When should seniors with dementia stop driving?

The following are some common indicators that a person's dementia is making it difficult for him or her to respond safely while driving. Whenever you notice such problems, record the date and time when these behaviors occur, and discuss them with the person and his or her doctor:

• Not signaling for turns or signaling incorrectly
• Confusion at exits
• Hitting curbs when trying to park
• Parking inappropriately
• Driving at inappropriate times
• Delayed responses to typical and atypical situations
• Getting lost along a familiar route
• Getting unexplained dents on the car
• Confusing the brake and gas pedals
• Stopping at a green or flashing yellow light
• Having near misses with pedestrians and other cars
• Getting citations for poor driving
• Having accident(s)

Some experts talk about the "grandchild test." If you would not let a grandchild ride in the car with the driver, then he or she probably shouldn't be driving at all.

If any of the behaviors listed above has occurred and the person will not voluntarily give up driving, then a formal evaluation by the motor vehicle bureau or private driving instructor should be sought. Most caregivers will restrict driving after a loved one has accumulated one or more of the warning signs listed above, but often a person with Alzheimer's will deny any problems and, when asked to limit their driving or stop driving altogether, will be highly resistant. Some people who have the early stages of memory loss recognize that they are having changes and go in for testing on their own initiative. This should be encouraged and supported.

An evaluation by a driver rehabilitation specialist, often an occupational therapist (OT), can be of great value in helping to make the difficult decision of taking away the car keys. A driver evaluation will assess the components of driving that may be compromised by this progressive condition. Areas assessed should include: attention, processing speed, visuospatial functioning, decision making, judgment, planning, memory, and behavior.

To find a certified driving rehabilitation specialist in your area who can perform such an evaluation, contact The Association for Driver Rehabilitation Specialists. Their phone (toll free in the United States and Canada) is 866-672-9466; their web site is www.aded.net.

For other driving evaluation programs throughout the country, contact the American Occupational Therapy Association, Inc. and ask for the nearest driver rehabilitation specialist. Their members-only phone number is 800-SAY-AOTA (729-2682); non-members can call (301) 652-6611; their web site is www.aota.org.

Occupational therapists with specialized training in driver rehabilitation are able to identify not only a driver's strengths, but also the physical, visual, and cognitive challenges the individual faces. As a result, occupational therapists can evaluate an individual's overall ability to operate a vehicle safely and, if necessary, recommend ways to limit risks.