Driving and dementia? How to help your loved one cope.

Driving and people with Dementia

Someone who is diagnosed with dementia may be able to continue driving for some time. However, they must fulfill certain legal requirements. As the person's dementia progresses, they will reach a point where they can no longer drive safely and must stop driving. Many people find this very difficult to accept. This factsheet explains the legal situation, and gives some tips on stopping driving.

Can a person with dementia still drive?

-A diagnosis of dementia is not in itself necessarily a reason to stop driving. What matters, from both legal and practical points of view, is whether or not the individual is still able to drive safely. However, they must fulfil certain legal requirements, including telling the Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales, or Driver and Vehicle Licensing Northern Ireland (DVLNI) in Northern Ireland, of their diagnosis. See 'Continuing to drive'.

-For experienced motorists, driving may seem to be a largely automatic activity. In fact, driving is a complicated task that requires a split-second combination of complex thought processes and manual skills. To drive, a person needs to be able to:

-Make sense of and respond to everything they see - including road signs and obstacles

maintain attention while 'reading the road'

anticipate and react quickly to the actions of other road users

take appropriate action (eg braking, steering) to avoid accidents

-Plan and remember where they are going.

Many people with dementia retain learned skills and are able to drive safely for some time after diagnosis. However, as dementia progresses beyond the early stages it has serious effects on memory, reactions, and the ability to perform even simple tasks. People with dementia will, therefore, eventually lose the ability to drive. The stage at which this happens will be different for each person but, according to research, most people stop driving within three years after the first signs of the disease.

People taking certain types of medication, such as night sedation or drugs for depression may also find that their driving ability is affected. If this is a problem for you or someone you know, speak to the General Practitioner or consultant about your concerns.

What if someone is unsure of their ability to drive?

If someone with a diagnosis of dementia is unsure of their ability to continue driving, they can take a driving assessment. To do this, they need to apply directly to one of the 17 independent approved mobility centers, and pay a fee - currently between about £50 and £130. For details of mobility centers that offer such an assessment, see 'Useful organizations' at the end of this factsheet. Note that many of the 17 main centers have additional 'satellite' centers to increase their coverage.

A driving assessment is not like a driving test. It is an overall assessment of the impact that the dementia is having on a person's driving performance and safety, and it makes some allowances for the bad habits that many drivers get into. It includes an interview with an occupational therapist and tests of reaction time and vision. A key part of the assessment is an on-road session with an advanced driving instructor in a dual-braking car (where there is a brake on the passenger's side as well as on the driver's side).

People with dementia often underestimate the impact of the condition on their driving skills. An independent assessment can provide an unbiased view. Where appropriate, mobility center staff will suggest strategies and adaptations to help the person to continue driving with greater safety and confidence.

Giving up driving

Many people with dementia choose to stop driving because they begin to find it stressful or they lose confidence. A person should consider stopping if, when driving, they:

feel less confident or more irritated

-Get lost even on roads they know well

-Begin to misjudge speed or distance

-Find themselves straying across lanes or hitting curbs

-Get confused if there are roadworks, for example, on a familiar route

-Feel at greater risk of having an accident

-Cause passengers to have concerns about their driving.

A person who feels as though they should stop driving will need support and understanding from their carer and family members. They may feel unhappy about stopping driving if they are accustomed to being independent, or if they have always driven their partner or family around. Stopping driving may make it harder to visit friends or family, go on a day out, or to the supermarket, place of worship or to visit the doctors.

All decisions about driving should consider these benefits of independence and mobility against issues of safety for the driver, passengers and wider public. It is better to travel safely on public transport than risk an accident in a car. For drivers with low annual mileage, public transport or even taxis are often cheaper than running a car.

If the person with dementia decides to stop driving, they should return their license. People living in England, Scotland and Wales should return their license to the DVLA. In Northern Ireland it should be returned to DVLNI - see 'Useful organizations' at the end of this factsheet.

Continuing to drive

If someone is diagnosed with dementia and wants to continue to drive, they must, by law, inform DVLA or DVLNI straightaway. Notification of the diagnosis should be sent with the person's full name, address, date of birth and the driver number on the driving license, if known, to the Drivers Medical Group (part of DVLA, see 'Useful organizations') or DVLNI.

In some cases the person's doctor will advise, as a precaution, that they stop driving immediately, at least until further assessments are carried out and reviewed (which can take several weeks). This medical advice should be followed.

DVLA/DVLNI will send the person a questionnaire that seeks their permission to obtain medical reports from the person's GP and/or specialists. This questionnaire can also be downloaded directly from the internet (see 'Useful organizations'). Once the person returns this questionnaire, DVLA/DVLNI will contact their consultant (or, if no consultant details are provided, their GP). Based on the medical information received, medical advisers at DVLA/DVLNI will make a decision as to whether the person can continue to drive.

