Dementia and driving

The information in this factsheet is current from 4 December 2006.

Dementia is the progressive impairment of brain function. It usually first appears as forgetfulness, then decreased problem-solving and language skills.

Difficulty with ordinary daily activities often follows, then severe memory loss and disorientation.

Alzheimer's disease

The most common form of dementia is Alzheimer's disease. Alzheimer's is a disorder affecting the function of the brain. A person can appear fully alert and awake, but their memory and judgement are impaired.

With Alzheimer's, recent memory goes first. People tend to forget events rather than details. (Rather than 'Who did I sit next to at the wedding?', a person with Alzheimer's will ask 'What wedding?')

No single feature distinguishes Alzheimer's disease – the total picture determines whether or not a person has Alzheimer's.

What should I do if someone close to me may have dementia?

If someone you know may or does have dementia, but continues to drive, discuss your concerns about their driving with them.

It's important to raise the issue early, while they're still able to make decisions about their driving future, such as selling their vehicle. Sometimes people with dementia will recognise their own limits and accept that they're putting themselves and others at risk. Give the person a chance to make the decision to stop driving.

They may be reluctant to stop driving, possibly because they can't understand fully that they have had a loss of skill. The problem must not be ignored, even if they're only travelling to the shops and back. You may need to get the person's family to help ensure they don't drive.

It's often useful to involve the person's medical practitioner, who can assess their fitness to drive and, if necessary, take appropriate action if they don't agree to stop driving.

Skills a driver must have to drive safely

These are the skills a driver must have to drive safely:

good vision in front and out of the corners of their eyes
quick reactions – being able to brake or turn to avoid crashes
good coordination between their eyes, hands and legs
the ability to make decisions quickly
the ability to make judgements about what's happening on the road.

Warning signs

A person with the early signs of dementia may begin to drive in some of the ways described below:

driving too slowly (this doesn't mean that all slow drivers have dementia)
confusion when stopping and changing lanes
becoming lost on a route that would not previously have confused them
ignoring traffic lights and signs – confusing the colour or order of the lights or failing to notice traffic lights, Stop signs or Give Way signs
not being able to make sound judgements about what's happening on the road.

You should also note the condition of their vehicle – having small scrapes may indicate unsafe driving (eg the car may have hit the side of a garage or gateway, and the driver may be misjudging widths and distances in driveways).

Alcohol and some medication will alter the driving ability and reaction time of a person with dementia. This combination is dangerous. You may need to take action by referring them to their doctor or advising the NZ Transport Agency (NZTA) that you have concerns about their driving.

It's important to remember that many driving skills are automatic. A confused person may appear to be driving well when they're really relying on habitual responses.

What can I do?

You must get help. First speak to the person's doctor and enlist their help (they may be able to arrange a driving assessment). A member of the Police traffic unit may agree to speak to the person too.

Get together with other family members and discuss your concerns. Involve other people, if necessary, for example, a social worker or person from Alzheimers New Zealand.

Insurance cover

Insurance companies require that any condition likely to affect a driver's ability must be disclosed, or the company has the right to turn down a claim. After notification of this condition, whether the company will continue to provide insurance cover or not depends on the recommendation of the family doctor and consultation with the insured parties. If the person with dementia is still driving, ask their insurance company if they'll be covered by insurance if they crash.

Coping when a person stops driving

Giving up the right to drive involves a loss of self-esteem and freedom. Anyone required to stop driving for health reasons may feel angry and frustrated.

Try to understand the person's thoughts, feelings and fears. It may be the first time they have had to face and accept that they have dementia.

If you, as a carer, don't drive, it's important to consider transport alternatives. These are some options:

Some families decide to sell the car and place the funds in an account to pay for taxis.
Total mobility vouchers (which give a reduction in taxi fares for those unable to catch a bus) may be available in your area. Ask your local Alzheimers New Zealand group (0800 004 001) where you can get them and what the requirements are. A disability allowance may be available to help with transport costs. Contact the person's social worker or assessment team for information.
Voluntary agencies, service groups or church groups may provide a car and driver for transport to and from medical appointments.
In some areas Age Concern offers minibus rides and monthly social outings.

The role of the NZ Transport Agency (NZTA)

The NZ Transport Agency is required by law to be sure that all drivers are medically fit and able to drive competently and safely. If the person won't voluntarily stop driving, the NZTA may revoke their licence – if it's considered necessary in the interests of public safety.

The role of doctors

Doctors may refer a person suspected of having dementia to an occupational therapist for an assessment of their driving. This isn't the same as a driving test – it's a more comprehensive assessment. Doctors also have a legal obligation to advise NZTA if they believe that a person unfit to drive is likely to carry on driving.

If you suspect a person may be showing signs of dementia, give them this simple test on common traffic signs.

Ask 'What does the sign mean?' and 'What action should the driver take?'

roundabout ahead sign pedestrian crossing ahead sign railway crossing ahead sign