There is guidance available in respect of medical standards of fitness to drive, particularly when the symptoms include lack of insight.
Please see this document (opens pdf) for more information.
“It is difficult to be on the passenger seat after years of driving” – person with dementia
We often think about driving as an autonomic action, but in fact it is a very complicated task. Driving involves highly complex interaction between senses, thought processes and manual skills. A person must be able to react quickly to other road users’ actions, judging distances, to be able to read road signs, and to remember where they are going.
Having a diagnosis of dementia doesn’t automatically mean that the person is unable to drive. Many are able to continue driving for some time after the diagnosis. Eventually, however, the illness will affect the person’s ability to drive. Abilities like judgement, attention, orientation, and memory, all of which are important for driving, will be affected.
In dementias that affect the frontal lobes of the brain like FTD, orientation is often retained, so the person affected rarely gets lost. Manual tasks may become difficult to do, like changing the gears due to loss of ability to carry out familiar movements (apraxia). Judgement may also be affected, for example judging the speed of the car or anticipating the moves of the other road users. People with Lewy body disease often experience visual hallucinations, which can result in change of the attention. These are some examples of how dementia can affect the ability to drive.
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When a person receives a diagnosis of dementia, there are legal requirements about driving. By law, anyone holding a current driving licence must inform the Driver and Vehicle Licensing Authority (DVLA) if they receive a diagnosis of dementia. The Alzheimer’s Society provides helpful information on driving and dementia.
If a person receives a diagnosis of dementia they must inform their insurance company, failing this will jeopardise the validity of their insurance. Driving without valid insurance is a criminal offence.
Giving up driving has great implications, emotionally and practically, for both the person with dementia and their family. It is often one of the first concrete loss for the person due to dementia. This can be extremely difficult time and it is important to have as much support as possible, from family members, friends, and professionals. It is also of utmost importance to involve the person with dementia in decision making and planning of alternatives. The needs of the person with dementia change over time. The importance of driving might change as well; this may helpful to keep in mind at the difficult times.
If the person or anyone else has noticed any changes, it is in the interest of the person themselves and other people to consider giving up driving. Sometimes it is the person in the passenger seat who is the first to notice any changes in the way the person with dementia is driving. The first sign may be not feeling as safe in the car as before. The following list may be helpful in monitoring changes.
Early signs of driving problems include:
“My children had a meeting without me and decided that they want me to stop driving, but they are making a big deal about nothing. I’m very comfortable on the road. I’ve driven longer than they’ve been alive” person with dementia
Driving has a symbol meaning of freedom and independence, as well as being a practical way of transport. It is not surprising that giving up driving is very hard. It is always best if the person with dementia decides voluntarily to give up driving, but sometimes the person may be unable to assess their driving skills or insist on driving even when it is no longer safe. There is no one right way to deal with the situation, what works for one doesn’t work for an other. Underneath are listed some possible interventions:
Get support when making and implementing the decision about driving:
Make the car inaccessible:
It is possible to find alternatives for getting around, this can make giving up driving less stressful: