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Driving and dementia

For many of us, driving is a lifeline. Not everybody has access to reliable public transport or amenities within walking distance.

Even if you don’t live in a particularly rural location, stopping driving can signify a loss of independence and self-confidence. When previously short journeys to the bank or supermarket must be meticulously planned according to sporadic bus timetables, it can lead to feelings of frustration and isolation.

Does a dementia diagnosis stop you from driving?

But it might surprise you to learn that a dementia diagnosis doesn’t automatically exclude someone from the open road. Providing it is safe and legal to do so, it may be fine to keep driving for a little while.

Although, as dementia is a progressive condition, anyone with the illness will have to eventually stop. Most people with dementia continue to drive for around three years after diagnosis.

By the time most people are diagnosed, they’ve been proficiently controlling vehicles for many decades. Driving to experienced motorists may feel largely like they’re on autopilot. But it’s a highly-skilled, complicated task requiring many different parts of the brain. 

Signs it’s time to stop driving 

In order to drive safely, attention and concentration are paramount. So too are good problem-solving skills to help you navigate obstacles in the road, potential diversions and the decisions of others. Motorists also need excellent judgement and quick decision-making powers.

While dementia can affect all of these skills, the most prominent symptom - memory loss - does not affect these factors too much.

In the early stages of the disease, it may be entirely possible to drive safely. However, symptoms such as hallucinations and delusions (common in Lewy body dementia) may require a person to stop earlier.

Other signs it may be time to hang up the keys include forgetting familiar routes, failing to observe traffic signs, driving at an inappropriate speed or becoming angry and confused on the road.

But driving ability after a life-changing diagnosis must be reviewed by a professional. That’s why it’s so important to let the Driving Vehicles Licensing Agency (DVLA) in the UK - or the Driver and Vehicle Agency, (DVA), in Northern Ireland - know if you’ve been diagnosed. A driver with dementia must also tell their car insurance provider. Otherwise, their policy will be automatically invalid. 

What to tell the DVLA

According to UK law, a driver who is diagnosed with dementia must tell their licensing agency immediately or risk a fine of up to £1,000.

The licensing agency will then send back a questionnaire for the person to fill in and request permission to contact the individual’s GP to obtain medical records. Based on the survey and medical reports, the DVLA will make a decision about whether the person can continue to drive.

There are three options you can expect:

Renew license

The DVLA will renew the license, usually for a year.

Revoke license 

The agency may decide to cancel the driving license if it believes the person must immediately stop driving. 

Request more information

Occasionally the DVLA will decide it doesn’t have all the evidence it needs to make an informed decision. The agency may require the individual to complete an on-road driving test first.

Continuing to drive safely 

Clearly, there are plenty of unsafe drivers on the road who do not have dementia. But if your loved one continues to drive after the diagnosis, and their license gets renewed, it’s important to be aware of the risks to themselves and others.

People with dementia are more likely to get lost, go too slow or forget to wear a seat belt. And studies point to an increased risk of multiple crashes in the early stage of the disease.

Even if the doctor or DVLA considers the individual safe to drive at the moment, the condition needs to be regularly reviewed.

It’s worth close relatives monitoring the person’s driving skills - as tactfully as possible - over the coming months. Regularly talk to them about their driving and how confident they feel about it. Remind them that short, regular trips can help them maintain their skills and are less likely to overwhelm them. And encourage them to drive in daylight, when possible, at quiet times of the day. Reassure them that if they no longer want to drive, you’ll support them and help them get around. 

What if they’re told to stop but won’t?

If a doctor advises someone with dementia to stop driving, they must do so immediately. But telling someone they need to stop driving can be a huge confidence blow.

Obviously there’s a huge difference between making the decision to stop and being told to give up your license. The symptoms of dementia can make it even harder for the person to recognise when this point has arrived.

As a carer, you need to pick a suitable time for this conversation and approach it sensitively. Be prepared for a negative reaction and the likelihood of this taking more than one talk to be resolved.

Remember, if your loved one disagrees, they’re not being deliberately difficult. In some cases, the person may be in denial of their condition, or forget that they’ve been told they must stop driving. They may feel humiliated, particularly if it’s someone much younger (with fewer years behind the wheel) who is telling them they’re unsafe.

If they refuse to engage with you on the subject, it’s vital to be empathetic. Acknowledge how tough it must be for the person grappling with a loss of autonomy.

Make sure your loved one has convenient alternatives to driving and highlight the potential benefits of these. For instance, public transport can lead to meeting new people and reduce feelings of loneliness. And it’s never been easier to sort out many daily chores, such as bills and groceries, online these days. Help your relative set up these accounts, so future trips into town can be fun excursions rather than for running essential errands.

Remember, you don’t have to deal with this situation on your own. If you’re constantly having to hide the car keys, you or your loved one’s doctor can write in confidence to the licensing agency, who can get the police involved. Charities such as the Alzheimer’s Society can also provide tailored advice on their helplines.

With support, understanding and a large dose of patience, someone with dementia can successfully adapt to not driving and find fulfilment and empowerment in the alternatives available to them.