervene, perhaps issuing a citation
- Asking the doctor to write a prescription that says, “Do not drive”
- Disabling the car by removing the battery
- Moving the car so that it is out of sight.
Some people respond to being reminded about what could happen in an accident, where the person or others could be badly hurt or even killed.
For people with Alzheimer's disease and their families, deciding when driving is unsafe can be stressful. Talking to health-care professionals, or families in similar situations can help.
D) Coping with the loss
The loss of freedom to come and go as one pleases can have a devastating effect on the person with Alzheimer's disease. He may have been the only driver in the household. Also, many communities lack alternative forms of transportation.
The lives of people with Alzheimer's disease should be as free and fulfilling as possible, but a totally risk-free life is not possible. Throughout the course of the disease, driving skills and abilities must be monitored. Never exaggerate the person’s difficulty to remove driving privileges earlier than necessary. But recognize that people with Alzheimer's disease who drive when not competent create an unacceptable risk for themselves and others in the community.
Contact your local Alzheimer Society for information about provincial regulations for reporting someone you think may be unsafe to drive. You can also inquire about where to find a driving assessment program in your province or territory.