How to Talk to Your Loved One about Dementia and Driving

If you have a loved one living with dementia and he or she has a driver’s license, you’ll eventually have to have the talk about driving. It’s one of the most difficult conversations you’ll probably ever have.

Holding a driver’s license isn’t just about being able to get from point A to point B. It represents independence and for many people, it’s a big piece of their identity. You can think to yourself, “Dad can no longer driver and I need to take his license. That’s all there is to it.” But there is much more involved than just removing a license from a person’s wallet. It’s about maintaining the person’s dignity and respecting them as an adult.

Tamara Ballard, Client Care Manager and Jennifer of Simple Local Life discuss some helpful tips for how to deal with dementia and driving.

Try telling someone they can no longer drive, and you’ll likely hear, “I’ve been driving all my life and never had an accident. Who are you to take away my license?” What happens next is up to you. You have a healthy brain and a choice to make as to how you approach this delicate situation.

First, it is important to recognize that you’re not wrong to be concerned about your mom or dad driving a vehicle if they’ve been diagnosed with dementia. The reality is that it’s not a matter of if the person will no longer be able to drive, it’s a matter of when. As you can appreciate, driving requires a person to have a high level of cognitive functioning. There are always risks involved when you get behind the wheel and those risks increase a) if you’re over 80. b) if you have dementia.

As well, if a person has had a previous accident in the past two years, statistics show they’re more likely to have another accident. Also, if a person has depression, a fall within the last year or sleep apnea, the risk associated with motor vehicle accidents increases even further.

The difficult question is how do you assess if a person has the cognitive abilities required to safely drive a car? Is there a test you can do in a doctor's office? Or is there a driving test that you can do in the real world? Unfortunately, there’s no easy answer.

You may have heard of the Mini-Mental State Examination commonly referred to as the MMSE. It’s a questionnaire that is used by doctors to measure cognitive impairment and as a screening tool for dementia. Evidence is divided as to whether or not the MMSE correlates with driving abilities. Some studies show an increased risk of accidents with a poor MMSE; others do not.

Next, you may suggest that a road test should be done. Bear in mind that in Nova Scotia, the Registry of Motor Vehicles (RMV) only has one road test for all drivers, and you can take it as many times as you want. They don’t have a different test to check the abilities of an older person or someone with dementia.

Another road test that can be performed is the Driver Evaluation Program which is part of the Nova Scotia Health Authority (NSHA). This is separate from the Registry of Motor Vehicles. The evaluation consists of two parts: clinical evaluation and an on-road evaluation. It costs about $400 and is performed by occupational therapists. A doctor can refer someone for a Driver Evaluation if they suspect changes in the person’s health may affect their ability to drive safely. The downside is that the test is only available in Halifax, there is a long wait list, and it may or may not be covered by a person’s health plan. The report is sent to the doctor, not to the Registry of Motor Vehicle.

If you have concerns about someone’s ability to drive safely, here are some tips to consider:

Think about how you would feel if someone told you that you could no longer drive. Put yourself in their shoes and have compassion.
Agree that they’ve been a good driver. Show that you’re on their side and not a mean person who doesn’t understand the situation. Again, show compassion and empathy. Listen to the person and paraphrase back their words so they know you’ve heard them.
Using a phrase like “maybe it’s time to retire” may be more acceptable than “it’s time to quit driving or you have to give up your license.”
Start early to research resources, programs and services available in your community. The reality is your parent will still need to get around so be proactive in creating a plan. Don’t leave them feeling like they’ll be stranded.
Talk to the doctor and explain your concerns. Ask for their support. Older people will often listen to the doctor and will respect their opinion. If the doctor recommends that they should no longer drive, they may be more accepting of the advice.
Regardless of what you do or how you approach the situation, a person may not willingly give up the license or the keys to the car. In that case, you may have to ask the doctor to request that RMV suspend the license.

Interestingly, in Nova Scotia, doctors are not legally bound to report patients they think are unsafe. Many doctors ethically, however, will feel obligated to write a letter to express concerns and will report the person as a matter of safety for both the driver and the public.

The bottom line is that you’ll have to talk to your parent about the change in driving status but before you do so, get prepared. And for the best outcome, make sure you approach it from a place of compassion and kindness. Fast forward and imagine you’re their age – how would you want someone to talk to you about your driving abilities?

Call Earth Angels Home Care at 902-893-3553 in Truro or 902-530-6205 in Bridgewater to learn more about our services and how we can help you care for a loved one living with dementia.