What should I do if I'm worried about my loved one driving?

By Nicole Ruggiano, PhD, MSW

Driving is often seen as a symbol of freedom and independence, which is why many families struggle when they aren't sure if their older relative should still be behind the wheel. Many care partners find it stressful to even discuss issues of driving safety with their loved one. In some cases, care partners may be premature in wanting to take away their loved one's keys. In other situations, families do not have the conversation about their loved one driving until after the person has an accident. What should families do?

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When is it time for someone to give up driving?

Giving up driving is difficult for many older adults for a variety of reasons. In some cases the person may not have other transportation available to meet their needs, which can be especially challenging in rural communities. When assessing someone's driving safety risk, it's important to remember that cognitive decline is not like a heart attack - it happens over time rather than all at once. Some people with early-stage dementia may still be able to drive. For this reason, it is important to have a conversation with your loved one early about driving when they can be fully involved in developing a plan to stop driving.

There are specialists, usually occupational therapists, who are trained in evaluating someone's driving abilities. Typically, professional driving evaluations involve several components such as a medical evaluation, driving test, and written test. Some of the things that they look look at include the driver's vision, reaction time, and motor functions. However, not everyone can afford a comprehensive driving evaluation by a specialist. In such cases you may look for signs in one's driving that may indicate safety issues, such as:

• Confusing the brake pedal with the gas pedal.​
• Driving as speeds that are unsafe.
• Evidence that the driver is hitting curbs or other types of small accidents.
• Making poor decisions at intersections and in traffic. 
• Having multiple traffic tickets.

My loved one was just diagnosed and is still able to drive. How can they reduce their safety risks?

Remember that there may be more options than simply "drive or not drive." In some cases, the driver may not be able to navigate a highway or driving long distances, but they may be able to safely drive on smaller streets in their community. In other cases the person may be able to drive safely during the daytime and not drive after dark. These possibilities should be explored, when appropriate. A specialist in driving evaluation may be helpful in identifying situations that are safe and unsafe for the driver or if there are tools that can help improve safety, like additional mirrors. If your loved one does not seem to pose an immediate safety risk when they drive there are things they can do to minimize their risks:

• Try to limit when and where you drive to reduce risks. For example, avoiding driving at night, driving in bad weather, and driving on highways. 
• Remove driving distractions. You may have always listened to the radio when driving but it may make it more difficult to focus now when it is playing in the car. 

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How do I talk with my loved one about giving up driving? 

Families often find that having the conversation about a loved one needing to give up their keys is very difficult. In some cases, the discussion can anger and upset the person who may have to stop driving. However, in other cases the driver may actually be relieved because they have been afraid that their driving is unsafe and hasn't shared that with anyone else. Some families have found it helpful to ask the person's health care provider or other person with authority to recommend that they stop driving. 

If you find yourself in a situation where you have to talk with your loved one about driving safety, there are some tips on having this conversation with them:

• Approach the conversation with empathy, love, and support when expressing your concerns. 
• Understand that the person may not be aware that they have been driving unsafely because of the memory and cognitive problems they have as a result of their dementia. 
• Acknowledge their feelings about losing their independence. 
• Offer alternatives that can support their transportation needs. 
• If they do not want to have the conversation, emphasize the need for planning ahead so the transition is easier when they stop driving.
• Don't blame yourself if the person becomes upset or angry. You may have to approach the topic more than once with them. 

The Takeaway

The symptoms associated with dementia are complex and can be challenging to cope with. Driving safety is one of many difficult conversations that are associated with a dementia diagnosis. While many people avoid having these conversations due to fear or discomfort, talking about driving safety early on in a dementia diagnosis can make the transition easier for the person with with dementia and their family. Fortunately, there are many resources available for families who need to have these conversations for their loved one's (and others') safety.

Resources that may help. 

Here are some additional support and information about driving and dementia:

• The National Institute on Aging's website on Driving Safety and Alzheimer's Disease. 
• The Alzheimer's Association's website on Dementia and Driving. This website includes videos about how families have dealt with the issue of driving and dementia. 
• The Alzheimer's Association Driving Contract. This is a resource that helps families have conversations about giving up driving and also can be used early on in their diagnosis to determine when 
• The Association for Driver Rehabilitation Specialists. This website can provide information about giving up driving. It also has information about how to find a driving evaluation specialist. 
• Your local Area Agency on Aging may have information and resources about alternatives to driving within your loved one's community.