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Dementia and Driving Don’t Mix

dementia-and-drivingIt’s not just about forgetting how to get to where they are going.  Older adults – even in the early stages of dementia – are simply at a much higher risk of accidents while driving.  While adults over the age of 85 make up only about 9 percent of the population, they are involved in 13 percent of the fatal crashes and 17 percent of the pedestrian accidents resulting in death.  Overall, the fatality rate of 85+ year old drivers is 17 times that of drivers 25 to 65 years of age according to the National Highway Traffic and Safety Administration.  Is dementia a part of that?  Yes, but only a part.

Aging is a process that not so subtly erodes an adult’s visual capacity for judging distance, recovering from glare and distinguishing objects in dark or semi-dark conditions.  Add to that the physical limitations that osteoarthritis can impose along with slower muscle reaction time and yes, memory deficits, and 85 plus year olds have the highest per-mile accident rates of any cohort beyond the teens.

If you are a caregiver to someone within this older cohort – 85+ – this is not a mandate to talk about the car keys just yet, but it is important to be alert to what may be unfolding.  Medical surveys of outpatients suggest that as many as 30% of older adults who have dementia may still be behind the wheel.  What to look for?  Dementia does not simply mean that an older driver gets confused in the parking lot at the mall or gets lost on the way home.  Dementia in the driver’s seat translates into unexplained dents or scratches on the car.  If you have occasion to drive with the older adult watch for difficulty in lane changes or lane wandering, challenges on turning or difficulty judging distances.  Accidents typically are the result of a growing series of mistakes and near misses on the road.

Early stage dementia patients may actually be safe drivers, but you should talk to your older loved one’s primary care physician.  They will not be able to speak to you about your loved one’s medical condition without sign-off from the patient, so that is a starting point.  And appreciate that not all physicians are well-schooled in diagnosing dementia, let alone treating it.  If you are concerned about dementia as it may be affecting your loved one’s driving, start by asking the physician about your loved one’s ability to pass a mini-mental exam or other cognitive tests such as the Clock Drawing Test that help assess executive function.  If the physician is not able to help, ask about possible referrals.

You may find that there are hospital providers who have actual testing programs or driving schools to help assess your loved one’s safety behind the wheel.  If the decision is made that your loved one is not safe driving, begin immediately to explore your transportation options.  Some older adults will be relieved that the stress of uncertain navigation is no longer a challenge, but others may view it as a significant loss of independence.  Be prepared to be an empathetic listener.  Steer clear of sentences that start with “at least” such as “at least you did not have an accident…”  Picture what you might feel in a similar circumstance and go from there.  Don’t try to gloss over the genuine loss your loved one will feel.

What are the public transportation options?  That may depend on how advanced the dementia is, because navigating train or bus routes can be as challenging as driving.  Paratransit and chauffeur services may be an option if they are affordable, but be careful on vetting the services.  Check with your local ombudsperson on aging for a secure option.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  Please email your questions to


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