Approximately one in nine Americans ages 65 and older, or 6.7 million people, are estimated to live with Alzheimer’s disease, and millions more have other types of dementia. What’s alarming is that the majority of older adults with cognitive impairment are still driving, despite concerns raised by caregivers and others, according to a study that was published in the Journal of the American Geriatrics Society.
But driving with dementia is risky, both for the person with dementia and for family members who may allow the person with dementia to continue driving. This is because drivers with dementia are more likely to be found to be at fault in an auto accident. Family members and other caregivers can also be found liable for allowing someone with dementia to drive when that driving results in a serious crash with resulting injuries. According to hg.org, a legal website, “(w)hen a person has a family member going through Alzheimer’s that drives, he or she can face liability when an accident occurs through negligence when he or she owns the vehicle and lets this person drive. Liability for the damages incurred can hold the owner of the car accountable for all necessary and relevant compensation involving the accident and injuries.”
According to some injury lawyers, there is actually a duty to stop a family member from driving with dementia. Here’s what one injury lawyer says about this issue:
“Upon being notified that the person with Alzheimer’s disease or dementia is no longer capable of driving safely, the caregivers or family members are then required to prevent the patient from driving. If they fail to do so, they may instead be held liable themselves if their loved one causes a crash.”
It may also depend on who owns the vehicle. In most states, adults are responsible for their own actions behind the wheel. Provided your aging parent is of sound mind, and is legally able to make decisions for himself or herself, you generally have no responsibility for the elderly parent driving. However, there are exceptions. For example, according to this Florida law firm, “If you loan your vehicle to someone you know to be unfit to drive, you may be liable for negligent entrustment. This can indeed create a serious issue of liability.”
In the Journal of the American Geriatrics Society study mentioned above, researchers assessed more than 600 adults over 65 years old who had cognitive assessment scores that indicated a likelihood of impairment. Of those with cognitive impairment, 61.4 percent were current drivers, and around one-third of all caregivers had concerns about their care-recipient driving.
How Dementia Makes Driving Unsafe
A diagnosis of mild cognitive impairment or early-stage dementia alone is not an automatic reason to stop driving. However, if the person has dementia that continues to progress, he or she will eventually lose the brain functions necessary to make the fast decisions and have the quick reactions they need to drive safely.
To drive safely, different parts of the brain all need to work together in a complex process to see and hear surroundings; decide what might happen; determine how to respond; and react quickly and physically. Many additional problems that are common with dementia make driving unsafe, including:
- Increasing forgetfulness;
- Limited attention span;
- Limited ability to quickly process information;
- Poor judgment and problem-solving ability;
- Disorientation to place;
- Low reaction ability; and/or
- Visual perceptual issues (how things are seen in space, in relation to each other).
The Dangers of Driving with Dementia
It has been proven that the longer people with dementia continue to drive after a diagnosis, the higher their chance of getting into a vehicle crash. For example, a 2017 review of motor vehicle crash risk found that dementia had “medium to large effects on driving impairment” and that people with dementia have an “increased likelihood of failing a road test compared to those without the neurodegenerative disease.” This is because changes that occur in those with dementia are much more complex than changes people without dementia experience with age, which often include problems with their vision and slower reaction time.
Those with Dementia May Not Recognize Driving Difficulties
Those with dementia may not recognize driving difficulties or be able to develop new behaviors to adjust to these changes. In addition, some people with dementia don’t remember making unsafe decisions while driving. Not recognizing their driving difficulties, the person with dementia may be defensive. As a result, the person with dementia is not the best person to assess their own driving ability.
You can help your loved one by becoming familiar with the warning signs which indicate that the person with dementia may be experiencing difficulty driving. These are some of the most common warning signs:
- Becomes lost on a familiar route.
- Lacks good judgment.
- Drives too slowly.
- Stops in traffic for no reason or ignores traffic signs.
- Signals incorrectly or does not signal.
- Has difficulty seeing pedestrians, objects, or other vehicles.
- Falls asleep while driving or gets drowsy.
- Parks inappropriately.
- Has difficulty with turns, lane changes, or highway exits.
- Drifts into other lanes of traffic or drives on the wrong side of the street.
- Gets ticketed for traffic violations.
- Is increasingly nervous or irritated when driving.
- Has accidents, near misses, or fender benders.
Discuss any concerns you have with the individual, family members, and health care providers. All involved will need to weigh potential risks and decide when the individual needs to stop.