DVLA/DVLNI may also ask the person to take a driving assessment of the kind described above, and will pay for it. If there is no driving assessment slot available at one of the mobility centers (see 'Forum of mobility centers’ at the end of this factsheet'), DVLA may ask the person to take a Driving Standards Agency (DSA) driving appraisal instead. This is similar, but taken in the person's own car. DVLA will pay for the DSA appraisal.

A person with a diagnosis of dementia would be breaking the law if they did not tell DVLA/DVLNI about their diagnosis, and could be fined up to £1,000. If a person with dementia does not inform DVLA/DVLNI about their diagnosis and continues to drive against advice from their doctor, the doctor may - after giving the person every encouragement to comply with the law - inform DVLA/DVLNI without the person's consent if they feel that the person is not safe to drive. Other people, such as family members, neighbors or police officers, may also contact DVLA/DVLNI in writing and ask for a medical investigation if they are concerned about a person's ability to drive.

A person with a diagnosis of dementia should also immediately inform their car insurance company. If they do not, their policy may become invalid. It is a criminal offence to drive without at least third party cover.

Driving and mild cognitive impairment

In May 2012, DVLA published guidance about drivers who are diagnosed with mild cognitive impairment (MCI - see factsheet 470, Mild cognitive impairment). So far, this guidance applies only to DVLA, not DVLNI. People with MCI have subtle problems with short-term memory, planning and attention. They do not have dementia, although some will develop dementia over time. MCI may affect a person's ability to drive. A driver diagnosed with MCI needs to notify DVLA only if their condition affects their ability to drive. The person's doctor or family members are good judges of this: if either is concerned, then DVLA needs to be told. As with dementia, if notified, DVLA will take up medical reports and make a decision as to someone's fitness to drive.

When DVLA/DVLNI decides that the person can continue driving

If, following its enquiries, DVLA/DVLNI decides that the person can continue to drive; they will issue a new driving license that will be valid for a limited period. For a person with dementia, the license duration is usually one year, although for very early dementia it may be longer, up to a maximum of three years. The person's condition will be reviewed at least once a year. It is also a good idea for relatives or others close to the person with dementia, to monitor the person's driving skills tactfully on a regular basis.

Reducing the risks

Someone with dementia can take steps to minimize their risk of having an accident when driving. Driving regularly helps to maintain skills and confidence. Short drives on familiar roads at quiet times of the day generally present fewer problems than long, unfamiliar trips or journeys in heavy traffic. Daylight and good road conditions will make driving easier, and some drivers get their passenger to navigate for them.

When DVLA/DVLNI decides that the person must stop driving

If, following its enquiries, DVLA/DVLNI decides that the person cannot continue driving; the person must return their driving license to DVLA/DVLNI and stop driving. However, there is an appeal process. A formal appeal must be lodged with the Magistrates' Court within six months in England and Wales. In Northern Ireland an appeal must be lodged with the appropriate Clerk of Petty Sessions within three months. Someone who has appealed against removal of their license is not allowed to drive in the meantime.

Tips: encouraging someone to stop driving

Giving up driving is not always an easy decision to make. Someone with dementia may be very reluctant to stop driving even if DVLA/DVLNI has concluded that they are not safe to drive. If you are a career, family member or friend, you may need to give some encouragement.

1. Acknowledge how difficult it may be for the person. They may have relied on driving as their main means of transport for much of their life, and may feel unhappy about losing some of their independence or self-esteem. Giving up driving will seem especially hard if physical problems make it difficult to use public transport, or if cuts in local public transport make it difficult to get about without a car.

2. Encourage them to take charge of their new transport arrangements - perhaps by getting details and timetables of local transport services, or opening and managing their own taxi account. (Many mobility centers offer an 'aftercare' service of practical local advice for people who have stopped driving.)

3. Point out some alternatives to driving. For example:

-The person could get a taxi to take them to the supermarket once a month. They could set up an account with a taxi firm they trust and like, and order taxis in advance.

-They could get a shoppers' bus to the supermarket and back.

-If possible, they could order shopping online and have it delivered to the house, or you could help them to do so.

-The person could ask the hospital about a driver to take them to medical appointments.

-They could pay their bills by direct debit so that they don't need to visit the bank or post office so often.

4.Point out some of the benefits to not driving. For example:

-The person will no longer have to look for parking spaces or pay for parking permits.

-They will no longer have to pay for petrol and car insurance, freeing up a significant amount of money each month.

-They won't have the stress of driving in busy traffic.

-Public transport can be sociable. They may like to chat to people on the bus.

-They may get more exercise if they decide to walk instead.

If the person refuses to stop driving

Some people who have been assessed by DVLA/DVLNI as being unsafe still refuse to stop driving, even if their GP and those around them have tried to encourage them to stop, and have pointed out alternatives. This can be a very difficult and upsetting situation.

It is important to realize that the person is probably not being difficult on purpose. Instead, the dementia itself may mean that the person lacks insight into how much their condition affects their driving. In some cases the person may be in denial about their diagnosis, or may not remember that their license has been cancelled.

**Taken directly from alzheimers.net