Driving and dementia in older patients is not an easy conversation, even for physicians

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Navigating the complexities of driving becomes a difficult issue that both families and medical professionals often grapple with. Driving symbolizes independence and self-sufficiency. Revoking this privilege can seem like it would lead to greater physical and emotional complications for the individual concerned. However, the urgency of this matter escalates critically when an individual develops a form of dementia. Yet, when both physicians and patients were surveyed, the majority reported that driving concerns were not broached during regular checkups. In fact, there are only six states in the U.S. that mandate physicians to report unsafe drivers. One-third of state department of motor vehicles websites lacked instructions regarding physician reporting of medically impaired drivers. So not only is there a lack of conversation, there is inconsistency on what steps a family or doctor can and should take.

Frequently, it is the physician who must initiate the conversation about driving abilities with older individuals and their families. Although it can be a difficult topic to broach, having this discussion is often the best way to prevent those who are no longer able to drive from endangering themselves and others on the road.

Mary Underwood
_{© Bridgeway Senior Healthcare}

Losing the ability to drive affects not only the person themselves but also the family members. With decreased independence of the individual, there often leads to increased dependence on the family, thus delaying the often inevitable decision.

The solution is not straightforward, such as enacting a policy that would strip away the driving privileges of anyone diagnosed with dementia. In the early stages of the illness, many individuals can make adjustments and continue to drive without incident. Nonetheless, given that most dementias worsen over time, a person’s capabilities and limitations will invariably shift.

Presently, it’s estimated that over 60% of older adults with cognitive impairments are still behind the wheel. This statistic raises red flags, especially considering that around 36% of caregivers for current drivers have voiced safety concerns. Those affected by cognitive impairments, along with their family members, attempt to mitigate risks. Strategies include avoiding nighttime driving, staying off the roads in poor weather, steering clear of unfamiliar routes, not driving long distances, and shunning highways or areas with dense traffic. Such strategies may be effective temporarily.

However, disease progression brings on impairments that affect driving irrespective of the conditions. Contrary to the common assumption held by many drivers, family members and even some professionals – that memory-impaired drivers primarily face the danger of getting lost – medical experts are aware that dementia impacts more than just short-term memory.

For instance, visual-spatial skills, such as depth perception, deteriorate as the disease advances, affecting the ability to gauge the distance to the car ahead or discern the position of traffic signals. Reaction time is also crucial for driving and is influenced by both aging and dementia. A person with dementia needs more time to stop or evade a situation. When you pair the delayed reaction time with slower and impaired decision-making skills, this compounds the difficulties a driver with dementia experiences.

Divided attention is another critical ability for safe driving, yet it becomes increasingly challenging for an individual with dementia. Focusing simultaneously on the vehicle ahead and a group of children on the sidewalk, for example, may prove difficult. Consequently, the driver may prioritize one over the other, elevating the risk of an accident.

Anticipating events is integral to driving. Predicting that a traffic light will turn red after yellow or that a child might chase a ball into the street are everyday anticipatory skills. These skills deteriorate with the progression of dementia, heightening the risk of accidents for the drivers and others on the road.

While it is evident that these physical changes occur, the question remains: Do they lead to more accidents? Research indicates not only a higher rate of accidents among drivers with dementia but also an increased likelihood of these incidents being fatal. One study, albeit with a small sample size, indicated that individuals with dementia are up to eight times more likely to be involved in a car accident than their counterparts without the condition.

There are numerous other factors related to aging that also impact a person’s driving ability. They include medication interactions, decreased hearing, visual impairments, and some issues with mobility and flexibility. However, it is important that the topic be part of the family member discussion. In addition, this is a topic that would be beneficial to discuss within the patient-physician relationship.

Mary Underwood is a social worker who has been working in the field of memory care for more than 35 years in a variety of settings, including nursing homes, assisted living communities, home care and adult day programs, and as a memory care writer and contributor to Bridgeway Senior Healthcare in central New Jersey. She has received recognition from state and national organizations for her programs and philosophies to improve the quality of care for those living with dementia. In addition to her professional experience, Mary’s father was diagnosed with a form of dementia in 2015.