Q+A – Dr. David Hogan

Dr. David Hogan, a specialist in geriatric medicine at the University of Calgary, shares his insights on dementia and driving

For someone who has been diagnosed with dementia, the topic of when to stop driving is a sensitive one. Losing that freedom and independence can often feel devastating for those who are told they are no longer safe behind the wheel.

A dementia diagnosis does not necessarily come with an immediate recommendation to cease driving, but it usually means that, at some point, the person will have to retire from driving. There are signs that we can look for to help tell when it’s time to get off the road.

Q  |  When should someone diagnosed with dementia stop driving? 

A | People with mild dementia can still be safe driving. They should be evaluated on a person-by-person basis. The fairest way to assess driving skills is by a comprehensive on- and off-road evaluation. Typically, a physician or occupational therapist would do the off-road assessment. They would examine the person’s cognitive abilities and aspects of their health that would be important to driving, like vision, grip and leg strength, coordination, and neck movement. On-road testing would preferably happen in a driving centre approved by the provincial ministry of transportation, where they would undergo a road test to show they are as safe as anyone else would be driving. They should be then be re-evaluated every six to 12 months so you can detect any changes that could impair driving ability.

Q  |  What about drivers who are further along in their dementia journey?

A | For people who have a progressive dementia, for example Alzheimer’s disease, they and their families should know giving up driving will be an inevitable consequence of their disease. At the stage of moderate dementia, when you are unable to perform two or more everyday activities, like dealing with medication or grocery shopping, you should not be driving.

Q  |  In what ways can having dementia affect someone’s driving skills? 

A | Dementia can impact the thinking skills necessary to safely operate a motor vehicle. People with dementia may show poor judgment or get lost in familiar areas, be inattentive while driving, not observe the rules of the road and ignore traffic signs. Other medical conditions they may have and the medications being taken can also affect safety while driving, for example if they have seizures and are not taking the medications prescribed to prevent them.

Q  |  What are the signs that it’s time for someone with dementia to stop driving?

A | Having close calls, reacting slowly to dangerous situations, veering across the median strip. Multiple fender benders with minor dents may indicate trouble judging distances. If driving makes them anxious, if they start to drive less, or avoid driving at all, that could be a marker that they’re having trouble driving. A useful question to ask a family member is whether they would be comfortable being driven somewhere by the person with dementia.

Q  |  How can families broach the topic of giving up driving with their loved ones?

A | Begin talking about it sooner, rather than springing it on them two or three years down the road after a diagnosis. If they continue driving, it’s helpful to talk with them about what would be the stage when they feel it would be time to retire from driving, and to identify who they will talk to for advice, like someone in the family who they trust is looking out for their best interests. It is best, but not always possible, for driving to be given up voluntarily, rather than be forced on the person.

Q  |  What are some tips for helping someone cope with the reduced freedom that comes from no longer driving?

A | Make a transportation plan with the person with dementia that identifies how the individual’s needs can be met once they don’t drive. This means sitting down with them to determine where they drive and why, then researching the available travel options. This would include using family and friends, volunteer programs, taxis and door-to-door services. Generally, public transit is not recommended for people with dementia. In a city like Calgary, you can get pretty isolated if you don’t drive. Think about how you can deal with their need to get around so they don’t feel removed from their community. [ ] 

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