Driving with dementia

Understanding driving ability

“One person I spoke with, the first words out of their mouth: ‘You’re still driving?'” - Keith (pictured), from Ottawa, Ontario. Keith lives with young onset Alzheimer's disease.

Driving a vehicle is a complex activity that requires several abilities and skills, such as:

• Quick reactions,
• The ability to divide your attention and multi-task (for example, watching a traffic light and pedestrians at the same time, while keeping your foot on the brake),
• Good judgement,
• An understanding and ability to recall the rules of the road,
• The ability to find a destination and
• Adequate eyesight and hearing.

Driving also represents freedom, independence and mobility. Although driving is a privilege, some people view it as a right.

Most people in the early stages of dementia can continue to drive safely and competently. However, because of the progressive nature of dementia, it’s critical to be aware of any changes in your driving patterns.

Risky driving behaviours caused by dementia

If you've been driving for many years, driving may feel mostly automatic. However, as dementia progresses, it will change your abilities, such as your level of concentration, judgement, orientation, perception and physical ability – all important and necessary skills for driving.

As a result, regardless of your driving skill and experience before you started having symptoms, your dementia will eventually put you at a higher risk for the following driving behaviours:

• Slow response times,
• Traffic violations,
• Taking too much time to reach a destination or not reaching the destination at all,
• Driving too slowly or too fast,
• Driving through stop signs or red traffic lights,
• Stopping at green traffic lights,
• Having difficulty merging with traffic,
• Making left hand turns in the face of oncoming traffic and pedestrians crossing the intersection.

These behaviours can increase your risk of a collision, which can cause serious injury and death for you and other people.

Knowing when to stop driving

Assessing your abilities

When your abilities have changed to the point that the risk of a collision becomes more likely, it's no longer safe for you to continue driving. You should stop driving as soon as possible.

When will you know that it's time to stop? It can be difficult for anyone to assess their own abilities in a neutral way:

• That's why it can help to ask someone you know and trust to give you an honest and forthright opinion – it could be your spouse, a good friend or your family doctor.
• Alternatively, it may be easier to hear an objective assessment from someone you don't know (see Can my driving ability be assessed by a professional?, below).
• In page three of our brochure, Conversations about dementia and driving, there is a questionnaire that asks a person to assess their driving ability. By getting someone you trust to fill out this questionnaire, you can get more insight on where your driving ability stands. However, be prepared to read an assessment that you may not agree with.

Having the conversation about stopping driving

Whenever it happens, the decision to stop driving won't be easy –and neither will the conversation that leads to that decision:

• After all, you're losing the privilege to drive due to changes in your abilities that you can't stop –because of this, it's totally normal to feel angry, sad, frustrated or hopeless.
• As well, it may add a strain on the relationship between you and your friends and family (particularly the person who will become your caregiver). They will likely notice changes in your abilities before you do, and may be the first to discuss whether you should stop driving.
• On the other hand, they may be hesitant to bring up the conversation about your driving ability, whether it's out of a desire to see you live independently or to avoid conflict in your relationship with each other.

Although losing the privilege of driving can be difficult, it's important to remember that it can be equally, if not more devastating, to be involved in a motor vehicle collision. A collision can result in serious disability or death for you or in trauma and death of others.

Strategies to manage your driving ability

Maintaining your driving ability

The good news is that, while your symptoms are mild, you can take steps to help you drive safely and independently for as long as possible:

• Settle into a consistent routine. Stick to the same route when you drive from place to place. Figure out when you most need to drive, and follow that plan. For example, do you drive to medical appointments, to shop, to meet with friends? Are there times when someone else can drive?
• Drive with someone that can assess your driving abilities on an ongoing basis. They can notice if there are any changes in your driving abilities and can spot risky behaviours that you may not be aware of.
• Use technology to support your capacity to drive. If you're driving by yourself, use assistive technologies such as a GPS to help you.
• Above all, living well with dementia has been shown to slow the progression of dementia. Challenging your brain, following a good diet and staying physically and socially active will all help you stay in the early stage of dementia for as long as possible.

Transitioning to living without driving

To help you plan ahead for the time when you must stop driving, consider the following strategies:

• Consider alternative forms of transportation. These can be public transit, taxis, services provided by community organizations, and transportation organized by family members and friends.
• Use these alternative forms of transportation while it is still safe for you to drive. This will help you get used to new routines that you will transition to after you hang up the car keys for good. As well, this may help you accept the difficult decision to stop driving when it eventually comes.
• Look into companies that offer home delivery services. These can be pharmacy or grocery home delivery services.

Other questions about driving and dementia

What does my diagnosis mean for my car insurance?

A diagnosis of dementia does not mean automatic denial of insurance.

If you have been diagnosed with dementia, talk to your doctor about the progression of your dementia and your driving abilities. Consider contacting your car insurance provider to share the information received from your doctor. Your provider will determine your car insurance coverage based on your specific situation. Failure to disclose a diagnosis could impact your insurance policy.

Can my driving ability be assessed by a professional?

When driving becomes a concern, look into the availability of a driving assessment. This could include a road test conducted by someone with experience in assessing drivers with cognitive issues.

If an on-road driving assessment is not available, enlist the help of a doctor (either a primary care physician or a specialist) to determine if and when you should stop driving and to be connected to available support and resources.

The healthcare provider may ask you and a family member about:

• Driving patterns (when and where you drive the most),
• Any differences noticed in your driving skills,
• Any unsafe or abnormal driving behaviour,
• Traffic tickets (for going too slow, too fast, improper turns, failing to stop),
• Crashes, fender benders or near-misses,
• Instances where you've been lost and
• How comfortable you and your family members feel about your driving abilities.

Can my doctor prevent me from driving?

Doctors are not the ones who determine if you are fit to drive. Doctors forward their medical opinion to the Ministry of Transportation. The Ministry of Transportation then determines if the person should continue driving.

Doctors are bound by law, in most provinces, and by professional ethics, to report medical conditions that could be a serious risk to road safety. They also may be held liable if a person in their care who has dementia is involved in a motor vehicle collision and they have not reported the person’s medical condition to provincial licensing authorities.

More useful links and resources

Conversations about dementia and driving. Alzheimer Society of Canada. In this information sheet, learn how dementia can affect a person's driving abilities and get strategies to help people living with dementia, caregivers and healthcare providers have conversations about driving cessation.

The Driving and Dementia Toolkit. The Champlain Dementia Network and the Regional Geriatric Program of Eastern Ontario, last updated March 2015. As a person living with dementia or a caregiver, you can download this fillable PDF to assess driving abilities and risks.

Dementia and Driving. Alzheimer's Association. This webpage from this U.S.-based dementia organization highlights realistic scenarios to help families start the conversation about driving. In English only.

Driving and Dementia. brainXchange, 2015. This webinar focuses on how dementia affects the ability to drive and on the evaluation process to assess fitness-to-drive. This webinar is brought by brainXchange in partnership with the Alzheimer Society of Canada and the Canadian Consortium of Neurodegeneration in Aging (CCNA). In English only.

Driving and Dementia. Alzheimer Society of B.C., 2020. In this 25-minute video, learn how dementia may affect someone living with dementia's driving abilities and strategies to ease the transition for driving cessation. In English only.

Driving and Dementia: Safety & Loss of Independence. Alzheimer Society of B.C., 2018. This handout outlines and contains some specific information for residents of British Columbia. In English only.