When Is a Person With Alzheimer’s Too ‘Far Gone’ to Drive Safely? Can Someone Drive With Mild Cognitive Impairment?
These are very sensitive issues and should be discussed with the afflicted person (if possible) along with the attending physician, family members, legal advisers, and so on. Although this website cannot and does not provide specific advice (whether legal or otherwise), we will lay out – for conversational and informational purposes only – some general, practical guidelines.
The first and most obvious point is that Alzheimer’s varies according to stages. (For a brief introduction, see HERE.) In early stages, Alzheimer’s may not significantly impair a person’s driving ability.[1] As the sufferer declines, regrettably, cognitive and reasoning functions, memory, and physical reflexes will inevitably diminish to the point that safe driving will no longer be possible. The main question is when, precisely, this tipping point occurs.[2]
In order to prepare for the virtually unavoidable conclusion, but before the relevant problems surface, it is wise to consider – and plan for – means of transportation that can serve as driving substitutes. In most cases, and for short trips, these alternatives (depending on the area) will be things such as buses, personal drivers, shuttles, taxis, trains, and the like.
(Although cycling, walking, and other similar activities may be options early on [and for more on their benefits, see HERE], numerous factors – such as physical enfeeblement and inclement weather – might remove them as recourses – whether permanently or temporality.[3])
If possible, you may want to test these (and other) options out, as well as consult with family members and friends who already utilize them, to help determine the one that best meets your loved one’s needs.
How do I keep driving safely? Pre- and Early-Stage Alzheimer’s
While your or your loved one’s ability to drive represents independence, it also may jeopardize his or her safety and that of other drivers on public roads. Therefore, again, these tips should be taken as general rules of thumb, but not as universally applicable – or even universally advisable. Consult pertinent healthcare providers for more insight and for case-specific recommendations. Keep in mind that some areas may have laws that govern some of these issues. It may therefore also be necessary or prudent to seek legal advice from a competent attorney.
That said, it is still true that simple measures may help to extend your or your loved one’s time behind the wheel. There are a few relevant categories. Here are a few things to consider.
Vision Considerations
- Schedule regular eye and vision examinations. This is one of the staples of general, preventative medicine in any case. But it is of vital importance when it comes to keeping a person safely operating a motor vehicle. (Did you know, some eye tests can actually detect Alzheimer’s? See HERE.)
- Update eyeglass or contact-lens prescriptions. This is really an extension of the previous point. Corrective lenses only function correctly if they are suitable.
- Periodically replace windshield wipers and, in general, keep the car’s mirrors, windows and windshield clean. Maintain headlamps in proper working condition and adjust the brightness on the vehicle’s instrument panel for optimal visibility.
Broader Health Considerations
- Schedule periodic wellness checkups. If cognitive-impairment is suspected, ensure that you or your loved one disclose all relevant concerns to a qualified healthcare provider. Tests such as the Mini Mental-State Exam might be usefully employed. (For more on this test and others, see HERE.)
- Your or your loved one’s life – as well as the lives of others – is more valuable than having a few more outings behind a steering wheel. Be sure to honestly bring driving-related questions to your physician.
- In certain cases, and for particular conditions, occupational or physical therapy may assist a driver in maintaining or rehabilitating skills that are essential for safe motor-vehicle operation.
Other Vehicle Considerations
It may be worth replacing a car or truck with a vehicle that is more suitable for your or your loved one’s condition or life station. Although some of the following are, by now, nearly universal, here are some general things that might get you thinking in the relevant direction.
- Automatic transmissions are usually easier to operate than manual transmissions.
- Power brakes and power steering should be available and properly functioning.
- Instrument panels should be easy-to-read and without extraneous or confusing information.
- Doors and seats should facilitate ease of vehicle entry and exit.
Commensensical Driving Dos and Don’t
Avoid distracting your loved one or competing for his or her attention. Don’t let your own mind wander. Minimize noise and reduce disturbances! Here are a few (fairly obvious) tips that might apply to some situations. If there is a common undercurrent, it would be: Exercise an abundance of caution and focus.
- Avoid driving in inclement weather, during high-traffic (“rush-hour”) times, or in the dark.
- Observe all rules of the road, including: checking traffic and signaling properly when changing lanes, looking twice before reversing, maintaining sufficient vehicle distance, and so on.
- Limit or postpone having conversations until out of the vehicle.
- Turn down music, podcasts, radio programs, and so on. In other words, concentrate on the road!
- Set air-conditioner or heater controls before the vehicle is in operation.
- Map routes and plan trips ahead of time and select roads for their drivability and not necessarily for their drive times.
- If you or your loved one drives infrequently, skills may slip. Keep in practice. Depending upon your area, it may also be possible to enroll in continuing-education courses in order maintain (or enhance) skills, in addition to acquiring strategies for coping with dementia or disabilities.
- Finally, as hard as it may be to read, it is a good practice to have competency assessed periodically – both through physicals administered by a healthcare provider as well as via relevant tests (driving, vision, and written).
When to Give up the License/Signs of an Unsafe Driver
You or your loved one may need to have significant restrictions imposed (up to and including license revocation) if certain warning signs surface. Here are things to look for. Your loved one:
- Has difficulty discerning the gas pedal from the brake pedal.
- Sometimes confuses turning right with turning left – or vice versa.
- Declines, forgets, or refuses to use turn signals (or displays other poor decision-making faculties).
- Changes lanes in a dangerous manner, does not yield correctly, or weaves in his or her lane.
- Has obvious trouble recognizing road signs.
- Routinely disregards or otherwise fails to obey traffic signals (e.g., not stopping at red; stopping on green; etc.).
- Cannot hear sirens from emergency vehicles.
- Cannot see or focus on the road.
- Does not seem to notice other cars on the road.
- Believes that most other drivers are going “too fast.”
- Believes that other drivers go “too slow.”
- Has had accidents, actual moving violations, “close calls” or “warnings” more and more frequently.
- Misjudges distances, as evidenced in virtue of erratic turning (turning too widely and veering out of a lane, or too narrowly and running onto the shoulder or a curb) or following other vehicles improperly (giving too much distance, or not enough).
- Has physical difficulties with the mechanics of driving. [4]
- Gets (inappropriately) angry, confused, or frustrated driving.
- Forgets how to navigate to or from familiar places.
- Feels fatigued or overwhelmed after brief periods of driving.
If children, other family members or friends become worried about someone’s driving ability, then this should be taken as an immediate and obvious red flag. Bear in mind that some Alzheimer’s-afflicted persons may be self-aware enough to accurately assess their own driving abilities and to honestly catalog their limitations. Other dementia patients do not display this sort of insight (or honesty) and, therefore, require much closer attention from doctors, family, friends, or other professionals.
Check Yourself!
AAA once published a self-assessment test under the title “Drivers 55 Plus: Self-Rating.”[5] The assessment included questions about whether you or your loved one:
- Habitually signals when changing lanes.
- Properly and regularly wears seat belts.
- Has difficulty navigating through four-way stops or otherwise busy intersections.
- Has trouble merging into congested highway traffic.
- Perceives himself or herself to be “slower” in terms of cognition, perception, reflexes, and the like of that.
- Has difficulty separating him- or herself from emotional states or becomes easily angered by high-traffic situations.
- Cannot stop his or her mind from wandering.
- Sees general practitioners and specialists (like eye doctors) regularly to ensure that overall health, prescriptions, and vision are optimal.[6]
[1] Of course, other conditions – for instance, those that result in blackouts, dizziness, or seizures – might undercut driving abilities. But these, except insofar as they are byproducts of dementia, lie beyond the scope of the present article.
[2] Bear in mind that there may be a transitional period during which the patient alternates between lucidity and confusion.
[3] At a certain point, it is likely that the patient will need full-time care. For a discussion of long-term care – with an emphasis on the attendant costs – see HERE.
[4] For example, maybe grandma has a problem shifting pressure between pedals. Perhaps grandpa’s arthritis prevents him from controlling the steering wheel or changing gears. It might be that dad cannot turn his head to check his blind spots. Maybe mom’s prescriptions are causing her to become sleepy and inopportune times.