Driving and Dementia: A Patient & Caregiver Guide

Purpose:
This guide is for people living with dementia (PLWD) and their caregivers to understand how dementia affects driving, recognize safety concerns, plan for transportation alternatives, and approach what can be a very difficult conversation.

1. Understanding Dementia and Driving

Dementia can affect memory, judgment, attention, and reaction times—all critical for safe driving. Not all people with dementia need to stop driving at the same time; it depends on disease progression and individual abilities.

2. Recognizing Unsafe Driving

Warning Signs

Forgetting familiar routes

Failing to observe traffic signs

Poor or slow decision-making in traffic

Driving at inappropriate speeds

Becoming angry or confused while driving

Hitting curbs or poor lane control

Errors at intersections

Confusing brake and gas pedals

Returning from a routine drive later than usual

Forgetting the destination during a trip

3. Alternative Transportation Options

Family and friends

Community shuttle services

Ride-sharing or taxi services

Local senior transportation programs (we can help with finding these!)

4. Emotional Considerations

Driving cessation can be emotionally challenging for both PLWD and caregivers.

Plan and discuss driving early in the disease.

Provide reassurance, emphasize safety, and involve the person in planning alternative transportation.

Seek support from counseling, caregiver support groups, or educational programs.

5. Discussing Driving with Your Loved One

Gaining Buy-In

Assess the person's insight into the problem, influences and whose opinion they respect. (How confident are you in your driving?)

Assess their goals. Do they merely want to get from A to B? Convenience? Feeling of independence? (Where would you like to go if you were driving?)

Assess for their responsiveness to authority, such as the doctor or DMV. (The doctor said that you should not be driving. What do you think about that?)

Leverage empathy for others’ safety, empathy for your own concern and worry. (When you get behind the wheel, it really worries me. What do you think about that?) 

"What's in it for them?" Is there something positive they will value that they can get out of this?

Specific tools & Strategies

Offer alternative transportation immediately

Ask the person to “copilot” with you, when you are driving and they tell you what they would do (while changing lanes, using blinkers, etc.)

If person is able to drive in good conditions/daytime, first transition them by limiting their driving to these periods

Reduce the need to drive by having groceries delivered and holding social gatherings at home

Physician note indicating inability to drive

Offer a driving test ($150-$700) for an objective report. 

• Some driving schools will offer a senior assessment. These may be less “official” in terms of formal evaluation, but may be sufficient to convince someone not to drive. An example is: https://www.drivecarmel.com/senior-driver-assessment.html. 
• More comprehensive fitness-to-drive tests are usually done by occupational therapists and will be more expensive. An example is: https://www.johnmuirhealth.com/services/physical-rehabilitation/adaptive-driving-program.html?

Locking or storing the keys, or removing the key battery

Car “kill switch” (<$100, installed by a mechanic) to temporarily disable the vehicle

Other disablers, including steering column lock

Emergency / Last-Resort Options

Remove keys if possible in imminently dangerous situations

Do not physically fight for keys. If person flees and is felt to be an imminent danger, call the authorities

Relocation or sale of the vehicle

6. Car Key Conversations: Scripts by Behavior & Feeling

Calm but Resistant (“I want to drive”)

“I know driving is important to you. The doctor wants to make sure it’s safe, so for now I’ll drive. Let’s talk with the doctor together about next steps.”

“You’re used to driving, and I understand that. Let’s park the car for today and plan a ride with a friend or me.”

Upset or Angry (“Why are you taking my keys?”)

“I know this feels frustrating and unfair. I’d feel the same. I’m keeping the keys safe because I care about you and don’t want you or anyone else to get hurt.”

“It’s okay to be upset. Let’s take a moment, and I’ll drive us to do something you enjoy.”

Confused / Forgetful (“I don’t know why I can’t drive”)

“You’ve had some near misses lately, and I want to keep you safe. The keys will be safe with me for now, and I’ll drive us today.”

“The doctor asked that we park the car until your next checkup. I’ll help get us where we need to go.”

Denying / Defensive (“I’m a good driver, I don’t need to stop”)

“I know you feel confident. The doctor thinks it’s safest to have a driving evaluation first. In the meantime, I’ll park the car so no one gets hurt.”

“Even great drivers can have accidents when memory or reaction times change. Let’s schedule a driving check and use another way to get around today.”

Sad or Depressed (“I feel like I’m losing my independence”)

“I know giving up driving feels like a big loss. You’re not losing independence — we’ll find safe ways for you to get out and do what you enjoy.”

“I’ll help make sure you can go where you want safely. Let’s plan a ride to your favorite place today.”

Attempting to Drive Despite Warning

“I can’t let you drive right now. I’ll drive us instead. Let’s go do something else.”

Redirect immediately: “Let’s put the keys away and take a walk / get a snack / call a friend.”

If danger is imminent: remove keys discreetly and involve authorities if needed.

Tips for All Situations

Stay calm and steady – your tone affects how they respond.

Keep statements short and clear – long explanations confuse.

Acknowledge feelings first – anger, fear, or sadness is real.

Offer alternatives immediately – rides, activities, or a planned outing.

Repeat consistently – memory issues may require repeated reassurance.