Dementia and Driving – The Difficult Conversation

I have been working in aged care for nearly 20 years and this conversation never gets any easier.  How do you raise concerns about someones driving and indeed their memory impairment without getting into an argument or offending them?  That’s a million dollar question!

If you are worried about someone’s driving, start talking about it gently and with empathy.  It is a conversation that requires tact, empathy and may need to be repeated several times.  The loss of freedom and the impact on the person self esteem can be  hard to cope wi Discussing concerns with a family member could also help.

What is Dementia?

Dementia is a set of symptoms which affects thinking, behaviour and the ability to perform everyday tasks.  It is a result of physical changes in the structure of the brain and is progressive, meaning that symptoms will gradually worsen over time.

Warning signs

A person with early signs of dementia may show the following decline in driving skills:

  • driving too slowly (this doesn’t mean that all slow drivers have dementia).
  • confusion when stopping and changing lanes.
  • Losing the car in a car park or forgetting where the car is parked.
  • becoming lost on a route which would not previously have confused them.
  • ignoring traffic lights and signs – confusing the colour or order of the lights or failing to notice traffic lights, Stop signs or Give Way signs
  • not being able to make sound judgements about what’s happening on the road.

You should also note the condition of their vehicle – having small scrapes may indicate unsafe driving, eg the car hitting the side of a garage or gateway, and the driver misjudging widths and distances in driveways.

Alcohol and some medication will alter the driving ability and reaction time of a person with dementia. This combination is dangerous. You may need to take action by referring them to their health practitioner or advising the NZ Transport Agency that you have concerns about their driving. It’s important to remember that many driving skills are automatic. A confused person may appear to be driving well when they’re really relying on habitual responses.

Discuss your concerns about their driving

If you know someone has dementia, but continues to drive, it can be really hard to discuss your concerns about their driving with them. Driving is a sign of our independence and people can be very defensive when you bring up the topic – understandably so.  Some people fail to see the danger in their driving,  possibly because they can’t understand fully that they have had a loss of skills. The problem must not be ignored, even if they’re only travelling to the shops and back.

They may be reluctant to stop driving, possibly because they can’t understand fully that they have had a loss of skills. The problem must not be ignored, even if they’re only travelling to the shops and back. You may need to talk to the persons family as well.

From my experience, it’s important to raise the issue early and gently as a conversation rather than a lecture! Talking about their driving while they’re still able to make decisions about their driving future, such as selling the car or not applying for a renewal of their licence. Sometimes people with dementia will recognise their own limits and accept that they’re putting themselves and others at risk. Give the person a chance to make the decision to stop driving.

It’s often useful to involve the person’s health practitioner, who can assess their fitness to drive and, if necessary, take appropriate action if they don’t agree to stop driving. The health practitioner could be their usual doctor (GP), a registered nurse or nurse practitioner, occupational therapist or a specialist if appropriate. Health practitioners also have a legal obligation to advise the Transport Agency if they believe that a person unfit to drive is likely to carry on driving.

Talk about it

  • Be kind – start gently talking about driving in general and mention the scrapes on the car etc
  • Don’t be bossy – the ‘you are a terrible driver and need to give it up’ talk rarely ends well.
  • Be sensitive to the loss of independence that comes from giving up driving.
  • How will the person stay socially active? Does your local Age Concern have transport to their events etc?
  • Think about other options – public transport, mobility scooter, total mobility vouchers.

It’s a really difficult and emotive conversation to have but it is a very important one.  Be gentle, be kind and keep talking.

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