Should you continue driving following a diagnosis of dementia?
Dementia is a broad term used to describe a progressive decline in memory and function, ie, mental ability. The most common form of dementia is Alzheimer’s disease. Dementia is characterised by several things including forgetfulness, an inability to carry out simple tasks and poor judgement.
Driving requires quick reflexes and decision-making. While most people voluntarily stop driving following a dementia diagnosis, some don’t. However, there will come a time eventually when driving is unsafe and not possible due to impaired thinking and reaction times.
Here’s some advice about driving and dementia:
Consult your GP
If you, or somebody you know, has been diagnosed with dementia, you must talk to your GP about whether it’s safe to keep driving or not. While driving provides independence, it can be unsafe if your brain isn’t functioning as it should be.
Your doctor has a legal duty to make an assessment, and may refer you to an occupational therapist for a driving assessment. This assessment is different from a routine driving test. Doctors are legally obliged to let the New Zealand Transport Agency (NZTA) know if they think a person is unfit to drive but is likely to carry on driving.
Let NZTA and your insurance company know
They will give you advice on what you need to do. Some insurance companies may have strict rules surrounding a diagnosis of dementia and insurance coverage, ie, you won’t be covered if you have an accident.
If you feel unsafe, stop
If diagnosed early on, you may come to your own realisation that it’s time to stop. If you feel unsafe or like you can’t react quickly if needed, then it could be time to stop. It’s best to stop driving before an accident occurs or your mental ability declines sharply.
Plan ahead
If you think it’s time to hang up the car keys, find out about other means of transport or financial help you may be entitled to. You could organise for friends or family to help you out with things like grocery shopping.
For more information visit NZTA’s website and the Alzheimer’s New Zealand’s website.
Information for healthcare providers on dementia and driving
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
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The following information on Dementia and driving safety is taken from Dementia and driving safety – a clinical guideline Auckland, Counties Manukau, Waitematā and Northland DHBs, NZ, 2014.
People who have moderate or severe dementia should be told that they must cease driving, and if they refuse to do this, there is an obligation to notify the New Zealand Transport Agency (NZTA) under Section 18 of the Land Transport Act.
Those who have MCI or mild dementia are more difficult to assess and many are safe to continue driving, at least in the short-term. Clinical bedside testing is a poor guide to deciding on a person’s driving safety, and they should be asked if they will undertake an Occupational Therapist (OT) Driving Assessment through one of the local agencies. These are unfortunately not funded. Following such an assessment, recommendations regarding driving should be communicated with the person, their family and the NZTA, where necessary. Remember that drivers can be approved to continue driving, or clinicians can recommend restricted driving such as only driving close to home and in non-busy daylight hours. However, for some the outcome will be that they must cease driving.
If a person with MCI or mild dementia declines an on-road test or cannot afford one, then we need to make the best decision we can based on an extended clinical assessment. This might include a combination of further cognitive testing, consideration of functional capabilities, review of mental and physical health issues, and a focused review of markers indicating that driving safety might be of concern, including inspecting the car. Questionnaires can be administered to both the person and their family. These can be combined with an alternative and cheaper forms of driving assessment, such as the On-Road Safety Test or using an AA driving instructor, but these tests are not as rigorous as the OT driving assessment, nor are they targeted at a potentially impaired group. Nonetheless they may all be helpful in reaching a clinical decision about driving safety. Occasionally neuropsychological tests may be recommended.
The results of these further investigations should then be reviewed and a clinical decision made about driving safety. Although this testing will not provide the same degree of certainty as the results of an OT Driving Assessment, they will inform us in making the best clinical decision we can about the issue of driving safety.
When the clinical decision is for the person to stop driving or restrict their driving, this should be documented and discussed with the person and their family. If they do not comply with this direction, then we are obligated to notify the NZTA under Section 18. If the person continues to drive in spite of having had their licence revoked, we again must notify the NZTA, as well as confronting them and their family. If a person is assessed as safe to drive, then a suitable review period should be defined.
Read more Dementia and driving safety – a clinical guideline Auckland, Counties Manukau, Waitemata and Northland DHBs, NZ, 2014
Other clinical resources
Driving assessment for patients with dementia – a how-to guide Goodfellow MedCases, NZ, 2020
Driving rules and assessment for older people BPAC, NZ, 2010
Regional HealthPathways NZ
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