What's the best way to bring up the topic of unsafe driving to someone with Alzheimer's?

For starters, do everything you can to avoid a power struggle. Respect that as long as the driver is mentally competent and not a clear danger on the road, it's his or her decision whether to stay behind the wheel. Include the person in discussions of specifics and safety concerns so that, ideally, he or she will be the one to conclude that it may be better to limit or give up driving.

There are a number of practical steps you can take to help make the initial discussions go as smoothly as possible.

Choose the messenger carefully. Give some thought to the best person to broach the subject of problematic driving. The most forceful or aggressive soul may not be best for this delicate job; the most important ingredient may be trust. Most married drivers, for example, say they'd most like to have the discussion with a spouse. But for some couples, that pairing would be disastrous. Some people are more likely to respond to a close friend than a family member. And if the driver is particularly persuaded by medical advice, then his or her doctor may be invaluable in explaining how and why Alzheimer's and other medical conditions can contribute to perilous driving.

Choose a place and time to talk. Set aside some time and pick a quiet spot where the driving discussion can be held confidentially and without interruption. Although it may be tempting, don't bring up the topic while the person is behind the wheel -- that's likely to be distressing and distracting, and it may exacerbate the unsafe situation.

A car accident or a significant change in health may be a natural catalyst for the talk about giving up driving. Otherwise, you might consider beginning the conversation with an opening line that removes the personal focus, such as:

• "With all the traffic and fast cars now in town, it sure is harder to drive around her than it used to be."

• "Did you hear about that car accident on today's news?"

• "When did (Grandma, Grandpa, a neighbor, a friend) stop driving?"

Be specific. If the person dismisses the idea that his or her driving has become a cause for concern, back it up with tangible things you or others have noticed: an increased number of dings or creases in the car, traffic tickets, or other drivers frequently honking at or passing the car. If the evidence still doesn't convince the person that your concerns are real, consider asking him or her to take a self-assessment test in private, such as "Am I a Safe Driver?," produced by the American Medical Association. More comprehensive (but less simple) is the Driving Decisions Workbook, published by the University of Michigan's Transportation Research Institute.

Research alternatives. Listen to the individual's particular concerns about not being able to drive -- missing hair appointments, grocery shopping, or a weekly card game, for example -- and consider other ways those needs could be met: a stylist who'll make house calls, online ordering and home delivery, a member of the poker group willing to provide a weekly pickup for the price of an occasional gas card.

Be prepared to offer alternative transportation plans, which may include:

• Names and phone numbers of friends and relatives willing to help with rides.

• Phone number of a dependable local cab company; some may even provide cost-savings vouchers for older passengers or those with disabilities.

• Phone numbers of local shuttle services; local community centers and religious groups often provide such transportation for older residents free or at a low cost.

• Bus and train schedules that cover routes the person commonly travels; if the idea of taking public transportation seems daunting or intimidating to the person, get someone to accompany him or her for a trial run or two.

Representatives from the nearest Area Agency on Aging may be able to suggest additional transportation possibilities that are available locally.

If possible, discuss these options with the person and include his or her thoughts and preferences when making an alternative transportation plan.

Be persistent. In a recent survey of older adults who reported that someone talked to them about their driving, more than half -- the majority of them women -- said they listened to and followed others' suggestions. While that still leaves a large number who remain reticent, the odds of listening go up with repeat conversations. If the person shuts you out or becomes too agitated when the topic of giving up driving is first broached, let it go. But gently raise your concerns again in a later conversation. Your persistence may help overcome the initial resistance to the idea.