How to Address Unsafe Driving with Loved Ones with Cognitive Impairment

Unfortunately, he or she may not want to stop driving and may not even think there is a problem. There are a few signs to watch out for that may signal that cessation of driving is necessary:

• Bumps, scrapes, or dents on the car without a clear ability to explain how they got there
• Taking an unusually long time to get somewhere. For example, taking hours to complete an errand that should only take a few minutes
• Getting lost in parts of town that should be familiar to them
• Consistently making unsafe driving decisions, such as pulling out in front of someone, failing to check a blind spot when changing lanes, or running through stop signs

It is also important to pay attention to your own instincts about the safety of the person's driving, even if there are no major red flags. For example you might ask yourself if you would feel comfortable allowing your own children or the person's grandchildren to ride alone with the person in the car. If the answer is 'no,' then it is likely time to start a discussion about driving cessation. These discussions can be awkward and uncomfortable, but are critical to ensure the safety of the driver him/herself, their passengers, and other drivers and pedestrians. For many adults, stopping driving means giving up a sense of independence and control over their lives, so this topic should be approached with sensitivity, at least at first. For example, you might try simply offering to drive, and let the person "relax," instead of worrying about driving or spending gas money. You might also talk about all of the expenses and hassles that come along with driving and owning a car, for example car payments, insurance, maintenance, gas, etc. ("Just imagine what someone could do with all that extra money!").

If these gentle approaches are ineffective and the person continues to drive, it may be necessary to let the person's doctor know or take the person for neuropsychological testing, or even an over-the-road driving assessment. Sometimes, hearing a professional advise them to stop driving is enough to ease this difficult transition.

Unfortunately in many cases, even when members of the person's family and healthcare team advise them to stop driving, they continue. These are incredibly frustrating and stressful situations, though when a person continues to drive even after having glaring and obvious safety issues, it is often the result of dementia. In many cases of dementia, a person's ability to recognize their own impairments is compromised. The medical term for this lack of awareness is called anosognosia, and it can make the person seem like they are simply being stubborn, difficult, or hardheaded. It is important to recognize that anosognosia is often a symptom of dementia, rather than a conscious and willful attempt to be stubborn, difficult, or hardheaded. When unsafe driving is caused by dementia, and anosognosia prevents the person from recognizing the clear and obvious dangers of their driving, sometimes some fairly drastic measures may be necessary to keep them and others safe. While some of these may seem dishonest or underhanded, they may be the only way to ensure safety. Some of these measures may include:

• Physically take their car keys away
• Physically remove the car from their home
• Disconnect the battery
• Take the car away for "repairs"
• File a report with the agency in your state that issues drivers licenses. In Missouri, this process is outlined here: https://dor.mo.gov/faq/driver-license/report-unsafe-driver.html#:~:text=To%20report%20a%20driver%20who,at%20any%20Missouri%20license%20office

At STLCCH our geriatric neuropsychology team can perform the assessments that can serve as a piece of the puzzle in deciding whether to stop driving, and if driving cessation is indicated, delivering those results with a data-driven and empathic approach.