Dementia - driving and travelling

A diagnosis of dementia does not always mean that the person is immediately unable to drive. Dementia produces a progressive and irreversible loss of mental functioning, which means that at some stage, the person will need to stop driving.

Dementia can cause loss of memory, limited concentration and insight problems. This affects a person’s judgement and ability to drive safely. When their driving ability is affected, the person with dementia will be a risk to themselves and to others.

Laws about driving with dementia

All drivers have an obligation to tell their licensing authority of any medical condition that might affect their ability to drive safely. Diabetes, some heart conditions and dementia are all medical conditions that need to be disclosed, because of their potential effect on a person’s driving ability.

The licensing authority will generally advise the driver to see a doctor, who will make an initial assessment of the driver’s medical fitness. After this, a formal driving assessment with an occupational therapy driver assessor may be required. Based on the result of any on-road driving test, medical advice and other information, the licensing authority will decide if the person can retain their driver’s licence.

Sometimes, a driver can continue to drive independently with a condition on their licence. These conditions might be that they can only drive close to home, at certain times or within certain speed limits. However, conditions can only be applied if the driver is likely to remember them.

Regular medical and driving tests will be needed, as dementia will cause a person’s ability to decline over time. While many factors contribute to safety on the road, driver health is an important consideration. Drivers must meet certain medical standards so that their health does not increase the likelihood of an accident.

In March 2012, new medical standards and clinical management guidelines came into effect for drivers of private and commercial vehicles. The standards are contained in the document Assessing Fitness to Drive 2012, which can be found on the Austroads website.

Reactions of people with dementia when they must stop driving

The aim of caring for someone with dementia is to support their maximum level of independence. For people living alone or in remote areas of the country, it can be especially difficult to manage without driving. Not being able to drive a car can be a threat to the independence of many people. For someone in the early stages of dementia, making the decision to give up driving may be quite challenging.

While some people will recognise their declining ability, others may not, or may simply forget that they are no longer safe to drive. For others, it will be a relief to be rid of the responsibility of driving.

Signs that dementia is affecting driving ability

To decide whether a person still has the ability to drive safely, consider their:

• vision– can they see things coming straight at them or from the sides, do they respond appropriately to stop and traffic signs and signals?
• hearing – can they hear the sound of approaching cars, car horns and sirens, and do they pay attention to these when in the car?
• reaction time–can they turn, stop or speed up their car quickly?
• problem solving – do they become upset and confused when more than one thing happens at the same time?
• coordination – have they become clumsy and started to walk differently, because their coordination is affected?
• alertness– are they aware of, and understand, what is happening around them?
• left and right–can they tell the difference?
• memory and confusion– do they become lost or confused on familiar routes?
• stop and go – do they understand the difference between stop and go coloured traffic lights?
• route finding – can they read a road map and follow detour routes?
• steering– are they able to stay in the correct lane and veer, change lanes or merge when required?
• mood – has their mood changed when driving? Some previously calm drivers may become aggressive or angry.

Changes in driving behaviour may have been occurring for some time without being noticed.

If you have concerns about a person’s ability to drive, try speaking to them or their doctor. You can also contact the driver licensing authority in your state or territory to discuss your concerns.

In Victoria, the driver licensing authority is VicRoads. The driver licensing authority may contact the driver and advise that a medical and driving test are necessary.

Talking with a person with dementia about driving

It is important to realise that very few people want to voluntarily stop driving and this is also the case for most people with dementia.

Some suggestions for when and how to raise concerns about driving include:

• Discuss the person’s driving when everyone is calm.
• Have the discussion when there have been changes in medications or health status, rather than a driving incident.
• Have short and frequent conversations, which are better for most people with dementia than a long one-off discussion.
• Concentrate on the person’s strengths and the positive aspects of other options.
• Acknowledge that giving up driving is hard to do.
• Normalise the situation by pointing out that everyone will have to stop driving at some point.
• Focus on the nature of the disease – many people with dementia have very safe past driving records, but this has no bearing on their safety as a driver with dementia in the future.
• Focus on the financial benefits of selling the car.
• Be respectful and try to understand how the person with dementia will be feeling.
• Offer to support the driver by driving them to appointments, social gatherings, shops and services.

If all else fails, you may need to hide the keys or remove or immobilise the car.

Support for families and carers

Dealing with driving issues can be difficult for some people with dementia and their families and carers. If you would like assistance or to speak to someone about your particular situation, you can contact the National Dementia Helpline or the Dementia Behaviour Management Advisory Service (DBMAS).

Travelling with a person with dementia as a passenger in a vehicle, plane or train

Many families and carers have happy and fulfilling times travelling with a person with dementia, but travel can also present a number of hazards and challenges. It is usually better to travel in the early stages of the illness, as later on, the person may become disoriented, agitated or distressed when travelling as a passenger in a vehicle.

Although people with dementia generally do best in well-ordered, familiar and stable settings, travel can be successful if the conditions are right and you undertake some thoughtful planning.

Warning signs against travel

Signs indicating that travel with a person with dementia as a passenger is inappropriate may include:

• consistent disorientation or agitation in familiar settings
• wanting to go home when away from home on short visits
• delusional, paranoid, aggressive or disinhibited behaviour
• problems managing continence
• teary, anxious, withdrawn behaviour in crowded, noisy settings
• agitated or wandering behaviour
• disregard for safe pedestrian behaviour near roads, traffic or other pedestrians
• non-compliance with wearing seatbelts.

If any of these signs are present, it may mean that travel as a passenger in any type of vehicle, train or plane is not a good idea.

If the travel is unavoidable, it is advisable to consult a specialist to explore whether medication may be useful to settle the person. Being a familiar and reassuring companion is the first consideration.

If none of the above signs are present, it may still be useful to undertake a ‘trial run’ by taking a short trip using the type of transport that is planned for the longer trip. This will help establish the person’s travel capacity. It will also give a good idea of whether to pursue the original plan or not.

Managing travel with people with dementia

Suggestions that can help to make travel more enjoyable for everyone include:

• Be prepared to be fully responsible for the person with dementia – this can be taxing, so try to get plenty of rest before the trip.
• You need to keep hold of all important possessions – passports, money, schedules and tickets.
• Encourage the person with dementia to wear an identification bracelet at all times. Make sure that the following information is also in their wallet or purse: name, address and phone number of your away-from-home address. Mark all clothing with their name.
• Take a list of important contacts, such as doctors and family.
• Remember to take enough medications to cover the period of travel, as well as prescriptions.
• Take a list of recent and current medications, which may be helpful if the person with dementia becomes unwell.
• If travelling by plane, consider notifying the airline that you are travelling with a person with dementia and ask staff for assistance.
• Take steps to provide a safe away-from-home environment – such as locking the door and leaving the bathroom light on all night.

Travelling by car with a person with dementia

When travelling by car, things to consider include:

• Whether the person is comfortable in the seat, especially when travelling for long distances
• Whether the person needs help fastening and unfastening their seat belt
• The safety of the person when getting out of the car, especially when parking near traffic
• The person’s state of mind – do not drive alone with a person who is agitated because your safety, as well as theirs and that of other people using the roads, may be at risk.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers