Alzheimer’s caregiving: When is driving no longer safe?

Alzheimer's disease has a profound emotional impact. One of the first questions many families ask is whether someone with Alzheimer's disease should stop driving immediately.

Safe driving requires a complex interaction of eyes, brain, and muscles, as well as the ability to respond quickly to unexpected circumstances. The complicated stops, starts, and zigzags of city traffic can cause someone with Alzheimer's to panic or freeze with indecision. A University of California study found that the driving skills of people with mild Alzheimer's were significantly poorer than those of other elderly people, including those with some other forms of dementia. When a person with Alzheimer's is only mildly impaired, the answer may not be simple.

Some advocates believe that driving privileges should not be taken away until a person clearly becomes an unsafe driver. But how do you know if it's no longer safe for a person to be driving before an accident occurs?

A person's general behavior in non-driving situations can give his or her family some clues as to whether or not safety behind the wheel is likely to be an issue. People who exhibit poor judgment, inattentiveness to what's going on around them, clumsiness, and slow or inappropriate reactions certainly should not drive. When it is time for a person to stop driving, how do you go about taking away the keys?

Try a tactful approach that preserves the person's self-esteem. Some folks agree to stop driving for reasons other than concern about their competency — for instance, the car needs repair or the license or registration has expired. Another option is a road test with a driver's rehabilitation specialist, who can offer an independent assessment of safety. Getting objective feedback from an impartial person can help.

People with Alzheimer's disease sometimes can accept a written prescription from a doctor that says, "Do not drive." In some states, physicians are required to report unsafe drivers and drivers with certain medical problems to the Department of Motor Vehicles.

If safety behind the wheel is a concern, and you've been unsuccessful in getting your loved one off the road, you can seek advice from a lawyer or an official with the Department of Public Safety in your state. Procedures vary, but generally, a driver's license can be suspended on the basis of a physician's written statement. If nothing else works, you can sell the car.

To learn more about preventing, treating, and living with Alzheimer's, buy A Guide to Alzheimer's Disease, a Special Health Report from Harvard Medical School.