Can you drive with dementia?

You can drive with dementia – in fact, around one-in-three people with dementia still drive. However, the important thing is whether you can still drive safely.

Dementia is not one illness. It’s a set of symptoms that gradually affects mental function and physical coordination. Driving is a fairly complex task, even though it seems like we can do most of it on autopilot.

The skills required for driving

Quick reactions: when two cars are bearing down on one another at 60mph, the gap closes at 120mph or 54 metres every second. In two seconds you’ve closed the length of a football pitch. It’s important to be able to react to danger to avoid accidents.

Memory: we have to remember where we are going and what we are doing. We need to remember where we left our car and also the road rules.

Patience and calmness: there’s a lot of questionable driving out there, and when someone’s faculties start to fail, it can cause and extra frustration for them.

Concentration: we have to switch between multiple different tasks while driving, maintaining our attention on what we are doing, anticipating what is going to happen and reading the road ahead.

Spatial awareness: with fast-moving objects all around us we need to be able to maintain the correct speed and distance from other vehicles and the correct road position within the lane.

Problem-solving: sometimes the road throws up unexpected challenges such as a detour, road works or a pedestrian crossing. We need to be able to respond to that appropriately.

Strength: driving requires some physical strength to turn the wheel, get into and out of the car, push the brake pedal and resist against the g-forces of cornering. Dementia doesn’t affect this, but dementia tends to affect older people who could have diminished strength.

Good vision and hearing: again, dementia doesn’t affect these directly, but will compound already diminished hearing and vision.

When will you lose the ability to drive safely?

It’s inevitable with dementia that eventually the driver will not be able to drive safely. How soon depends on what complicating factors there are with other illness, ailments and medication, and how quickly the dementia advances.

The Alzheimer’s Society says that most people with dementia stop driving within three years of the diagnosis.

Getting a diagnosis of dementia

A person in the early stages of dementia may resist getting a diagnosis either because they don’t want to confirm what they suspect, or they believe that the mild memory loss they are experiencing is natural.

If you have a friend or relative who you suspect has dementia, it’s important you encourage them to get it checked. In terms of driving, you might notice the following:

• More dents and scratches on the car
• Driver turns up late after getting lost
• Driver forgets where their keys are frequently
• Driver seems to have other symptoms of dementia (forgetfulness, clumsiness, etc)

The legal requirements for people with a dementia diagnosis

This can be quite difficult for the person with dementia as they are starting on the pathway to reducing their independence.

A doctor will make a diagnosis. They will talk to the person about driving. In many cases the doctor will advise that it is OK to continue to drive in the meantime; for some people, the doctor may advise stopping driving immediately pending an assessment, and for others immediately and permanently.

A person who is diagnosed with dementia is legally required to contact the relevant licensing authority promptly (Driver and Vehicle Licensing Agency or the Driver & Vehicle Agency). The fine is £1,000 for not doing it. The doctor will provide a recommendation and the DVLA/DVA will either:

1. Renew the person’s licence (usually for one year)
2. Cancel or revoke the licence immediately
3. Order an on-road driving assessment with the driver

A person diagnosed with dementia must tell their insurance company.

Many people with dementia voluntarily surrender their licence.

Driving assessment

If a driver has to do a driving assessment they should book it with their local centre. The test is not like a typical driving test; it makes allowances for bad habits drivers have picked up. The test is conducted by a specialist occupational therapist and an advanced driving instructor. It takes about two hours and contains:

1. An interview to assess the drivers medical and driving history, and any current driving problems. This stage has a short written test of mental abilities
2. A reaction time and limb strength test will be conducted on a static rig. Eyesight is checked.
3. On-road assessment in a dual-control car with the driving instructor. The advanced driving instructor sits in the passenger seat and the occupational therapist in the back seat.
4. Returning to the centre, the driver will be given the verdict and advice on how to prepare for not driving.

Continuing driving

Driving is a skill that must be practiced. People in the early stage of dementia benefit by driving regularly, but changing their driving habits: choosing quieter times, sticking to routes they know well, only driving in good weather conditions, having a passenger in the car to help, and not having distractions such as the radio.

Stopping driving

Either the driver or DVLA will decide when it’s time to stop driving. It can be appealed, but the person must not drive while the appeal is pending.

Many dementia sufferers give up driving because they find their diminishing driving ability frustrating.

If the dementia is advancing rapidly, the person may not have the mental ability to assess their own driving safety. There are ways to discourage driving and, ultimately, you can ask the DVLA to intervene. Options are:

• Hide the car keys
• Park the car where it’s not a visible and constant reminder
• Arrange alternative transport

Smoothing the way to stopping driving

The biggest challenge for people who must stop driving is the loss of independence. In rural areas where other transport options are fewer, this can be difficult unless the person has a close network of friends within walking distance.

You can help by making a plan and acknowledging that the decision is a difficult one. There are alternative transport options available:

• Taxis and Uber
• Voluntary organisations that help with social trips and trips shopping
• Hospital-arranged transport

You can also help by changing bills so that they are paid online or by direct debit, and organising some food shopping to be delivered.

There are some advantages to not driving:

• Selling the car will free up some cash
• Not driving will reduce expenses such as insurance and fuel
• In some areas it might be possible to rent an owned garage or parking space to another person, giving an income source
• More exercise due to walking
• Meeting people on public transport

Having dementia doesn’t necessarily mean the end of driving immediately, but it will eventually mean that the driver has to give up driving. A supportive family and network of friends can make this transition much more pleasant.