Dementia Aware: what you need to know about driving when you have dementia
Driving is a complex activity involving many regions of the brain working simultaneously. Due to the progression of brain damage, the person with dementia gradually loses the ability to drive safely, and recent studies reveal that people with dementia are four to seven times more likely to have a driving accident www.thehartford.com/alzheimers.
Perhaps one of the most difficult decisions a person with dementia will face, is when to give up driving. The ability to drive* and go anywhere is liberating; driving is the epitome of freedom, control and independence. Not being able to drive is a blow to one’s pride, to selfhood and social identity.
This does not mean that upon diagnosis the person should stop driving immediately. Studies show as many as 76 percent of people with mild dementia can pass a driving test and can safely drive (Iverson, 2010). But over time (three to six months after diagnosis), when the person’s insight about driving ability and other important issues is strongest, the caregiver and doctor should initiate a discussion about driving.
The discussion will likely not be easy, and there may several discussions. The person with dementia needs time to understand why, to grieve the loss of freedom, independence and control, to consider options, talk with friends or other people with dementia. The most important thing to remember is that the person with dementia be treated with dignity and respect, and his/her feelings are supported and acknowledged. We want to empower and encourage the person with dementia to make the decision to stop driving.
Signs a person with dementia may have problems driving:
- Driving less
- Road rage
- Traffic violations: people over 70 with two or more tickets in past three years were more likely to have a motor vehicle crash (Knopman, 2010)
- Becomes lost on a familiar route
- Running red/amber lights
- Parking illegally e.g. fire hydrant
- Avoids driving at nighttime or in the rain
- Makes unsafe driving decisions e.g. overtakes car on a corner
It may be helpful to ask the doctor to complete a SIMARD MD driving test*. This test enables the doctor to identify people with cognitive difficulties that compromise the ability to drive safely. It is recommended that the test is administered upon diagnosis, when there is a significant decline, and at least every six months for a person with dementia who is still driving (www.driveable.com).
The test comprises four parts:
- Word repetition and recall
- Number conversion exercise
- Name items sold in a grocery store in one minute
- Recall of words from first exercise
Some people with dementia and caregivers have found it helpful to review different transportation options and start using them so the person with dementia feels comfortable and can incorporate into his/her routine.
A word of caution about making a signed plan/contract which identifies when person with dementia will stop driving e.g. an accident, help walking, etc. whilst helps the caregiver decide when the person should stop driving, when it is time, the person with dementia will likely have forgotten the plan and refuse to cooperate. This can create more tension and stress between person with dementia and caregiver.
The fact is, that even as the dementia worsens, and/or accidents increase, most people with dementia will deny they are a danger on the road and will refuse to stop driving. This means that the decision to stop the person from driving falls to the caregiver and the doctor.
What to do if the person with dementia refuses to stop driving:
- Every healthcare practitioner has a responsibility to report a person who has a health condition that impairs the ability to drive safely to the Office of the Superintendent of Motor Vehicles (OSMV)
- If you have concerns about a person’s ability to drive, write a letter explaining your reasons to the OSMV
- Ask your doctor to complete the SIMARD MD screening test on the person with dementia. If the results show the person should not be driving or the results are the doctor must report the findings to the OSMV. This assessment should be repeated every six months
- OSMV may refer person to be tested by DriveABLE: computer test to assess cognitive abilities. If the assessment is inconclusive, an on-road test will be given. Please note, if OSMV refers the person to DriveABLE, there is no fee; however, if the doctor refers person to DriveABLE, the fee is $300.
- If the person with dementia is not fit to drive, OSMV will send a letter and revoke his/her driver’s licence
- If the person with dementia is deemed fit to drive, OSMV may still request the doctor reassess the person every six months
Strategies to prevent use of car:
- Remove car keys OR substitute other keys
- Park car in another location e.g. friend’s garage
- Sell the car
- Disable car: disconnect battery, remove distributor cap etc.
- Caregiver/family member drives
- Other transportation e.g. taxi, HandyDart
- If vehicle is disabled, ensure person with dementia does contact tow company
*Driving includes motorbikes, all terrain vehicles (ATV), snow vehicles (snowmobile), and water vehicles (boats, Ski-Doo).