When a Loved One Is Diagnosed with Alzheimer’s Disease, Should They Give Up the Car Keys?

Dad has been diagnosed with early-stage Alzheimer’s disease. He insists that it’s still perfectly safe for him to drive—but is it? This conversation has led to some tense moments as the family discuss the best way to care for Dad as the disease progresses.

Some of the common changes of aging can make driving unsafe. Hearing and vision loss or impaired manual dexterity from arthritis or osteoporosis make it harder to act quickly and maneuver the car skillfully. Changes in memory and thinking caused by Alzheimer’s disease also can seriously narrow the margin of safety on busy streets and highways. Driving requires the ability to concentrate, to make quick movements, and to anticipate what’s ahead and make split-second decisions.

Experts say that people in the early stages of the disease may still be able to drive, with certain limitations. Sometimes as the disease progresses, a person is well aware that their driving is impaired, and they self-limit, driving only during the daytime and on familiar routes. Many eventually voluntarily give up driving.

But, reports the National Highway Traffic Safety Administration (NHTSA), sometimes seniors with dementia are unaware that their driving skills are deteriorating. Then it may be time for family to step in. Driving safety isn’t something to be in denial about. Families should keep the conversation going, and not sweep the subject under the rug.

When Is It Time to Give Up the Keys?

NHTSA says people with dementia and their families should be alert for the following signs that Alzheimer’s is affecting their driving ability and it’s time for an evaluation:

• Needing more help with directions or with learning a new driving route.
• Forgetting one’s destination, or where one parked the car.
• Trouble making turns, especially left turns.
• Misjudging gaps in traffic at street crossings and on highway ramps.
• Trouble seeing or following traffic lights and road signs.
• Getting traffic citations or warnings.
• Being honked at often by other drivers.
• Stopping at green lights, or hitting the brakes at the wrong time.
• Trouble staying in one’s driving lane.
• Less muscle control, so it’s hard to push down on the pedals or turn the steering wheel.
• Finding unexplained dents and scrapes on the car, fences, mailboxes, garage doors, and curbs.
• Trouble controlling anger, sadness, or other emotions that can affect driving.

Studies show that family members are often the first to notice these “red flags”—and, says the American Academy of Neurology, family who report their loved one’s driving is “marginal” or “unsafe” are usually correct. Urge your loved one to talk to the doctor about their driving. The doctor might recommend an evaluation by a driver rehabilitation specialist. You can find one of these experts through the American Occupational Therapy Association. In some states, doctors are legally required to report medical conditions that could make it unsafe for a patient to drive.

Having the Conversation

The decision about driving can be one of the most difficult conversations seniors and adult children can have! The Alzheimer’s Association recommends that families begin the discussion earlier rather than later, while the person with Alzheimer’s is still able to participate in the decision-making process. The association offers a series of helpful videos in their Dementia & Driving Resource Center.

It is definitely better to have this conversation before there is an accident or other crisis! It may take a little time for your loved one to accept this change. Be respectful, and allow your loved one to express their feelings—which may range from anger to grief to relief or a combination of them all. University of Colorado School of Medicine’s Dr. Emmy Betz suggests that seniors and their families establish an “advance directive” for driving, in which the person agrees to hand over the keys if their doctor or family believe they are no longer able to drive safely. Talk to the Department of Motor Vehicles in your state to find out what your options are for having your loved one called in for testing. Experts warn that it can be very difficult to prevent a person with dementia from driving! Even if they have lost their license and you’ve hidden the car keys or even disabled the car, your loved one may try to drive anyway.

Giving Up the Car Keys Doesn’t Mean Giving Up Mobility

One thing that can make the decision and conversation easier is to pair it with an exploration of transportation alternatives. While the person with dementia is still safe getting out and about, but should not drive, public transportation is an option. Check out mass transit (bus, train or subway), taxis, rideshare programs, or transportation services for older adults. Eventually, it will be unsafe for the person with dementia to travel about alone, but it’s important to ensure that they don’t succumb to inactivity and isolation, which can hasten the progression of the disease and lead to depression, agitation and sleep problems. Call your local senior services agency to find out about paratransit and other special transportation for people with dementia. Adult day care, home care, or a memory care community may also be a good choice to keep your loved one safe and connected.