Dementia - driving and traveling

A diagnosis of dementia does not always mean that the person must stop driving immediately. However, dementia causes a progressive and irreversible loss of mental functioning, so at some stage the person will need to stop. Dementia can cause loss of memory, limited concentration and reduced insight, all of which affect a person’s judgement and ability to drive safely.

Once driving ability is affected, the person with dementia becomes a risk to themselves and to others.

Telling the licensing authority#

All drivers have an obligation to tell their driver licensing authority of any medical condition that might affect their ability to drive safely. Diabetes, some heart conditions and dementia all need to be disclosed because of their potential effect on driving.

The licensing authority will generally advise the driver to see a doctor, who makes an initial assessment of medical fitness to drive. After this, a formal on-road assessment with a trained driver assessor, such as an occupational therapist, may be required.

Based on any on-road test, medical advice and other information, the licensing authority decides whether the person can keep their licence. Sometimes a driver can continue to drive with conditions on their licence, such as only driving close to home, at certain times, or within certain speed limits. Conditions can only be applied if the driver is likely to remember them. Regular medical and driving reviews will be needed, as a person’s ability will decline over time.

While many factors contribute to safety on the road, driver health is an important consideration, and drivers must meet certain medical standards so that their health does not increase the likelihood of a crash.

Signs that dementia is affecting driving#

Changes in driving behaviour may have been happening for some time without being noticed. To judge whether a person can still drive safely, consider their:

• vision - can they see things coming towards them or from the sides, and do they respond to stop and traffic signs and signals?
• hearing - can they hear approaching cars, horns and sirens, and do they pay attention to them?
• reaction time - can they turn, stop or speed up quickly?
• alertness - are they aware of and do they understand what is happening around them?
• left and right - can they tell the difference?
• memory and confusion - do they become lost or confused on familiar routes?
• stop and go - do they understand the difference between red and green traffic lights?
• route finding - can they read a road map and follow detours?
• steering - can they stay in the correct lane and change lanes or merge when needed?
• problem solving - do they become upset and confused when more than one thing happens at once?
• coordination - have they become clumsy or started to walk differently?
• mood - has their mood changed when driving? Some previously calm drivers may become aggressive or angry.

If you have concerns about a person’s ability to drive, try speaking with them or their doctor. You can also contact the driver licensing authority in your area to discuss your concerns. The authority may then contact the driver to advise that a medical and driving assessment is needed.

Talking about giving up driving#

The aim of caring for someone with dementia is to support the greatest possible independence. Not being able to drive can be a real threat to a person’s independence, especially for those living alone or in remote areas.

For someone in the early stages of dementia, deciding to give up driving can be very challenging. Some people recognise their declining ability, while others may not, or may simply forget that they are no longer safe to drive. For some, it is a relief to be rid of the responsibility.

Very few people want to stop driving voluntarily, and this is also true for most people with dementia. Some suggestions for when and how to raise concerns:

• Discuss the person’s driving when everyone is calm, ideally after a change in medication or health status rather than straight after a driving incident.
• Have short, frequent conversations rather than one long discussion.
• Concentrate on the person’s strengths and the positive aspects of other options, and acknowledge that giving up driving is hard.
• Normalise the situation by pointing out that everyone has to stop driving at some point.
• Focus on the nature of the disease; a safe past driving record has no bearing on safety as a driver with dementia in future.
• Point out the financial benefits of selling the car.
• Be respectful and try to understand how the person feels.
• Offer to drive them to appointments, social gatherings, shops and services.
• If all else fails, you may need to hide the keys or remove or immobilise the car.

Dealing with driving issues can be difficult for people with dementia and their families and carers. Dementia support services and helplines can offer advice if you would like to talk through your particular situation.

Traveling with a person with dementia#

Many families and carers have happy, fulfilling trips with a person with dementia, but travel can also present hazards and challenges. It is usually better to travel in the early stages of the illness, as later on the person may become disoriented, agitated or distressed as a passenger.

People with dementia generally do best in well-ordered, familiar and stable settings, but travel can still succeed with thoughtful planning.

When travel may not be appropriate#

Some signs suggest that travel as a passenger in any vehicle, train or plane is not a good idea, including:

• refusing to wear a seatbelt
• consistent disorientation or agitation in familiar settings
• wanting to go home even during short visits away
• delusional, paranoid, aggressive or disinhibited behaviour
• problems managing continence
• teary, anxious or withdrawn behaviour in crowded, noisy settings
• agitated or wandering behaviour
• disregard for safe behaviour near roads, traffic or other pedestrians

If any of these signs are present, travel may not be advisable. If travel is unavoidable, it is worth consulting a specialist about whether medication may help settle the person, and being a familiar, reassuring companion is the first consideration. If none of these signs are present, it can still help to do a ’trial run’ with a short trip using the type of transport planned for the longer journey, which helps establish the person’s travel capacity.

Tips for smoother travel#

• Be prepared to take full responsibility for the person, which can be taxing, so get plenty of rest beforehand.
• Keep hold of all important possessions, such as passports, money and schedules.
• Encourage the person to wear an identification bracelet at all times.
• Keep their name, home address and phone number, and the name, address and phone number of your away-from-home address, in their wallet or purse, and mark all clothing with their name.
• Take a list of important contacts, such as doctors and family.
• Take enough medication for the whole trip, plus prescriptions and a list of recent and current medications, which helps if the person becomes unwell.
• If traveling by plane, consider telling the airline you are travelling with a person with dementia and ask staff for assistance.
• Provide a safe away-from-home environment, for example by locking the door and leaving the bathroom light on overnight.

Traveling by car#

When traveling by car, consider:

• The person’s state of mind. Do not drive alone with a person who is agitated, as your safety, theirs, and that of other road users may be at risk.
• Whether the person is comfortable in the seat, especially on long distances.
• Whether the person needs help fastening and unfastening their seatbelt.
• The person’s safety when getting out of the car, especially when parking near traffic.

Key points#

• Dementia can cause loss of memory, limited concentration and reduced insight.
• When their driving ability is affected, the person with dementia becomes a risk to themselves and to others.
• Regular medical and driving reviews are needed, as a person’s ability will decline over time.
• While many factors contribute to safety on the road, driver health is an important consideration.
• If all else fails, you may need to hide the keys or remove or immobilise the car.

Where to get help#