What Tools Can Help People Make the Decisions to Stop Driving?
Scientists in Canada have created a comprehensive, user-friendly, and interactive digital Driving and Dementia Roadmap that offers different information for different users. Medical professionals, family members, and individuals with dementia all have separate pathways that offer advice on when to stop driving, how to tell a loved one that the time to stop driving has arrived, and setting up a transportation plan for people’s lives after they stop driving.
“There’s no one-size-fits-all solution to any of these but there are red flags that can tell us when a family member’s driving is becoming unsafe. And, when it comes to the conversations about what the end of driving looks like, it’s important to approach them with care and compassion. Giving up driving is a major life transition that’s fraught with emotion,” explained Dr. Gary Naglie, geriatrician and co-creator of the Roadmap.
Talking to a Loved One with Dementia About Giving Up Driving
It is never going to be an easy conversation, but the Roadmap has a section with resources to help people have more successful conversations about driving cessation with their loved ones, including worksheets and videos. A key takeaway from all this is that, as hard as it is to have these conversations, the alternative is worse.
“The consequence of not talking about it is that, in most cases, it winds up being an abrupt decision,” said Dr. Naglie. “And it’s usually in a later stage where the adult living with dementia is told they have to stop driving and they’ve not been afforded the opportunity to participate in the decision and they’ve not been afforded the opportunity to, at least, plan with others for what life after driving will be like.”
“That’s the reason we came together on this,” Dr. Mark Rapoport, co-creator of the Roadmap, recalled. “Gary (Naglie) works in geriatric medicine and I work in geriatric psychiatry and there have been far too many times we’ve had to be the bearers of that bad news because nobody’s wanted to talk about it.”
In addition to a conversation, here are some other actions you should take:
- Arrange for an Independent Driving Evaluation: The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are usually available through driver rehabilitation programs or your state’s Department of Motor Vehicles (DMV) / Motor Vehicle Administration (MVA).
- Continue to Monitor Driving: If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly over time.
- Re-evaluate Every Six Months: Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.
- Involve Person in Discussions: If the person is still of sound mind, encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive, and consider their feelings and input to the conversation.
- Consider Support Groups: Support groups provide a good venue for both the caregivers and individuals in the early stages of dementia to talk about their feelings and get advice from others in a similar situation. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.
- Involve the Doctor: If the individual is reluctant to talk about driving, ask the individual’s physician or care manager to bring up the subject of driving during health care visits. Many states require physicians to notify the DMV of any patient diagnosed with dementia. Doctors have even been sued in some states for failure to report patients with dementia to their state DMV when that patient continues to drive and causes a motor vehicle collision.
- Begin Discussions Early: Try early on to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will need to find the solutions that work best in their situation.
- Limit Driving: Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin to gradually modify their driving. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations.
- Reduce the Need to Drive: Ways to reduce the need to drive can include grocery and prescription delivery, arranging for a hairdresser to make home visits, inviting friends and family over for regular visits, and taking the individual on social outings.
- Make Arrangements for Alternative Transportation: Consider making a list with the names, phone numbers, and times of availability of those willing to provide transportation. Public transportation such as subways and busses in urban areas, and rideshare options such as Uber and Lyft, may also be good alternatives to driving. Senior and special needs transportation services can be helpful. Eldercare Locator is a nationwide directory assistance service designed to help older persons and caregivers locate local support resources, including transportation, for aging Americans.
When Persuasion Fails
Ideally, an individual will limit or stop driving on his or her own. In fact, some states require individuals diagnosed with dementia to report themselves to the DMV/MVA. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. While it is important to maintain respect for the individual’s feelings, you must put safety first. As a last resort, you may have to prevent his or her access to a car. Some methods to do that include hiding the car keys or moving the car out of sight.
Laws and Policies in Virginia, Maryland, and DC
- Virginia DMV Cognitive Impairment Policy
- MD MVA Cognitive Impairment Policy.
- DC DMV Cognitive Impairment Policy
Plan in Advance for Your Loved One with Dementia
Do you have a loved one with cognitive impairment or who has been diagnosed with Alzheimer’s or another form of dementia? The Farr Law Firm is dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. We help protect assets while maintaining comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. If you have a loved one who has been diagnosed with Alzheimer’s or another form of dementia, please call us to make an appointment:
Northern Virginia Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797
About Evan H Farr, CELA, CAP
