Care and support - Safety - Driving with dementia

For many people, driving represents freedom and independence. This is why making decisions about driving are difficult. Dementia affects some of the abilities that are essential for driving, such as rapidly judging distances, making quick decisions, and multi-tasking. Research tells us that people who continue to drive with dementia are involved in more car accidents than other drivers. It is important to remember that losing the ability to drive is part of the disease process, and it is not something a person should be blamed for or made to feel badly about. It is a function of the disease, and making the decision to stop driving is about personal safety and the safety of others.

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network.

While some people are able to drive for some time after receiving an early diagnosis, there will come a time when driving will no longer be safe. It is important to see your doctor every six-twelve months and talk to your partners in care to discuss any concerns you may have and alternatives to driving.

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network.

There are signs that you and your family should look for when making decisions about when driving might not be safe anymore. Some of these signs include:

• Car crashes or mild "fender benders" (hitting or scraping other cars, walls, garbage cans)
• Getting lost when driving to familiar places
• Forgetting where you are going
• Near misses with other vehicles or pedestrians without noticing
• Receiving traffic citations for speeding, driving too slowly or improper turns
• Other drivers honking at you or showing signs of irritation
• Running stop lights without realizing it or stopping at a green light
• Confusing the gas and brake pedals
• Going the wrong way against traffic
• Merging without looking
• Needing a family member to act as a co-pilot
• Family members feeling uncomfortable driving with you

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network.

The Ministry of Transportation relies on doctors to identify changes to a person's medical status that may affect their ability to drive safely. Your doctor will continue to see you for follow-up after you have been given a diagnosis of dementia. At each visit you will be asked about your driving. You or your family can discuss any changes in your driving that have been noticed. If the doctor notices some of your abilities for driving have changed, your doctor is required by law to inform the Ministry of Transportation that your medical condition has changed. Your doctor is obligated to do this, even if you have discussed the issue together and you agree not to drive.

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network.

The Ministry of Transportation will review the report from your doctor. They will send you a letter in five to eight weeks indicating one of the following possibilities:

• Your medical report is approved and you can continue driving or
• More medical information is required to make a decision. You will be told in your letter what medical information is needed and the date it is expected or
• You will need to pass a three-part driver's test (written, vision, and road test) administered by Drive Test or
• You will be required to complete a formal driving evaluation at a Ministry Approved Driver Assessment Centre or
• Your license has been suspended. This decision can be reconsidered with up-to-date medical information from your family doctor or specialist confirming your condition has improved.

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network. 

There are a number of assessment centres with specialized staff who use paper and pencil tests and road tests to evaluate driving skills. These tests focus on driving skills that may change as a result of dementia. There is a fee for taking the test, from $500-$800. The Driver Assessment Centre will send a report to the Ministry of Transportation who will make the final decision about your licence. You will be provided with a list of Ministry Approved Driver Assessment Centres in your letter if an assessment is necessary.

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network.

Drivers can appeal a decision by requesting an administrative review. This is an in-person meeting held with a Ministry representative, usually conducted at a local government office.
or
You can file a formal appeal of your license suspension to the License Appeal Tribunal A $100 fee is required for this appeal. The tribunal has the authority to uphold or set aside decisions of the Ministry. Decisions are made within 10 days after the appeal.

Source: The information above was reproduced from Kingston, Frontenac, Lennox and Addington Dementia Network. (n.d). Driving and dementia: a guide for patients and families. Ontario, Canada: Kingston, Frontenac, Lennox and Addington Dementia Network.

Getting rides from family and friends who are willing to help is a good alternative to driving. There may also be local services and programs who can offer rides by appointment for a low cost. For example, some taxi or car services offer reduced rates for older adults and/or persons with dementia. Taxis or car services can offer flexible service and are cheaper than owning or maintaining a car. For people with mild dementia, public transit (e.g., buses, trains) can be a low cost alternative to taxis or driving.

Your family can help you to meet your needs in other ways including:

• Arranging to have prescription medicines, groceries and meals delivered.
• Request hairdressers make home visits.
• Scheduling people to visit regularly.
• Arranging for friends or family members to take you on errands and to social and religious events

Source: The information above was reproduced and adapted from Hartford Financial Services Group. (2009). At the crossroads: family conversations about Alzheimer's disease, dementia and driving. Hartford, CT: Hartford Financial Services Group. 

Giving up driving can mean a loss of independence for many people and can feel threatening. Many families delay having these conversations because they want to avoid hurt feelings. The following tips can help you address driving and dementia with your loved one.

• If possible, take advantage of the early stages of dementia to discuss transportation options for when the person must limit and eventually stop driving.
• It works well to have several short conversations rather than a long one-time conversation. A good time to have this discussion might be when a person has a change in medication or health status.
• Regular monitoring of driving can help care partners respond appropriately.
• Keep a written record of observed driving behavior over time.
• If safety is an immediate concern, it is best to be direct with your family member.
• Make requests of both family and non-family members for help in meeting the emotional, social and transportation needs of the person with dementia. Doctors, lawyers, financial planners and local support groups can provide information to ensure the person with dementia gets the best support

Source: The information above was reproduced and adapted from Hartford Financial Services Group. (2009). At the crossroads: family conversations about Alzheimer's disease, dementia and driving. Hartford, CT: Hartford Financial Services Group.