What course of action is open to the caregiver of a person with Alzheimer's disease when faced with clear evidence that driving should stop? How can the caregiver avoid confrontation when suggesting that a driver's license should be surrendered? How does the caregiver balance the dignity of the person with AD with the safety of others? How can a health care professional help?
Some drivers with dementia will begin limiting their driving, realizing that they are having problems. But others may not recognize patterns of dangerous driving, or are unable to assess their own skills. They tend to overestimate their driving abilities, and often deny having trouble. Denial can often be attributed to fear of loss of independence, freedom, and control: life without a car is unacceptable.
When trying to determine if driving has become dangerous, a caregiver can ask this question of himself or herself: would I permit my grandchild or any child to ride with this driver? Other family members should be consulted for additional opinions. However, adult children should be alert to the possibility that a caregiver may try to protect their loved one by withholding information about driving problems.
Taking away the car keys is one of the most difficult decisions facing caregivers of people with Alzheimer's. Planning and honest communication are key. Involve the driver and other family members in discussions. To prepare for this discussion, imagine what it would be like if you had to stop driving. An open discussion with all family members presents an opportunity for all to voice opinions and concerns. Caregivers must also be careful to guard against two extremes: over-reacting to a minor incident and ignoring alarming trends.
Before confronting a person with dementia with accusations of dangerous driving, it's helpful for caregivers to document incidents, to present a record of observations of driving behavior. The record should note time, date, place, and a brief description of the occurrence. Of course, a serious crash, traffic tickets for moving violations, scrapes and dents, and other physical evidence of accidents are indicators that driving needs to cease immediately.
A plan to gradually limit driving is preferable to a sudden halt. As part of the plan, caregivers can use a document such as one developed by The Hartford Insurance Company, called "The Agreement with My Family about Driving." This document involves the person with mild dementia while that person is still capable of sound reasoning and designates a person to be responsible for taking steps to curtail or stop driving when safety becomes an issue. Adopting a plan allows caregivers to have a course of action mapped out before a crisis occurs. Of course, not everyone with dementia will either agree to this plan or adhere to it. The Hartford also provides a "Warning Signs for Drivers with Dementia" worksheet to help document driving incidents.
When caregivers encounter opposition to pleas to stop driving, they can turn to professionals for help. Physicians, attorneys, care managers, financial planners, support groups, and the department of motor vehicles offer objective, third-party opportunities for guidance. A call to the State motor vehicle department to arrange for a driver's test is usually confidential. Attorneys and other planners can help by offering an objective assessment of driving skill, allowing the caregiver to defer to an expert's opinion.
The perceived loss of freedom from loss of a license can cause depressed mood and social withdrawal. To divert attention away from the loss of driving privileges, caregivers should focus instead on other activities the person may still be able to enjoy. If the car is used to maintain social contact, then a plan to stop driving must address how to continue those contacts. Trips to see friends or to visit the library, barbershop, hairdresser, or grocery store can continue by seeking alternate forms of transportation, so that the person with AD doesn't feel abandoned, isolated, or restricted. These include:
Another alternative is for caregivers to arrange to have prescription medications, groceries, and meals delivered, and to have hairdressers make home visits. Senior and special needs transportation services can be found in the local phone book, or by contacting the local Agency on Aging. Religious and community groups also may be good sources of help.
Most experts agree that "copiloting," in which the caregiver rides with the person with dementia, is not a safe option. The passenger cannot foresee dangerous situations in time to give instructions, and the demented driver cannot always follow directions.
The best course of action for caregivers is to use common sense, communicate openly and frequently, and seek help from professionals. Poor driving by a person with dementia is unlikely to improve. When all else fails, and the person with dementia insists on driving even if he or she poses a hazard, caregivers can:
In the future, with further research, it may be possible to find technological solutions that could allow drivers with dementia to reduce their risk of crashes. Research may yet yield more reliable predictors of crash risk for drivers with dementia and help create retraining programs to allow continued safe driving for some period of time.
Alzheimer's Association. (2001) Fact Sheet: Driving. Alzheimer's Association, 919 North Michigan Avenue, Suite 1100, Chicago, IL 60611-1676, 1-800-272-3900. Internet: www.alz.org. 
Family Caregiver Alliance. (2001). Fact Sheet: Driving and Dementia. Family Caregiver Alliance, 690 Market Street, Suite 600, San Francisco, CA 94104, 415-434 3388. Internet: http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=432 .
Maryland Motor Vehicle Administration. (1999). Is it Time to Stop Driving? A Sensitive Guide for Caregivers of People with Alzheimer's and Related Disorders. Publication DC-169. Available from the Motor Vehicle Administration, 6601 Ritchie Highway, NE, Room 200, Glen Burnie, MD 21062, 1-800-638-8347 in Maryland, or 301-729-4550. Internet: www.mva.state.md.us .
National Institute on Aging. (2002). AGE PAGE: Older Drivers. Available from the National Institute on Aging, PO Box 8057, Gaithersburg, Maryland, 20898-8057, 1-800-222-2225. Internet: www.nia.nih.gov//health/publication/older-drivers .
The Hartford Financial Services Group, Inc. (2000). At The Crossroads: Alzheimer's Disease, Dementia & Driving. Available from The Hartford, 200 Executive Boulevard, Southington, Connecticut 06489 (Request "At The Crossroads" and specify English or Spanish). Internet: www.thehartford.com/alzheimers/ .