When To Take Away The Keys: When and How to Stop A Person with Dementia from Driving
- Shawnee Canjura
- Jan 28
- 6 min read
One of the most challenging moments in the caregiver experience is deciding when and how to stop a loved one with dementia from driving. First comes the doubt, "Maybe I'm being too hasty. Maybe they're right and they are still safe to drive". Then comes one small piece of evidence after another that slowly urge you to make the tough choice but once that choice is made, now you have to decide how to do it: Is it a conversation? Can someone else do it for me? Do I do it even if it upsets them? Will they be upset forever? Is this cruelty?
The thought cycle described above is nearly universal. If you find yourself caught in this moral dilema then hopefully you'll find it reassuring that it's also a sign that you truly care about your loved one and are only acting in their best interest.
I frequently tell my clients, there will never be the 'right time' to get them to stop driving. There is only 'too soon' and 'too late'.
Read below to get clarity on when and why driving becomes a safety issue for people with dementia, and steps you can take for a conscientious transition.
Why Someone with Dementia Should Stop Driving
Physical Changes Impact the Brain's Ability To Process
Slower Processing Speed
Research shows that individuals with cognitive impairments, including MCI and dementia (including Alzheimer's), may pose a heightened safety threat while driving. Specifically, studies indicate that:
People with moderate dementia are approximately 45% more likely to be involved in accidents compared to those without cognitive impairments.
Even mild cognitive impairment can lead to slower reaction times, increasing the likelihood of dangerous situations on the road.
It is crucial to monitor these signs and consider the implications for driving safety, as delayed reaction times can significantly impact not only the individual with MCI but also other's on the road.
Signs of Delayed Reaction Time
Difficulty in Decision Making: Individuals may struggle to make quick decisions while driving, leading to potential accidents.
Increased Hesitation: A noticeable delay in responding to traffic signals, changing lanes or changes in the environment.
Altered Perception
People living with dementia experience something called Altered Perception. This change in how their brain processes stimulus can make someone living with dementia misinterpret their environment and struggle with how high, long, wide, deep or near things are. This can make approaching cars seem faster than they are, pedestrians seem further and signs illegible.
Signs of Altered Perception
Increased Road Rage or Anxiety: Getting angry at the car that is 'tailgating them' or 'zooming past', when safe distance and speed are being followed
Increased Anxiety: feeling anxious about taking an off ramp because the turn seems too sharp
Pointing Out the Obvious: making quotidian observations like the color of each pedestrians shirt, or reading each storefront sign out loud as it comes into view likely indicate that the brain is working overtime to identify and categorize what it is seeing
Apraxia
Apraxia is the loss of motor skills needed for movement and coordination, like steering a wheel and operating the gas and brake pedals. In some forms of dementia, loss of coordination occurs before noticeable memory loss. An inability to control one's body translates to an inability safely to control 2 ton vehicle.
Signs of Apraxia
Loss of Finger Coordination: struggling with buttons on remote controls, phones and microwaves. Difficulty tying shoe laces.
Moving Slowly: moving more slowly than normal or with increased hesitation.
Having "The Talk"
If your loved one is already exhibiting many of the symptoms above, they also probably have anosognosia, the inability to recognize their own condition. You've probably already noticed this: they seem unwilling to accept that they have dementia or need help. It's not denial or stubbornness though. The brain of a person with dementia undergoes so much change that they are frequently incapable of comprehending their diagnosis and it's implications.
If this is the case for your loved one, they will not be able to collaborate with you on their own care plan. You will have to make the decision for them, there will never be a time in which they see your point and agree to stop driving. The best way to move forward then is to try and position yourself as their ally and make someone or something else the reason that they cannot drive anymore.
Get Help From Officials
The easiest way to do this is to ask their doctor to notify the DMV of their dementia diagnosis so that the DMV orders an evaluation. This way, you get to remain the 'good guy' in their view and this is good not just for both you and your loved one, because your loved one's happiness is really the top priority. If your loved one lives in California, Oregon, Delaware or Pennsylvania, this may be the best option for you. If you live outside of those states, officials may be able to help to varying degrees, I recommend contacting your local police department and DMV for specifics.
Some states mandate that doctors notify the DMV of a dementia diagnosis: California, Oregon, Delaware and Pennsylvania. If your loved one lives in these states,
Some states are completely illogical and expect drivers to self report their diagnosis: Hawaii, Alabama, Indiana, Missouri, Montana, Nebraska, New Mexico, New York, North Dakota, Ohio, South Carolina, Utah, Virginia, Washington.
The remaining states accept reports to the DMV from doctors, family, friends and police but have no explicit mandates on precautionary testing.
Make The Car The Problem
Pull the spark plug, kill the battery, do anything to make the care inoperable (but salvagable!). This immediately removes the danger while also maintaining their dignity and sparking their curiosity rather than paranoia.
Loose The Keys
Just like disabling the car, misplacing their car keys is a great way to maintain their dignity, remain their friend, and easily get them onto the next thought as they rummage through the house looking for the keys. This should not cause anxiety, it will likely just help them refocus onto something new.
Managing Emotional Reactions
Of course, there will inevitably be times when your loved one gets upset with you about this, or something else. Here are some strategies to help change the mood:
Validate Their Feelings
Telling them that you did it for their own safety, saying 'remember, we agreed about this', anything at all like that will only come across as a lie. This is in large part because of the anosognosia.
So just agree and say how you're going to help them.
"You're right, I shouldn't have done that. I don't know what I was thinking. Let's call the DMV and schedule a follow-up appointment. But first...."
"You're a great driver, I don't know why the doctor thought you shouldn't drive. I've been trying to convince them to retest you. In the meantime, why don't I drive us..."
Practical Solutions After Transitioning Away From Driving
Explore Alternative Transportation
Investigate local transit options, ride share programs (that you manage for them), or volunteer-based services. For instance, many cities offer discounted taxi rides for seniors–some as low as $5 for short trips.
Encourage Mobility Independence
Suggest trips with friends, accompany them on walks and encourage safe outdoor activities like gardening to maintain a sense of independence.
Final Thoughts
The decision to prioritize safety over your loved one's spoken wishes is almost never an easy one. The only time it will be easy, is if you've waited too long and had a brush with disaster: maybe they got lost and you couldn't find them, maybe they got into an accident, maybe they were involved in a fatal collision and are responsible for the injury or death of others. Given these two choices, it is best to act sooner, rather than later. 'Sooner' comes with difficult emotions for both you and your loved one, but they can be managed through the right approach and are preferable to the results of 'later'.
About The Author:
Shawnee Canjura is the owner of The Dementia Doula, a coaching service for the caretakers and loved one of those with dementia. She began this work after being the full-time, unpaid caregiver for her mother, who was diagnosed with Alzheimer's in 2016. What started out as the worst experience of her life eventually became her most positive and transformative one. She offers individual and group sessions to help clients get past the headaches and the heartaches of the experience as quickly as possible, so they can experience the joyful and meaningful moments that remaining.
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