Welcome to Driving with Dementia

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I am a family/friend caring for a person with dementia who is still driving. I am interested in:

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Recognizing when it becomes unsafe to drive

At the earliest stages of dementia, the person with dementia may notice changes in their driving. As a result, they may make adjustments as to when they drive. For example, they may only drive in the daylight and/or only to places that they are  familiar with. However, as the dementia progresses, they will lose their ability to determine on their own when they are no longer able to drive safely and that they should stop driving. To decrease the risk of accidents, it’s important that you get involved.

Learn the warning signs

You can’t rely on the person with dementia to recognize when their driving is unsafe. So you must regularly observe their driving and monitor any changes in their driving skills. To help you notice the warning signs indicating that their driving is unsafe:

Source: Reitman Centre, Department of Psychiatry, Sinai Health through Enhancing Care for Ontario Care Partners funding, part of Ontario Ministry of Health and Long Term Care's Dementia Strategy.

 

Source: www.careblazers.com 

Balance independence with road safety

The best approach is to base driving decisions as much as possible on objective information. As soon as there is a dementia diagnosis, observe the person with dementia’s driving on a regular basis, and watch for signs of changes in how they drive. This will help you avoid delaying action or taking action too soon.

In addition, knowing the warning signs that the person with dementia’s driving skills are changing helps make sure you don’t miss any indications that their driving ability is declining. Keep in mind that:

  • Minor incidents, even if they only happen once, may mean that it’s time that the person with dementia seriously consider giving up driving.
  • When minor incidents become more frequent—or there is a major incident—then it’s time for the person with dementia to stop driving.

 As you regularly monitor the person with dementia’s driving, be sure to also:

  • Have discussions with the person with dementia about their driving ability on a regular basis.
  • Talk about any concerns you have with the person with dementia's healthcare providers. 

Here's what some family members have to say:

  • Have the person with dementia drive you places and be aware of their actions. If you question anything, it is time to act. It isn't just about your loved ones. It is also about others on the road who may be injured if something were to happen.
  • Stay connected to the medical team for support if needed to reinforce the message about not driving when the time comes.

Learn when an in-car driving assessment is necessary

An in-car driving assessment is necessary as soon as you feel that the person with dementia's driving may be unsafe. The purpose of an in-car driving assessment is to determine if the person with dementia may continue driving and if so, to what extent.

Understand what an in-car driving assessment involves

An in-car assessment goes far beyond the type of driving test that the person with dementia took to become a licensed driver in the first place. Instead of testing general driving ability, it assesses whether the person with dementia’s driving skills are affected by dementia. All driving assessments are not the same. They vary depending on where the assessment is offered, what it focuses on, and the type of assessor.

 

Specialized driving assessment centres

These centres specialize in assessing people with conditions that could make their driving unsafe, including cognitive issues like dementia. The assessment is conducted by a driving instructor and an Occupational Therapist (a type of health care professional).

For example, it typically includes:

  • Clinical Evaluation: Review of medical and driving history and clinical tests related to driving performance:
    • Vision – like depth perception, peripheral vision, visual-spatial skills, and contrast sensitivity
    • Cognitive ability – like judgment and memory, following instructions, speed of brain reaction
    • Motor skills – like strength, range of motion, coordination, sensation, and reaction time
  • On-the-road Evaluation: Assessment of negotiating traffic, attention, problem solving, and judgment.
  • Results: Rather than just “pass” or “fail,” a written report provides the clinical results, driving strengths, and weaknesses, and recommendations. The recommendations include whether driving should stop or continue and if so, under what conditions. In addition to the written report, the Occupational Therapist will also discuss the results with you and the person with dementia


Government driver’s licence authorities and driver training schools

What is included in the driving assessment varies by region, but it usually does not specifically assess whether the person with dementia’s driving skills are affected by dementia.

For example, it typically does not include:

  • Details of the strengths and weaknesses, just “pass” or “fail”
  • Cognitive test
Because the driving assessment is not aimed specifically at assessing driving skills of people with dementia, the person with dementia could pass the assessment but actually be unsafe to drive. This type of driving assessment is not a valid indicator of whether the person with dementia is safe to drive.

    Get the most out of an in-car assessment

    When making arrangements for the person with dementia to have an in-car driving assessment, ask the assessment centre these questions:

    • Does the person with dementia's doctor need to send a referral?
    • What is included in the assessment?
    • What type of professional conducts the assessment?
    • How much does the assessment cost?
    • Is a written report provided after the assessment?
    Understand how the doctor can help

    The person with dementia's doctor is a valuable resource who can help by:

    Discussing your concerns about unsafe driving

    It’s likely that the person with dementia’s doctor has had experience with patients whose driving abilities have been affected by various conditions—including dementia. Think about meeting with the doctor privately without the person with dementia to discuss any driving issues that you have noticed. The doctor may then recommend that the person with dementia come in for an in-office assessment as described below.

    Conducting an in-office assessment of driving ability

    When a patient has a medical condition like dementia that increases the risk of car accidents, the doctor has certain legal obligations. For most provinces and territories in Canada, the doctor must assess the person with dementia’s cognitive abilities and make a recommendation regarding whether or not they should continue driving.

    At a doctor’s appointment during an in-office assessment, the doctor will review any medications the person with dementia is taking, evaluate cognitive functions like memory and thinking processes, and may do a physical exam. Then the doctor will discuss the results of the assessment and recommendations with the person with dementia. 

    If the recommendation is to stop driving

    • Most provinces and territories in Canada require doctors to send a report of their recommendation to the Ministry of Transportation.
    • In the United States, the laws about doctor reporting vary from state to state.
    • If you are worried that the person with dementia may forget that they are not supposed to drive, ask your doctor for a letter like this (click here) to use as a reminder. It was produced by The Regional Geriatric Program of Eastern Ontario.

    If the doctor is unsure of driving ability

    • The doctor will likely refer the person with dementia for an in-car dementia driving assessment.
    • If the assessment determines that the person with dementia should stop driving, your doctor may need to let the driving authorities know this recommendation.

    If the doctor feels it’s safe for the person with dementia to keep driving

    • The doctor will likely recommend monitoring the person with dementia’s driving ability.
    • For example, the doctor may recommend having the person with dementia come in for a doctor’s appointment about every six to 12 months to have another in-office assessment.

     

    Watch these videos

    See how there are a number ways you can identify warning signs to unsafe driving in the first three videos. In addition, the third video discusses what to do when the person with dementia is reluctant to see a doctor regarding driving.


    Source: Reitman Centre, Department of Psychiatry, Sinai Health through Enhancing Care for Ontario Care Partners funding, part of Ontario Ministry Of Health and Long Term Care's Dementia Strategy

     

     
    Source: www.careblazers.com 

     


    Source: www.careblazers.com

     

    See how various family/friend carers notice changes in the person with dementia's driving. Although some of the content is specific to Australia, most of the ideas are helpful no matter where you live. 


    Source: Alzheimer's Australia Vic. 

     

    See how this daughter encourages her mother to think about having her driving assessed. Please note that the video mentions a resource called the Eldercare Locator at eldercare.gov that is based on the United States so it is not applicable in Canada.


    Source: Alzheimer's Association  

    Try this worksheet

    Click on the titles below. After reviewing a worksheet, when you close the worksheet's web page, it will automatically take you back to here. 

    • Use this Dementia and Driving Decision Aid to help you decide the right time to stop driving. This is a Canadian adaptation of the decision aid that was produced by the University of Wollongong, Australia. Please note, it may take about a minute to download.