Dementia and Driving
5 Tips to Get a Dangerous Driver With Dementia off the Road
Virtually all people with dementia eventually lose the mental abilities required to drive safely. Worse, people with dementia tend to be very poor judges of their driving ability, which may mean they don't have the capacity to decide when it's time to give up the keys.
During mild dementia, family caregivers should be watching for signs that it's time to stop driving and should be ready to intervene when things seem unsafe. (Note: By moderate dementia, it's essentially impossible to drive safely.)
Once a family decides that the safety risks of driving have become substantial, then comes the tricky part: getting the driver to stay off the road.
Here are five strategies to try. It's likely that a combination of a few of these strategies will work better than just one, and that new strategies might be necessary as the disease progresses.
Some of these options may seem harsh or mean, but remember: Just like drivers impaired by drugs or alcohol, drivers impaired by dementia are a danger not only to themselves but to innocent people such as their passengers, other motorists, pedestrians, and cyclists.
1. Talk to Your Loved One.
Just as with older drivers without dementia, the first step to getting a dangerous driver with dementia off the road is probably having a simple conversation with him or her.
Simple, but definitely not easy.
Bring up your concerns in a relaxed, nonconfrontational setting, and see how he or she responds. Assume it will probably be a series of conversations, not just one -- and assume that the harder you push, the harder he or she will push back.
Don't make it a control issue, with you giving the orders. Make it a genuine back-and-forth, where your loved one can voice his or her concerns and you can work together to brainstorm alternatives to driving.
While some people with dementia are relieved to give up the keys, many lack the self-awareness to realize how unsafe they are on the road. Those people are the ones most likely to feel hurt and criticized by your comments. And realize that this gentle option may not work in later dementia: He or she may forget that you had the conversation or jump in the car purely out of habit.
2. Propose Alternative Sources of Transportation.
This is a huge one. Someone who doesn't have an easy way to get to the hair salon or the pharmacy is a lot more likely to get behind the wheel than someone who has a friend or neighbor stopping by to pick him or her up.
There are transportation services for every situation and every budget. If friends or neighbors are busy, look into paratransit companies or personal care attendants. Some families set up charge accounts with reputable taxi companies so their loved ones can just call for a ride whenever they want. People in urban areas may be able to use public transportation or walk, provided they're still functioning well enough to do so safely.
Whatever the solution, talk to your loved one and make sure he or she is OK with the arrangement. If driving himself isn't an option, he may prefer being driven by a friend over taking paratransit -- or he may dislike the neighbor's driving style but enjoy the social aspect of a paratransit van.
3. Enlist Help.
It's possible to test your loved one's driving yourself, but in some cases, it's a whole lot easier to get a professional involved.
Occupational therapists can perform on-road driving tests, and they can also help a driver who is moderately safe learn how to drive more safely, including planning the safest routes to everyday destinations. Occupational therapists also may be required to report dangerous drivers to the DMV in certain states.
In most states, you can make an anonymous call to the DMV to report an unsafe driver. The DMV will require him to come in for testing, generally written and behind the wheel, and can revoke his license if he's dangerous.
Doctors can perform vision, cognition, and motor skills tests in the office, although they may not be able to tell how safe a person with mild dementia is on the road. If a person has progressed to moderate dementia, or if an outside evaluation confirms poor driving skills, many doctors will write a prescription for "no driving," which some patients will follow. Also, in some states doctors are required to report to the DMV certain medical conditions that affect driving.
In general, having a professional tell your loved one he can't drive is a lot easier for him to hear than having a family member tell him the same thing.
Note, though, that determined people with dementia may keep driving, with or without a license.
4. Disable, Relocate, or Sell the Vehicle.
If an unsafe driver with dementia continues to get behind the wheel, it's time to take drastic measures. Remember, many people with dementia have lost the capacity to assess their driving, so you may need to override your loved one.
Ask a mechanic to disable the car, have the tires "stolen," shave the keys, park the car at a friend or relative's house, or sell it if that's legally feasible.
Of course, if the person is lucid enough to know what's going on -- and thinks he's a fine driver -- he might be able to get around these tactics by calling a tow truck, getting new keys made, or buying a new car.
5. Try White Lies.
Consider using white lies, especially if your loved one's memory has deteriorated to the point where all you're trying to do is alleviate his worry.
Creative storytelling often results in solutions that satisfy the family and the former driver alike. One family successfully replaced the car keys with ones that looked the same but didn't work, so that the person with dementia could still get into the car and try to start it without the danger of actually going anywhere. Every time he asked about it, his caregiver told him they were planning to get it fixed.
Try telling your loved one that the car's in the shop -- even if it's at a relative's house. Or let him know that his grandniece needs the car -- even if the kid in question won't get her license for another five years.
With a little creativity, it's possible to satisfy a former driver while also keeping him -- and anyone else who might be hurt by his driving -- out of danger.