When Should Someone With Dementia Stop Driving? A Physician Explains

Dr. Catherine Madison is a neurologist with Seniors At Home, a division of Jewish Family and Children’s Services and founding director of the CPMC Ray Dolby Brain Health Center in San Francisco. After eight years in the Air Force, she returned to California to care for her mother with Alzheimer’s disease. She is the author of “Navigating Memory Loss: Essential Questions and Answers on Alzheimer’s and Dementia.” 

Americans place a high value on their independence and mobility. However, when conditions such as anosognosia — the inability to recognize one’s own cognitive decline — are present, this sense of independence can become compromised. 

Recognizing this potential circumstance allows us to construct safeguards that protect both individuals with cognitive impairment and their communities. This can be particularly hard when it comes to decisions about when someone should stop driving.

There is abundant discussion around this topic in the legal field — much of it centered on arguments defending the right to drive after a DWI conviction. In these discussions, it is often claimed that unimpeded mobility through driving is a constitutionally protected right.

The importance of driving varies according to location and means. Individuals living in non-urban areas, for example, may depend more heavily on driving because essential resources such as grocery stores and health care facilities are less likely to be within walking distance and public transit may be limited or nonexistent.

Having worked with individuals and families navigating dementia, I have found that driving remains one of the most difficult topics to address and plan around. Families often feel conflicted about restricting a loved one’s independence, and patients may remain unaware of any need for limitations.

Addressing this delicate matter

In the state of California, the Department of Motor Vehicles (DMV) lists the following medical conditions that can affect safe driving: diabetes, dementia, visual impairment, and lapses in consciousness. There are vehicle codes that outline a medical provider’s duty to report certain patients for a driving evaluation. Given the growing number of regulations that medical providers must follow, it is understandable that this requirement can sometimes be overlooked.

California Vehicle Code also has forms that family members can submit if they are concerned about a loved one’s safety behind the wheel. Anonymity can be requested but not guaranteed, which may discourage some family members from filing a report for fear of being seen as “the bad guy.”

Some on-road and simulator-based research suggests that older adults with dementia may demonstrate impaired driving skills and capabilities. However, the research methods are not consistent and sample sizes have often been small, meaning there is still no universally accepted guidance on when someone should stop driving.

Potential implications and liability

In the absence of clear guidance, legal systems at the state and local levels often evaluate these cases individually. In California, wrongful death claims arise when someone dies due to another party’s negligence, recklessness, or intentional misconduct. In certain circumstances, this could include a family member who knew about a loved one’s cognitive impairment but allowed them to continue driving.

Unlike criminal cases, which often result in imprisonment, these civil lawsuits focus on financial compensation for surviving family members who have experienced significant loss. Settlements  in such cases have ranged from several hundred thousand to several million dollars. Some law firms even advertise a “wrongful death settlement calculator” for victims.

Strategies to prevent emotional turmoil

Some studies suggest that people with cognitive impairment may begin limiting their own driving, which can help reduce risk. However, setting reasonable driving limits while also introducing supportive transportation alternatives can improve safety without sacrificing autonomy.

Families may choose to temporarily disable a vehicle to prevent driving, and maintain that arrangement indefinitely. When this strategy is used, families must also be prepared to provide reliable alternative transportation and additional support. 

A treating medical provider may submit a form to the DMV requesting a formal driving evaluation and explain to the patient and family that this step is required under state law. In California, the evaluation typically includes an interview, along with written and behind-the-wheel driving tests. This process can be demanding even for drivers without cognitive impairment.

In these situations, the medical provider may find themselves in the uncomfortable role of appearing to be the “bad guy,” which can strain the therapeutic relationship and make it more difficult for the provider to remain a trusted member of the care team.

Finding the right balance

Driving is deeply intertwined with our sense of autonomy and remains essential to the average American’s ability to function independently.

For this reason, it may be wise to think in advance about how we would handle the eventual loss of this independence ourselves.

The growth of ride-share services and the emergence of self-driving vehicle technology will help create more acceptable and practical alternatives to driving in the future.

For now, the best approach is to use clear communication with members of the care team to share concerns about a loved one’s safety — or lack thereof — behind the wheel. They may not see this themselves, but family could be at risk if they choose to be blind.