Dementia and Driving: Is It OK?

Can seniors with dementia drive? Sure they can. Whether they should is another matter entirely.

Surprisingly, there's no standard-issue medical or legal answer about whether a diagnosis of Alzheimer's or another cause of dementia should require one to automatically give up the keys. That leaves caregivers to finesse the situation.

The usual advice is middle-of-the-(ummm)-road. Some authorities say long-term "automatic" habits like driving may be retained for awhile after diagnosis. The Alzheimer's Association sides with those who say a diagnosis isn't sufficient reason to withdraw driving privileges.

Instead, individual assessments are usually recommended for those with mild cases. (Although in one Australian study, 63 percent of people with Alzheimer's flunked on-road tests.) Every-six-months follow-ups are urged. If you have any doubts, there are lists of warning signs you can use.

But there's also this:

• Driving requires thousands of snap judgments and reactions, attention, memory, multitasking, spatial coordination, and other skills. All these things will progressively erode in someone with dementia. But no one can be sure when.
• Drivers with dementia who take antidepressants, antipsychotics, or sleep meds are 50 percent more likely to have road accidents than people with dementia who don't take them, says a study on 8,700 drivers described in a letter in the current Journal of the American Geriatrics Society.
• Drivers with dementia have double the accident rate in general, studies show.
• People with Alzheimer's drive an average of 10 months longer than their caregivers think is safe, according to The Hartford Financial Services Group, a major insurer that joined with the MIT Age Lab to tackle this issue last year.

Yes, it's important that skill, rather than mere prejudice, is the deciding factor. But the safety of others on the road can't be compromised at the expense of a desire to preserve independence and dignity. I'll admit this hard-driving perspective comes from someone who also doesn't think 15- or 16-year-olds have the brain maturity to drive yet, and who feels the distractions of cell phones (hands free or no) and text messaging should be illegal for anyone in the driver's seat. I wouldn't let my father drive me anywhere for years, because even before his dementia diagnosis he seemed to have lost the necessary skills.

Call me a nervous ninny. But when two tons of fast moving steel are involved, overworrying -- and erring on the side of safety -- seems perfectly appropriate. If you're dealing with an Alzheimer' or dementia diagnosis, the question shouldn't be "whether." You should advance directly to how do I encourage this person to stop driving and how do I plan alternatives.

Image by Flickr user Hamed Saber under a Creative Commons Attribution license .