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    Dementia Symptoms & Caregiver Strategies: Cognitive Impairment and Driving: Easing the Transition and The Importance of a Driving Contract

    Signs of unsafe driving

    Determining when someone can no longer safely drive requires careful observation by family and caregivers. The following list provides warning signs that it's time to stop driving:

    • Forgetting how to locate familiar places
    • Failing to observe traffic signs
    • Making slow or poor decisions in traffic
    • Driving at an inappropriate speed
    • Becoming angry or confused while driving
    • Hitting curbs
    • Using poor lane control
    • Making errors at intersections
    • Confusing the brake and gas pedals
    • Returning from a routine drive later than usual
    • Forgetting the destination you are driving to during the trip
    Driving evaluation

    A person with cognitive impairment may begin to have difficulty with complex tasks such as driving. Although family and caregivers can watch for signs of unsafe driving, a proactive strategy would be to get a comprehensive driving evaluation by an occupational therapy driving rehabilitation specialist. The evaluation provides a more objective understanding of the current impact of the disease on driving capacity and results in a plan of options. The goal is always to retain the highest level of independence and mobility in the community.

    Initial recommendations may include strategies to reduce driving risk during the early part of the disease. The occupational therapist can offer strategies specific to the individual's goals and needs. The American Occupational Therapy Association website includes a national database of driving specialists as well as a wealth of resources for both people with cognitive challenges and their families.

    Limit Driving

    Because the progression of cognitive impairment varies, individuals who have demonstrated the ability to still drive safely should begin gradually to modify their driving. This can reduce the risk of an accident if the individual's driving skills decrease significantly between evaluations. Making the transition from driver to passenger over time can help ease the adjustment. Encourage your loved one to try some of the following:
    • Drive only on familiar roads and avoid long distances.
    • Avoid heavy traffic and heavily traveled roads.
    • Avoid driving at night and in bad weather.
    Reduce the Need to Drive

    Individuals able to maintain an active life often adjust better to the loss of driving privileges. The following are some ways to reduce the need to drive:
    • Have groceries, meals, and prescriptions delivered to the home
    • Arrange for a barber or hairdresser to make home visits
    • Invite friends and family over for regular visits
    • Arrange for family and friends to take your loved one on social outings
    Having the Conversation

    Losing the independence driving provides can be upsetting. It is important to acknowledge a person's feelings and preserve their independence, while ensuring the person's safety and the safety of others. Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. Encourage the individual with cognitive impairment to talk about how this change might make him or her feel. Helping the person with cognitive difficulties make the decision to stop driving - before you have to force them to stop - can help maintain a positive sense of self-esteem. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.
    • Initiate a dialogue to express your concerns. Stress the positive and offer alternatives.
    • Address resistance while reaffirming your unconditional love and support. Empathize that it is uncomfortable having this conversation and stress the importance of preparing for the future.
    • Appeal to the person's sense of responsibility.
    • Reinforce medical diagnoses and directives. Ask the physician to write a letter stating that the person must not drive. Or ask the physician to write a prescription that says, "No driving." You can then use the letter or prescription to reinforce the conversation.
    • Consider an evaluation by an objective third party.
    • Understand that this may be the first of many conversations about driving
    Try to begin discussions early while your loved one has insight into his or her condition and establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will have to find the solutions that work best in their situation.

    When the conversation does not go well

    Some people give up driving easily, but for others this transition can be very difficult. Be prepared for the person to become angry with you due to the memory and insight issues that are part of being cognitively impaired.
    • Be patient and firm. Demonstrate understanding and empathy.
    • Acknowledge the pain of this change and appeal to the person's desire to act responsibly.
    • Ask a respected family authority figure or your attorney to reinforce the message about not driving. A lawyer or financial planner may also be willing to discuss driving as part of the individual's legal and financial planning.
    • If your loved one is reluctant to talk about driving, ask their physician to bring up the subject of driving during health care visits.
    • If the conversation does not go well, do not blame yourself. Cognitive difficulties impair insight and judgment, making it difficult for people to understand that their driving is no longer safe and can cause mood and personality changes that make reactions more pronounced than they normally would be.
    When Persuasion Fails

    Ideally, an individual will limit or stop driving on his or her own. However, some individuals with cognitive difficulties may forget that they should not drive or insist on driving even though it is no longer safe. While it is important to maintain respect for the individual's feelings, safety needs to come first.

    Try experimenting with ways to distract the person from driving. Mention that someone else should drive because you're taking a new route, because driving conditions are dangerous, or because he or she is tired and needs to rest. Tell your loved one they deserve a chance to sit back and enjoy the scenery. You may also want to arrange for another person to sit in the back seat to distract the person while someone else drives. If there is a history of anger and aggressiveness, it's best not to drive alone with the person.

    As a last resort, you may have to prevent his or her access to a car. Some methods include:
    • Control access to or hide the car keys
    • Give the person a set of keys that looks like their old set, but that don't start the car
    • Disabling (removing the distributor cap, the battery, or starter wire) or selling the car
    • Moving the car out of sight
    Make Arrangements for Alternative Transportation

    It will be important to make alternative transportation arrangements so that the individual's mobility and activity level are not unduly restricted. Commonly used transportation options are:
    • Family and Friends. Family members, friends, and neighbors can offer to drive the individual to social engagements and appointments. Consider making a list with the names, phone numbers, and times of availability of those willing to provide transportation.
    • Public Transportation. For individuals with mild cognitive challenges, public transportation may be a good alternative to driving. It works best for those who are already familiar with the public transportation system in their area. Persons with more impairment may not be able to figure out routes and schedules.
    • Taxis. Taxis can be a good option if someone meets the individual at both ends of the taxi ride. You may be able to set up a payment account with the taxi company so that your loved one does not have to handle money.
    • Senior and Special Needs Transportation Services. The Yellow Pages of many telephone books have a special section in the front with the names and addresses of various service organizations. Look under transportation or community services for the names of agencies that provide transportation for special needs.
    • Eldercare Locator (800-677-1116) is a nationwide directory assistance service designed to help older persons and caregivers locate local support resources, including transportation, for older adults.
    Caregiver Support

    Balancing safety with respect for an individual's desire to drive can be difficult and emotionally trying. Enlist the support of other family, friends, caregiver support groups and health professionals when making and implementing difficult decisions about driving.

    • Dobbs, A. R. (1997). "Evaluating the Driving Competence of Dementia Patients." Alzheimer's Disease and Associated Dementia. Vol. 11, Suppl: 8-12.
    • LA 4 (2001). Dangerous Driving and Seniors.

    The Importance of a Driving Contract

    Planning ahead

    For people with cognitive impairment, it is never too soon to plan ahead for how your loved one will get around when they can no longer drive. Putting a plan in place can be an empowering way to make their voice heard.

    Planning ahead before driving becomes an issue provides an opportunity to make choices and maintain independence and safety. A driving contract allows you and the person you care for to openly discuss what they would like to happen when he or she is no longer able to drive.
    You can use the sample driving contract [PDF] to start the discussion.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: