Driving With Dementia - Is it Safe? Learn How to Tell

Can someone with dementia still drive, and what are signs that it is dangerous to yourself and others to continue? Learn what to watch for and other resources HERE.

How Do You Know When It’s Time to Stop Driving?
This week we discuss safe driving - how to know when it is time to give up your car keys, especially after a diagnosis of dementia.  Disease, age, changes in physical abilities can all impact safe driving. We discuss the warning signs, why it's important not to ignore, and a guide to finding alternative transportation.

See our website for show notes with resources and loads of information on transportation options to maintain independence as long as possible.

In This Episode:
02:14 - Recipe of the Week: Tennessee Onions Casserole
02:53 - Remembering Jimmy Carter
07:39 - Driving with Dementia: When is it Time to Stop? (Plus finding transportation alternatives)
18:11 - How to Talk to Someone About Giving Up the Car Keys
26:05 - Outro

Related Content:

• S4E40: How to Avoid a Car Accident and Stay Safe on the Road
• S3E47: Frontotemporal Dementia Part 1 – What Is FTD?
• S4E16: Understanding Vascular Dementia, the Second-Most Common Form
• S1E48: Alzheimer’s Disease
• S5E37: Memory and Alzheimer’s Disease
• S2E1: Lewy Body Disease
• S1E49: What to expect during screening for memory loss
• S1E34: Huntington’s Disease

Chapters

• 0:00 Intro
• 2:53 Remembering Jimmy Carter
• 7:39 Driving with Dementia: When is it Time to Stop?
• 18:11 How to Talk to Someone About Giving Up the Car Keys
• 26:05 Outro

Transcript

Driving With Dementia, Is It Safe?- Learn How To Tell

This podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording. Hello and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement.

I'm Marianne Matzo, nurse practitioner, and I use my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every person viewpoint to our podcast. We are both here because we believe that the more you know, the better prepared you are to make difficult decisions.

Welcome to this week's show. Please relax, get yourself a cup of hot chocolate and an orange, or maybe a brownie if it's been that kind of week, and thank you for spending the next hour with Charlie and me as we talk about the issues of people with dementia driving their car. Like the BBC, we see our show as offering entertainment, enlightenment, and education, and divide it into three halves to address each of these goals.

Our main topic is in the second half, so feel free to fast forward to that flight of idea free zone. In the first half, Charlie has our recipe of the week and talks about the recent death of President Jimmy Carter. In the second half, I'm going to delve into the potential dangers of a person with dementia continuing to drive, and in the third half, Charlie has suggestions about how to talk with an older adult about handing over the car keys and giving up driving.

So Charlie, how's your January going? Well, it's cold and gray. Winter has set in. How about yours? Well, we had nearly 80 degree weather on Tuesday.

I have roses blooming in my garden. I'm a little flummoxed about what's going on. Aren't we all flummoxed about what's going on? So, we continue our road trip around the United States in search of state related famous recipes with our travels this week taking us to Tennessee.

Tennessee, the home of the Grand Ole Opry, Smoky Mountains, Elvis, Dollywood, and Tennessee Onions. Tennessee Onions is an old fashioned onion casserole that is a creamy cheese casserole and so much more than the sum of its parts. Try it once and we know it will become one of your favorite contributions to the next funeral lunch that you attend.

At the end of 2024, former President Jimmy Carter died on December 29, aged 100. His presidency lasted only one term and political scientists relegated his presidency to the bottom third of the list of presidents. But he redefined what a post-presidency could be.

His successes as president, his work to eliminate diseases and strengthen free and fair elections, and his involvement with non-profits like Habitat for Humanity, which builds and renovates affordable housing. He also won the Nobel Peace Prize for, quote, his decades of untiring effort to find peaceful solutions to international conflicts, to advance democracy and human rights, and to promote economic and social development. Additionally, Mr. Carter wrote and discussed death, especially his own.

In November 2019, Mr. Carter fell and fractured his pelvis, and after that, several illnesses and injuries. What set it in was that despite his mental sharpness and physical robustness, he was 95 and would not That's it. Okay, Sandy, got it.

Sorry. What set in was that despite his mental sharpness and physical robustness, he was 95 and would not live forever. While discussing death remains taboo and people choose to be fearful rather than educate themselves about how they want to die, Mr. Carter wrote and commented frankly, both publicly and in Sunday school lessons, a collection of observations that amounted to a direct, clear, developing exploration of death.

He wrote more books than any other American president, and he wrote about death. He discussed death in speeches and in communication with friends. His observations were a product of his Christian faith and his experience with death, seeing many of his closest family members, including all of his younger siblings, die before him.

His advancing age affected his views. He described the sense of the inevitable looming over him and the increasing health struggles, including cancer that had spread to his brain. At that Sunday school in November 2019, he said that he did not think he would survive for long after his cancer diagnosis in 2015.

I assumed, he said, naturally, I was going to die very quickly. He lived nine more years. In his 1996 book Living Faith, Mr. Carter wrote, By the time I was 12 or 13 years old, my anxiety about this, meaning death, became so intense that at the end of every prayer, until after I was an adult, before amen, I added the words, and God, please, help me believe in the resurrection.

In 2018, he wrote, I realize that my physical strength and endurance are steadily declining, and I am having to learn how to conserve them, but I have found with relief and gratitude even when facing the prospect of an early death from cancer in my liver and brain, that my faith as a Christian is still unwavering and sustaining. From the book Faith, A Journey for All, if I were an amputee, for instance, my prayer would not be to restore my leg, but to help me make the best of my condition and to be thankful for life and opportunities to be a blessing to others. At the moment, we are monitoring the status of my cancer, and my prayers about my own health are similar to this.

Please go to our webpage for this week's recipe for Tennessee Onions Casserole and additional resources for this program. Everyone Dies is offered at no cost, but is not free to produce. Please contribute what you can.

Your tax-deductible gifts will go directly to supporting our non-profit journalism so that we can remain accessible to everyone. You can also donate at www.EveryoneDies.org Marianne? Thanks, Charlie. According to the Bureau of Labor Statistics, a car accident occurs every 13 minutes in the United States.

By 2050, it's predicted that one in four drivers will be over the age of 65. While technology and new regulations are making vehicles safer, motor vehicle crashes are a leading cause of injury and death in older adults. To learn more about safe driving, you can listen to our podcast by the title and you can see the link in the show notes.

Today, we're going to drill down a bit about safe driving to talk about when it's time to give up your car keys, especially after a diagnosis of dementia. Dementia is a loss of memory, language, problem-solving, and other mental abilities, and we have quite a few podcasts about dementia and the different types of dementia if you want to delve into those. But the term dementia is pretty broad and describes the mental changes that may then go on to a diagnosis of Alzheimer's, Frontotemporal Dementia, Lewy Body Dementia, or Vascular Dementia, just to name a few types.

Multiple types of dementia are progressive and gradually worsen over time. While individuals may still drive safely in the early stages of dementia, this becomes riskier as the disease progresses. Dementia can affect insight and judgment, potentially creating a dangerous driving situation.

It can also lead to mood and personality changes that may lead to more unpredictable or aggressive behavior behind the wheel. In fact, some of the first signs of Alzheimer's disease are changes in certain driving habits. Babulal and colleagues did a study looking at preclinical Alzheimer's disease and driving.

Now, preclinical Alzheimer's disease is a stage of Alzheimer's disease in which changes in the brain occur years before symptoms affecting memory, thinking, or behavior can be detected by affective individuals or their healthcare practitioners. So, essentially, Alzheimer's kind of cooks in your brain for quite a while, and our brains are amazing things that they can kind of take, other parts can take up the slack for what's going on with dementia, so it can take years before there's even any symptoms that there's something going on. These researchers put a tracker in the research subjects' cars and documented that cognitively normal people with more abnormal Alzheimer's disease biomarker values at baseline, so that's at the beginning of the study, had worse scores on an on-road driving test, and their analyses over time show that Alzheimer's disease biomarkers predicted time-to-road test driver ratings of marginal or fail.

So, they did a blood test on people, looked to see if they had these Alzheimer's disease markers, and then, you know, they didn't have any symptoms, but they had these markers, and so they tracked them with this car driver tracker thing and watched them over I think it was five years to see what happened. As a result of the study, certain driving changes may signal oncoming dementia. These are swerving out of their lane or off the road, changing everyday behaviors and routines to take shorter trips, getting lost more frequently, and not driving at the suggested speed limit.

Now, I have to be honest, I have done a few of these, but the researchers are talking about changes over time driving patterns, not you know, you started out with a lead foot and you still have it at 80. Dementia in driving laws will vary from state to state. In some states, individuals with dementia must report their diagnosis to the proper officials, such as the state Department of Motor Vehicles or Department of Transportation, which may result in the loss of the license.

Now, there's a link in the show notes so that you can look up the law in your own state. In many states, no explicit law prevents people diagnosed with dementia from driving. However, healthcare practitioners, law enforcement, and immediate family can report concerns of an unsafe driver to the state's Department of Motor Vehicles, which will trigger an investigation by the medical review unit.

This may result in the loss of a driver's license. How do you know when it's time to stop driving? It can be challenging for some people to recognize it's time to stop driving because of safety issues. If you or your loved one has been diagnosed with dementia, observe their driving skills and watch for signs indicating it's no longer safe to drive.

Warning signs to look for are getting angry on the road may be typical for some drivers, but if you're especially frustrated or confused while driving, the next steps need to be taken. It's a good indicator that it's time to give up the keys when you miss or disregard traffic signs and signals or showing signs of unsafe driving. Swinging outside your lane, decreasing use of appropriate driving etiquette, forget where you are, or get lost on familiar roads, increasing dependence on navigation aids in familiar areas, having a hard time telling the difference between the brake and the gas pedals, repeatedly having dings, dents, or scratches in the car paint, stopping in traffic for no reason, lacking good judgment, and signals incorrectly or not at all.

Other factors to consider are anxiety, nervousness, or irritation about driving, recommendations from a doctor to modify or stop driving, spikes in car insurance premiums due to driving issues, comments from family, friends, and neighbors about unsafe, erratic, or aggressive driving, two or more traffic tickets or warnings within the past two years, taking excessive amounts of time to complete a simple errand without any explanation about what's going on, and difficulty seeing pedestrians, vehicles, and other objects. The decision to stop driving can be toughest for people in the early stages of dementia. As symptoms become apparent, it may be safe to drive, especially during the day.

You may safely keep your independence by, for example, riding with a loved one and ask them to observe how well you operate the car and respond to your surroundings. As a mother of two daughters, I would suggest they not be your daughters because you drive terribly anyway. Limit the time of day you drive.

It's harder to drive at night than during the day. Limit where you go. Driving around the neighborhood may be safe, but getting on the freeway is probably a bad choice.

People who are in the middle to late stages of dementia should not be driving because they are dangerous to themselves and others. It's too easy to lose focus, run a red light. Everyone with dementia will have to stop driving at some point, typically within about three years of their diagnosis.

And because of the dementia diagnosis, it's going to be up to the people around them to help determine when that point is. Now you can consult with a healthcare practitioner or have local department motor vehicles administer a driving test. These are ways to get a concrete answer instead of just leaving it up to your symptoms.

Losing the ability to drive doesn't mean that people living with dementia must be confined to their homes. Instead, consider seeking alternative transportation that you can use to travel safely independently. Check local services such as free or low-cost buses, taxis, and carpools.

Your local area agency on aging can help you search for nearby options. Other resources include online eldercare locator and Rides and Sight, which help determine transportation options for other adults, and I put those links in our show notes. Additionally, check with local churches and community groups as they might have volunteers who drive older individuals to various locations.

Family and friends are also an option. I have a long list of resources in the show notes, so take a look at that. And in this day and age, you know, with Uber and Lyft and those kind of car services, it's not too expensive and I have a friend who has MS and she has an Uber driver that she asks for the same person all the time.

This person knows her, knows where the places she likes to go, helps her in and out of the car. So, yeah, she's paying for the service, but she also has made a friend of her Uber driver. Cars are complicated, two-ton machines that should only be operated by someone who can react quickly, understand the cues from other drivers, and think logically in a changing environment.

Disease, age, changes in physical abilities can all impact safe driving. In our third half, Charlie's going to talk about how to talk with someone about giving up the car keys. Charlie? First, recognize that giving up a driver's license may be a big step for older adults.

Maggie Kuhn, an elder advocate, used to say that older adults and teenagers are alike in that they both want to drive their own cars. But when the time comes that their driving is neither safe for them or the rest of the people on the road, and sometimes the sidewalk, we are faced with having the talk. Approach the topic with compassion and sympathy, but also be firm, because the sooner they get out of this unsafe situation, the better things will be for everyone on the road, including them.

This talk is often one of the most difficult ones to have with elders, especially if they have dementia and don't remember how unsafe their situation has become. Please do not treat them like you would a child. They are not children, and they are not your children.

