Driving ... The Alzheimer's Association

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Driving is a complex activity that requires quick thinking and reactions, as well as good perceptual abilities. For the person with Alzheimer's disease, driving becomes a safety issue. While he or she may not recognize that changes in cognitive and sensory skills impair driving abilities, you and other family members will need to be firm in your efforts to prevent the person from driving when the time comes.

That said, it's important to consider the person's feelings and perceived loss of independence when explaining why he or she can no longer drive. Helping the person with dementia make the decision to stop driving — before you have to force him or her to stop — can help maintain a positive sense of self-esteem.


How dangerous is it?

Previous studies demonstrate that poor driving performance increases with increased dementia severity. However, not all people with Alzheimer's are unsafe drivers at a given point in time. What's more, drivers with dementia are not in more crashes than non-demented elderly drivers, suggesting that dementia should not be the sole justification for suspending driving privileges. Instead, an on-the-road driving test, or other functional test, is the best way to assess driving skills in dementia.

Some state agencies have special drive tests to determine how well a person sees, judges distance and responds to traffic. Ask the person who administers the test to explain the results to you and the person with dementia. If your state does not offer special testing, private assessments (generally fee-for-service) may be available. Your local Alzheimer's Association may be able to provide a list of these programs.


How do you know when the time has come?

There are also a number of steps you can take to assess the person's ability to drive.


1) Look for signs of unsafe driving

Signs of unsafe driving include:
• 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

Keep a written record of your observations to share with the person, family members and health care professionals.


2) Learn about your state's driving regulations

In some states, such as California, the physician must report a diagnosis of Alzheimer's to the health department, which then reports it to the department of motor vehicles. That agency then may revoke the person's license. Check with your local Alzheimer's Association for information on driving regulations in your state.


Tips to limit driving

Once it's clear the person with dementia can no longer drive safely, you'll need to get him or her out from behind the wheel as soon as possible. If possible, involve the person with dementia in the decision to stop driving. Explain your concerns about his or her unsafe driving, giving specific examples, and ask the person to voluntarily stop driving. Assure the person that a ride will be available if he or she needs to go somewhere.

Other tips to discourage driving include:

• Transition driving responsibilities to others. Tell the person you can drive, arrange for someone else to drive, or arrange a taxi service or special transportation services for older adults.

• Find ways to reduce the person's need to drive. Have prescription medicines, groceries or meals delivered.

• Solicit the support of others. Ask your physician to advise the person with dementia not to drive. Involving your physician in a family conference on driving is probably more effective than trying by yourself to persuade the person not to drive. Ask the physician to write a letter stating that the person with Alzheimer's must not drive. Or ask the physician to write a prescription that says, “No driving.” You can then use the letter or prescription to tell your family member what's been decided.

• Ask a respected family authority figure or your attorney to reinforce the message about not driving. Also ask your insurance agent to provide documentation that the person with dementia will no longer be provided with insurance coverage.

• Experiment 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 the person he or she deserves 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 the disease is in an advanced stage, or there is a history of anger and aggressiveness, it's best not to drive alone with the person.

• If the person with dementia wanders, he or she can also wander and get lost by car. Be prepared for a wandering incident and enroll the person in MedicAlert® + Alzheimer's Association Safe Return®, a 24-hour nationwide emergency response service for individuals with Alzheimer's or related dementia that wander or who have a medical emergency. To find out more information or to enroll, contact your local Alzheimer's Association, call 1.888.572.8566 or register online at www.alz.org.

• In the later stages, when the person is no longer able to make decisions, substitute his or her driver's license with a photo identification card. Take no chances. Don't assume that taking away a driver's license will discourage driving. The person may not remember that he or she no longer has a license to drive or even that he or she needs a license.


What if the person won't stop?

If the person insists on driving, take these steps as a last resort:

• Control access to the car keys. Designate one person who will do all the driving and give that individual exclusive access to the car keys.

• Disable the car. Remove the distributor cap or the battery or starter wire. Ask a mechanic to install a “kill wire” that will prevent the car from starting unless the switch is thrown. Or give the person a set of keys that looks like his or her old set, but that don't work to start the car.

• Consider selling the car. By selling the car, you may be able to save enough in insurance premiums, gas and oil, and maintenance costs to pay for public transportation, including taxicab rides.

• In some states, it might be best to alert the department of motor vehicles. Write a letter directly to the authority and express your concerns, or request that the person's license be revoked. The letter should state that “(the person's full name) is a hazard on the road,” and offer the reason (Alzheimer's disease). The state may require a statement form your physician that certifies the person is no longer able to drive.

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research.

Updated July 2007