the topic of driving cessation early, even prior to a potential
diagnosis of dementia or at least at the earliest manifestation of any cognitive symptoms, helps the person with dementia as well as their
friend/family carers to gradually prepare for cessation. Starting a
dialogue early also helps establish that driving cessation is an ongoing
Regardless of whether your assessment indicates that the person with dementia is in an early stage and will eventually need to stop driving or whether they need to stop driving immediately, it is essential
to address practical issues, as well as to validate and manage their unique emotional needs. It is equally important to ensure that you recognize
and manage the many ways that the driving cessation process can be
emotionally challenging for you.
Many people with dementia and
their family/friend carers report that driving cessation has a huge
impact on their emotional lives, which is often not acknowledged or
addressed by their healthcare providers. This neglect can compound the
emotional turmoil they are already experiencing.
indicates that healthcare professionals often overlook emotional
responses due to a narrow focus on practical considerations and because
they do not know how to address the emotional aspects of driving
cessation. To make sure you provide support for both practical and
emotional issues, take an individualized approach that incorporates the
Although dementia is often only recognized in moderate or severe stages, initiate the topic of driving cessation with older patients/clients and their family/friend carers prior to a potential diagnosis. This gives them the chance to gradually adjust to the possibility that one day, due to health conditions, they may no longer be able to drive. Broaching the topic early also helps pave the way for keeping the discussion going. An ongoing dialogue allows you to address both practical and emotional concerns as they naturally arise.
Frame driving ability as a health issue by incorporating discussions about driving into routine health maintenance. Explain that there are many health issues common in older adults that can negatively impact driving. This approach allows you to cover a range of topics in a natural and non-threatening way including:
Research indicates that people with dementia want to be involved in planning and decision making about their driving cessation journey. Creating an atmosphere of respect and helping them maintain a sense of independence by “having a say” can go a long way in facilitating collaboration and shared decision making to the extent possible.
Bringing carers into the discussion can often further help foster collaboration. When you explain the risks associated with dementia and driving, as well as how driving cessation impacts quality of life, family/friend carers may become more empathetic towards the concerns of the person with dementia. As a result, family/friend carers may be better prepared to have ongoing discussions and support the person with dementia as they transition to driving cessation. It is important to be careful when navigating confidentiality issues and potential tensions between the person with dementia and their family/friend carers.
Strategy in action:
Occupational Therapist: It’s a bit of an art… there’s no cookie cutter… For me it’s about listening, about figuring it out. When you’re talking to them, you’re asking questions and they’re answering you, you get a feel for where they’re at so then it becomes a little easier to push my luck here a little bit... In OT land I always think the front door may be locked, but there’s got to be a side window… You just keep gently looking. You keep trying to find that way in where you can make that connection and try to get them to realize, even if it’s just a seed.
Geriatric Psychiatrist:Family members are a mixed group. Some recognize the concerns and are concerned about it. Sometimes they are the source of the push to have the person assessed. And sometimes it's even more challenging though when you have a family member, say like a spouse, who is reliant upon that person for their transportation needs. And so, they say that the person is a good driver and you're being unreasonable in taking away their license.
Build trust by being direct and honest and by attentively listening to the person with dementia and their friend/family carers’ situation and challenges. Use your judgement to assess whether it would be helpful for you to take on the role of “the bad cop” (i.e., the one sharing the bad news) as a way to preserve family relationships. Similarly, depending on your location, consider positioning your province’s driving authority as “the bad guy” by explaining your legal obligation to report unsafe driving.
To validate and help manage the emotional impact on everyone involved, including your own, try these approaches for facilitating effective communication.
this leading educator in dementia, Teepa Snow, recommend strategies for
how to talk to a person with dementia who is reluctant to
stop driving. Also, in this video, she advises on what not to say.
In addition, in the video below a healthcare professional uses a range of techniques to help communicate effectively with the person with dementia.
Source: Dr. Anna Byszewski
People with dementia want to be part of the cessation process and family/friend carers require assistance from healthcare providers. Accordingly, fostering an approach that emphasizes early planning for cessation, whenever possible, allows everyone a chance to adjust to the inevitability of cessation. An emphasis on planning also promotes ongoing communication providing you with continuous opportunities to manage the therapeutic relationship. Encourage an inclusive and supportive approach by using the following planning tools directly with the person with dementia or by recommending them to their family/friend carers.
As a way to broach the topic of planning ahead for when the person with
dementia can no longer drive, consider recommending these resources:
Presuming the person with dementia does not need to imminently stop driving, you should advise family/friend carers to directly observe the
driving of the person with dementia and monitor them for warning signs. They cannot rely on the person with dementia to recognize when their
driving is unsafe. However,
for family/friend carers to provide valuable information, they need to
directly observe the person with dementia driving in the recent past. Recommend these resources:
Driving is certainly a convenient way to get around, and yet it is not the only way. To help ensure that the person with dementia is still able to get
around and is as independent as possible, work with them—or recommend
that their family/friend carers work with them—to develop an alternative
transportation plan. It’s important to involve the person with dementia
so that they feel respected and have a sense of control. Follow these
1. First, identify all the things the person with
dementia likes to or needs to do on a daily, weekly, monthly and yearly
basis like grocery shopping, socializing, going to the gym, birthdays
and anniversaries. To help, download one of these worksheets produced by The Hartford or
recommend them to family/friend carers:
2. Next, brainstorm ways to get errands done
without driving. For instance, the person with dementia may be able to
change certain routines. Instead of visiting the bank, the family/friend
carer could set up automatic bill payments. Other ideas include:
3. Then, brainstorm ways for the person with
dementia to continue doing the things they like to do without driving.
However, keep in mind that relying too heavily on just one family/friend
carer to do all the driving or make all the driving arrangements, can
be highly stressful and should be discouraged. Instead, try to share the
driving responsibilities by using different forms of transportation.
Using a variety of driving options also decreases the person with
dementia’s isolation and expands their social circle. Beyond family and
friends, possible transportation options depend on the person with
dementia’s specific situation such as whether they live in an urban or
rural area. Ideas include:
4. In addition, share these alternative transportation options for the province or territory where the person with dementia lives.
To help allay anxiety around costs associated with alternative travel
options like taxis, recommend this transportation cost calculator produced by The Hartford. Once the costs associated with owning and
operating a car are factored in—such as gas, repairs, and insurance—
many people with dementia and family/friend carers are surprised to
learn that it may be less expensive to just rely on taxis/ridehailing.
Explain to family/friend carers, that in addition to healthcare
professionals talking to the person with dementia and/or giving this letter to them that is provided by the Regional Geriatric Program of Eastern Ontario, other authority figures may also be helpful in reinforcing the
cessation message. For example, a religious leader, the family lawyer
or a familiar police officer.
If nothing else is working, advise family/friend carers to:
It’s important to recognize that you may face numerous challenges while facilitating the driving cessation process. In particular, it can be especially stressful managing reactions and tensions that may arise between you and the person with dementia and/or their family/friend carers. Ideally, the communication and planning tools described above will help lessen the emotional impact on the person with dementia and their family/friend carers—and in turn, this should also help mitigate the emotional impact on you. Here are some additional strategies you can try to lessen the emotional strain.
Here are some opportunities for additional learning:
We invite you to take this brief online survey that will help us improve the website.