Remember to have respect and kindness as you raise this delicate issue. Before discussing how to fix a problem, it's important to identify it. Then, take time to talk about why they have issues with driving and what those problems might be.

Some elders will right off the bat say, you're right, let's sell the car or give it to a grandchild. Great, you dodged a bullet on this one, and be sure to thank them for the wisdom in doing the hard thing. Ask for the keys or take the car that day, though.

You don't want a situation where they decide they will run to the store just this once and something bad happens. It's okay if they like to see it sitting in the driveway. Just ask for the keys so that it stays there.

But this conversation is often not this easy. People living with dementia often lack the awareness or judgment to know that they are a risky driver, and so it may be very upsetting when you talk to them about stopping driving. A formal driving evaluation may help them see the safety issues they are having with driving.

Reinforce that with them, that an unsafe driver is a danger on the road and that they can hurt themselves, you, or your family. Ask them to listen to the second half of this program with you. Sometimes hearing about a subject from someone other than the someone close to them can make a difference.

It is important to remember that only the State Motor Vehicle Division can take away a driver's license. If none of this works and they still insist on driving, you can ask their healthcare practitioner to notify the Motor Vehicle Department and they can address taking the driver's license. When people drive without a license and the issue becomes the car itself, both the car and the keys can be kept out of sight.

The car can be disabled so that it won't start. If they insist on having their car keys, get ones that don't start the car. If they decide to give up driving, you must help them transition to other forms of transportation.

This might include arranging for a car service, how to contact Uber or Lyft, or helping them to learn the public transit system. For the older adult, giving up their ability to drive can mean a lot of changes in their daily routine. Helping to establish routines provide a sense of stability and can be very reassuring during a time of change.

Help them to create new routines that will work for them. This might include things like grocery shopping or getting to appointments. It is essential that you are there for them as they pass on their keys and transition into a new way of doing things.

By offering assistance, you can help make this change easier to manage. Even though they can no longer drive, older adults still want to feel independent. This is critical for maintaining a healthy and thriving quality of life.

Respect their decisions and the choices they make for themselves. This will help them feel independent and in control of their lives. Most of all, be patient and loving.

This is a hard change to adjust to. Have you ever been in a situation where you've had to talk to an older person about giving up their car keys? Yes. How'd it go? Not well at first and for a while.

What wound up happening, my father got into two accidents, neither one of which were his fault. He was hit by other cars. One of my brothers pointed out to him that his rates were going to go up, which really pissed off my father because he really did do nothing wrong.

At this point, he was 91 years old. That was already a big strike against him. He had to renew his insurance policy or whatever it was in the car and just realized, yeah, it was going to cost him a lot more money.

That was a way he was able to diplomatically and graciously hand over the keys. He was fine after that. It was a little, I'm going to say rough, actually not even that.

It frustrated him a couple of times. He just wanted to jump in the car and take off. He adjusted well.

My brother and sister, all of them were, each one was within a mile and a half. It was never a problem to go and pick him up. In the end, it worked out fine.

That's good. From some of the situations that professional have been involved in, that's a really good story. Some people really resist it, really get agitated.

For some people, they want to be able to have their car keys. If they're in the later stages of dementia, get them a set of car keys that don't go to a car that's anywhere around. That way they have their car, their keys.

I had an uncle with Alzheimer's disease. I remember sitting with him and him showing me his wallet and the pictures and things that were in his wallet. You know how there's that window in men's wallets where you put your driver's license? Even with his advanced dementia, he was able to say, that's where my driver's license used to be, but I don't have it anymore.

He just was such a sad face that he knew it was supposed to be there. He knew he didn't have it. He was of the generation, my dad's brother was of the generation that his wife could drive, but she didn't because he did all the driving.

For him not to be able to do it, it was a real loss. Hopefully these ideas that you've presented will help people have that tough conversation to keep everybody safe. Yeah, it is a tough conversation on many levels.

Please stay tuned for the continuing saga of Everyone Dies, and thank you for listening. This is Charlie Navarette and from President Jimmy Carter, I found I was absolutely, completely at ease about death. I'm going to live again.

And I'm Marian Matzo, and we'll see you next week. Remember, every day is a gift. This podcast does not provide medical advice.

All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment. Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast.

If you think you may have a medical emergency, call your doctor or 911 immediately. Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.