The conversation you've been dreading is here. Your mom with early-stage dementia insists she's fine to drive, but you've noticed she's missed turns on familiar routes, driven too slowly, and gotten confused at intersections. Your dad became defensive and angry when you suggested he stop driving, saying you're trying to take away his independence. Deciding when someone with dementia should stop driving is one of the most difficult, emotionally charged, and practically complicated challenges families face.
Why the driving conversation is so difficult:
Driving represents independence, identity, and adulthood. For many people, especially those who've driven for 50+ years, giving up driving feels like losing who they are. The person with dementia often lacks awareness of their declining abilities and genuinely believes they're driving safely. Meanwhile, you're caught between respecting their autonomy and preventing them from hurting themselves or others. The stakes couldn't be higher: you're balancing their dignity against public safety.
What makes driving with dementia dangerous:
- Dementia impairs judgment, reaction time, visual processing, attention, and decision-making
- All of these abilities are critical for safe driving
- The person with dementia typically cannot accurately assess their own driving safety
- Risk to the driver, passengers, pedestrians, and other drivers increases as dementia progresses
- Even early-stage dementia can impair driving in ways that aren't obvious to the driver
Key Takeaway:
Understanding when and how to address driving safety protects everyone while helping your loved one maintain dignity and quality of life through other means. Don't wait for an accident—act when warning signs appear.
Warning Signs of Unsafe Driving with Dementia
Certain behaviors indicate driving is becoming or has become unsafe.
Driving behavior red flags:
Getting lost on familiar routes:
If they get confused driving to places they've been hundreds of times (grocery store, church, friend's house), cognitive impairment is affecting navigation.
Example: Your mom drives to the same grocery store she's visited for 20 years but takes a wrong turn and can't figure out how to get there, or gets there but can't find her way home.
Slow reaction time:
Noticeable delays in braking, responding to traffic signals, or reacting to unexpected situations.
Example: Your dad continues through an intersection several seconds after light has turned red, or brakes suddenly because he didn't notice stopped traffic ahead.
Confusion at intersections:
Uncertainty about right-of-way, sitting at green lights, confusion about which lane to be in, or difficulty with turns.
Driving too slowly:
Significantly below speed limit in ways that create traffic hazards. While some older adults drive cautiously, extreme slowness (20 mph in a 45 mph zone) indicates impaired processing.
Misjudging distances:
Following too closely, pulling out in front of oncoming traffic, difficulty parking (hitting curbs, crooked parking).
Missing traffic signs or signals:
Running stop signs or red lights, ignoring yield signs, not noticing pedestrian crossings.
Difficulty maintaining lane position:
Drifting between lanes, driving on shoulder, trouble staying centered in lane.
Near-misses or accidents:
Even minor fender-benders or situations where only others' quick reactions prevented accidents are serious warning signs.
Behavioral signs while driving:
- Anxiety or agitation: Becoming visibly stressed, anxious, or frustrated while driving. White-knuckling the steering wheel.
- Defensive anger: Getting angry when passengers offer navigation help or point out errors.
- Avoiding challenging situations: Refusing to drive at night, in bad weather, on highways, or in unfamiliar areas (compensating for declining abilities).
- Increased honking from other drivers: Other drivers frequently honking suggests they're responding to unsafe driving behaviors.
Physical signs affecting driving:
- Unexplained dents, scrapes, or damage: New scratches, dents, or damage to vehicle that they can't explain or don't remember happening.
- Physical limitations worsening: Stiffness making it hard to turn to check blind spots, vision problems, slowed movements making quick reactions impossible.
For more context on recognizing dementia progression, see our article on signs dementia is getting worse. For comprehensive stage information, see our dementia staging and progression guide.
Medical Assessment of Driving Ability
Don't rely solely on your judgment. Professional assessment is critical.
Doctor evaluations:
Ask the doctor to assess driving safety:
At every appointment, ask: "Is it still safe for [name] to drive?" Make this a standard question throughout dementia progression.
What doctors assess:
- Cognitive function (memory, attention, judgment, processing speed)
- Visual processing and perception
- Physical abilities (reflexes, range of motion, strength)
- Medications that might impair driving
- Insight into own abilities
Limitations of office assessment:
Doctors can't observe actual driving. Someone who seems relatively alert in a 15-minute appointment may be unsafe on the road. Describe specific concerning behaviors you've observed.
Doctor recommendations carry weight:
When doctors say "it's time to stop driving," that external authority helps the conversation. The doctor becomes the "bad guy" rather than family.
Formal driving evaluations:
Occupational therapy driving assessment:
Certified driving rehabilitation specialists conduct comprehensive evaluations including:
- Clinical assessment of cognitive and physical abilities
- Behind-the-wheel evaluation in controlled settings
- Written report with specific recommendations
- Sometimes recommendations for adaptive equipment or limited driving (daytime only)
Where to find evaluations:
- Ask doctor for referrals to certified driving rehabilitation specialists
- Contact AOTA (American Occupational Therapy Association)
- Some DMVs offer or require driving tests for medical concerns
Cost considerations:
Driving evaluations typically cost $300-500 and often aren't covered by insurance. However, objective professional assessment is worth the cost for the information and documentation it provides.
Benefits of formal evaluation:
- Removes family from the "bad guy" role
- Provides objective, professional assessment
- Creates documentation for legal purposes
- Sometimes extends safe driving with recommendations
- Helps person with dementia accept limitations when it comes from professionals
DMV reporting requirements:
- Varies by state: Some states require doctors to report dementia diagnoses to DMV. Others leave reporting to family. Check your state's requirements.
- Voluntary reporting: Even where not required, family members can report unsafe drivers to DMV in most states. DMV may require re-testing or medical evaluation.
- License revocation: DMV has authority to suspend or revoke licenses when medical conditions impair safe driving.
For guidance on discussing medical concerns, see our questions to ask doctor after dementia diagnosis article.
When Different Dementia Types Affect Driving
Different types of dementia impair driving abilities in different ways and timelines.
Alzheimer's disease and driving:
- Early-stage Alzheimer's: Some people can drive safely in early stage, though abilities decline. Frequent re-evaluation is essential.
- Typical timeline: Most people with Alzheimer's need to stop driving within 1-3 years of diagnosis, though this varies.
- What fails first: Navigation and wayfinding (getting lost), divided attention (can't monitor multiple things simultaneously), decision-making in complex situations, slower processing of information.
- When to stop: When getting lost on familiar routes, showing confusion or delayed reactions, missing signs or signals, or doctor recommends stopping.
Vascular dementia and driving:
- Often needs to stop earlier: Strokes that caused vascular dementia may have affected areas controlling visual processing, attention, or motor control.
- Physical impairments: Weakness on one side, visual field deficits, or slowed reactions from stroke damage may make driving impossible even in early dementia.
- Sudden changes: New strokes can suddenly make previously safe driver unsafe immediately.
For detailed vascular dementia information, see our vascular dementia symptoms and care guide.
Lewy body dementia and driving:
Often need to stop very early:
Lewy body dementia impairs abilities critical for driving:
- Visual processing problems
- Fluctuating attention and alertness
- Movement difficulties (Parkinson-like symptoms)
- Visual hallucinations
Dangerous combination:
Someone with Lewy body dementia might see things that aren't there while driving, have sudden episodes of confusion, or experience movement freezing.
General recommendation:
Most people with Lewy body dementia should stop driving at or shortly after diagnosis due to unique risks.
For comprehensive Lewy body dementia care, read our Lewy body dementia family care guide.
Frontotemporal dementia and driving:
Behavioral symptoms create dangers:
FTD affects judgment, impulse control, and social awareness before memory:
- Risky driving behaviors (speeding, aggressive driving)
- Poor judgment about safety
- Impulsivity
- Lack of awareness of problems
Often needs to stop early:
Behavioral changes and lack of insight make FTD patients particularly dangerous drivers even when memory is relatively intact.
For detailed FTD information, see our frontotemporal dementia behavior changes guide.
Having the Conversation About Stopping Driving
How you approach this conversation significantly impacts the outcome.
Timing the conversation:
- Don't wait for an accident: Have the conversation when you first notice concerning signs, not after someone gets hurt.
- Early conversations: In early-stage dementia while person still has some insight, introduce the topic: "At some point, dementia may affect your driving. Let's agree now that we'll work together to assess this regularly and that you'll stop when it's no longer safe."
- When it's time: If multiple warning signs exist or doctor recommends stopping, don't delay the conversation further.
Framing the conversation:
- Use external authority: "Dr. Smith said the dementia has progressed to where driving isn't safe anymore" is easier than "I don't think you should drive."
- Focus on others' safety: "I'm worried you might accidentally hurt someone" can be more effective than "you might get hurt."
- Acknowledge difficulty: "I know how important driving is to you and how hard this is. This must feel really unfair."
- Offer solutions: "Let's figure out together how to make sure you can still get where you need to go."
Sample scripts:
If they have some awareness:
"Dad, I've noticed some things lately that worry me about your driving: you've gotten lost twice going to familiar places, you missed that stop sign last week, and the car has some new dents. I'm concerned the dementia is affecting your driving safety. I think it's time to have Dr. Johnson evaluate whether it's still safe for you to drive. If the doctor says it's time to stop, let's work together to find other ways to get you around."
If they lack insight:
"Mom, Dr. Chen says your dementia has progressed to where she doesn't think it's safe for you to drive anymore. I know you disagree and this feels unfair. But we need to follow the doctor's recommendation. We're going to figure out transportation so you can still do everything you want to do, just not by driving yourself."
If they become angry:
Stay calm. Acknowledge feelings without backing down: "I understand you're angry. This is a really difficult change. But I can't risk you hurting yourself or someone else. We'll get through this together."
For more communication strategies, see our guide on how to talk to someone about memory problems.
Taking Away the Keys: Practical Strategies
Sometimes talking doesn't work and you need to physically prevent driving.
If they agree to stop driving:
- Remove temptation immediately: Take car keys and secure them where they can't find them. If they have spare keys, get those too. Consider disabling vehicle or moving it off property.
- Don't assume agreement today means compliance tomorrow: They may forget the agreement.
- Create visible reminder: Post note on key hook: "You don't drive anymore. Call [your name] for rides."
- Celebrate the decision: "Thank you for making this responsible choice. I know it's hard."
If they refuse to stop:
Strategies that work:
- Hide all keys: Every set, including spares. Check drawers, coat pockets, garage.
- Disable the vehicle: Remove battery, remove distributor cap or spark plugs, use club on steering wheel, disconnect starter.
- Move the vehicle: Park at a friend's house or storage facility out of sight.
- Blame the car: "The car needs repairs and won't be drivable for a while." Keep "repair" timeline indefinite.
- Involve doctor: Ask doctor to write a prescription or official letter: "[Name] is not medically cleared to drive due to dementia."
- DMV reporting: Report unsafe driver to DMV. License suspension provides external authority backing your decision.
- Sell or donate the vehicle: Most definitive solution. If they ask, "The car died and wasn't worth repairing."
When they try to drive anyway:
- They're looking for keys: Redirect: "Let's have coffee and I'll drive you later." Don't argue about keys.
- They insist they need to drive somewhere: "Where do you need to go? I'll take you" or "We can go together after lunch."
- They become agitated: Stay calm. Distraction often works better than confrontation: "Did I tell you about [topic]?" or "Help me with [task] first."
- They take someone else's keys: All family members should hide their keys when visiting.
Legal protection:
Document everything:
- Doctor recommendations to stop driving
- Incidents, near-misses, accidents
- Your efforts to stop driving
- Date keys were taken
Liability concerns:
If they drive and cause accident after you knew driving was unsafe, you could face liability. Taking keys protects everyone legally and physically.
Transportation Alternatives
Stopping driving doesn't mean stopping independence if alternatives exist.
Family and friends:
- Coordinate family drivers: Create schedule where different family members provide transportation on specific days
- Establish routine rides: Regularity helps: "I'll pick you up for church every Sunday at 9am"
- Recruit friends and neighbors: Many friends willing to provide occasional transportation
Ride services:
- Rideshare apps (Uber, Lyft): If your loved one can use smartphone, rideshare is convenient
- Taxi services: Traditional taxis work for those not comfortable with apps
- Senior transportation services: Many communities have specialized transportation with door-to-door service and assistance
- Medical transportation: For medical appointments, check if insurance covers non-emergency medical transportation
Community resources:
- Senior centers: Many provide transportation to/from the center and on outings
- Faith communities: Churches, synagogues, mosques often have volunteer driver programs
- Area Agency on Aging: Contact local agency for senior transportation resources
- Public transportation: If available and they can manage it, buses or trains with familiar routes
Hired drivers:
- Professional caregivers: In-home care agencies often include transportation as service
- Private drivers: Hire someone specifically to drive (consider background checks)
Delivery services:
Reduce need for transportation:
- Grocery delivery
- Meal delivery
- Prescription delivery (most pharmacies deliver)
- Online shopping
- Telemedicine appointments when appropriate
For more about maintaining independence, see our article on early stage dementia what to expect.
Helping Them Adjust to Not Driving
Loss of driving requires significant emotional adjustment.
Acknowledge the grief:
- This is real loss: Driving represents independence, adulthood, spontaneity, identity. Losing it is genuinely difficult.
- Validate feelings: "I know this is really hard" and "I understand you're angry/sad" acknowledge the difficulty without changing the decision.
- Don't minimize: Saying "it's not that bad" or "you didn't drive that much anyway" dismisses their legitimate grief.
Maintain independence through other means:
- Reliability matters: Promised rides that don't materialize are worse than no promises. Follow through consistently.
- Spontaneity when possible: "Want to go get ice cream?" maintains some spontaneity even without driving.
- Control in other areas: They've lost control over transportation. Let them control other aspects of life: what to eat, what to wear, how to spend time.
Gradual adjustment:
- First weeks are hardest: Expect anger, sadness, repeated arguments about driving. This improves with time.
- Creating new routines: New patterns for getting places become familiar and less distressing.
- Focusing on maintained abilities: Emphasize what they can still do independently rather than dwelling on driving loss.
When they forget they can't drive:
In later stages:
May forget they're not supposed to drive and look for keys or ask to use the car.
Responses:
- "The car's in the shop"
- "We don't need the car today; I'm driving"
- Distraction and redirection rather than explanations they won't remember
For more on communication as dementia progresses, see our dementia stages explained for caregivers guide.
Legal and Insurance Considerations
Understanding legal implications protects everyone.
Liability if accident occurs:
- Your responsibility: If you know driving is unsafe and allow it to continue, you may be held liable for damages if accident occurs
- Estate liability: The estate of person with dementia may be liable for damages from accidents
- Protection: Taking keys, disabling vehicle, reporting to DMV all document your efforts to prevent unsafe driving
Insurance coverage concerns:
- Undisclosed medical conditions: Driving with undisclosed dementia diagnosis may void insurance coverage
- License suspension: If license is suspended but they drive anyway, insurance won't cover accidents
- Reduced coverage: Some insurers drop or restrict coverage when dementia is disclosed
Reporting obligations:
- Check state laws: Requirements for reporting medical conditions to DMV vary
- Family reporting: Most states allow family members to report unsafe drivers to DMV anonymously
- After accidents: Accidents may trigger automatic DMV review of driving fitness
How CareThru Helps Manage the Driving Transition
Decisions about driving require documentation and coordination.
Documenting concerns: Log specific driving incidents with dates and details: "Got lost driving to church on Sunday October 15, 2024. Took 45 minutes to find way home from familiar 10-minute route."
Tracking progression: Regular notes about cognitive and physical abilities show decline over time, supporting decisions about when to stop driving.
Communication with family: Share documented incidents with family members who may not witness driving problems, building consensus about safety concerns.
Medical appointment preparation: Pull up specific examples to share with doctors when discussing driving safety. Concrete incidents are more useful than vague concerns.
Transportation coordination: Once driving stops, organize family member schedules, hired driver arrangements, and transportation needs in one place.
Preserving independence: Track activities, appointments, and social engagements to ensure transportation loss doesn't lead to isolation or missed important activities.
The platform doesn't make the driving decision, but it provides documentation and coordination that support safe transitions.
Frequently Asked Questions About Dementia and Driving
Should someone with dementia ever be allowed to drive?
In very early-stage dementia, some people can drive safely with frequent monitoring. However, dementia is progressive and eventually makes driving unsafe for everyone. The question isn't if they should stop, but when. Require regular medical and driving evaluations, watch for warning signs, and be prepared to stop driving when concerns emerge. Err on side of safety given stakes involved.
How do I convince someone with dementia to stop driving when they insist they're fine?
Use external authority (doctor's orders), focus on safety of others, involve professionals in assessment so it's not just your opinion, and ultimately may need to physically prevent driving by taking keys or disabling vehicle. Recognize they may never agree or understand, which is a symptom of dementia. Your responsibility is keeping them and others safe, not getting their agreement.
What if they drive and I'm in the car with them?
If you have concerns, don't get in the car as passenger. Your presence as passenger validates that driving is safe and puts you at risk. Offer to drive instead. If they insist, make an excuse why you can't go or take separate transportation. Never let children ride with someone who drives unsafely.
Can someone with dementia take a driving test to prove they're safe?
Formal driving evaluations by certified specialists are more appropriate than standard DMV tests. These comprehensive assessments evaluate both cognitive abilities and actual driving. If evaluation shows unsafe driving, accept those professional findings. If evaluation says safe to continue with restrictions (daytime only, familiar routes), follow up frequently as dementia progresses.
Is it illegal to drive with dementia?
Dementia diagnosis alone doesn't automatically make driving illegal, but driving while impaired is illegal. If dementia impairs judgment, reaction time, or decision-making to dangerous levels, continuing to drive is illegal regardless of license status. Additionally, driving with suspended license (which can happen after medical reporting) is illegal.
What if they need to drive for work?
If still working, dementia that affects driving ability likely also affects job performance. Most people with dementia significant enough to impair driving should stop working as well. Discuss with employer about work accommodations, disability leave, or retirement. Safety concerns override employment needs.
How do you take car keys from someone who becomes violent or aggressive?
Safety first. If they become physically aggressive, involve medical professionals or law enforcement. Some options: disable car without their knowledge so it won't start (they may give up after unsuccessful attempts), move car to location they can't access, get doctor to order driving cessation, involve DMV to suspend license, or as last resort consider guardianship proceedings if they lack capacity to make safe decisions and are dangerous.
What if they live alone and stopping driving means they're stranded?
This is genuinely challenging but doesn't change the safety imperative. Before taking keys, establish transportation alternatives: family member schedules, hired drivers, senior transportation services, delivery services. In some cases, inability to safely drive and lack of alternative transportation means living alone is no longer safe option, requiring move to accessible location or residential care.
Disclaimer: This article provides general guidance about dementia and driving safety and is not a substitute for professional medical, legal, or driving assessment. Driving decisions should involve healthcare providers, sometimes formal driving evaluations, and consideration of individual circumstances. Laws vary by state regarding medical reporting and license revocation. Always prioritize safety of driver, passengers, pedestrians, and other drivers.
Sources
- Alzheimer's Association. (2024). "Dementia and Driving." Available at: https://www.alz.org/help-support/caregiving/safety/dementia-driving
- American Academy of Neurology. (2010). "Practice Parameter Update: Evaluation and Management of Driving Risk in Dementia." Neurology, 74(16), 1316-1324.
- National Highway Traffic Safety Administration. (2024). "Older Drivers." Available at: https://www.nhtsa.gov/road-safety/older-drivers
- Carr, D. B., & Ott, B. R. (2010). "The Older Adult Driver with Cognitive Impairment." JAMA, 303(16), 1632-1641.
- Man-Son-Hing, M., et al. (2007). "Systematic Review of Driving Risk and the Efficacy of Compensatory Strategies in Persons with Dementia." Journal of the American Geriatrics Society, 55(6), 878-884.
- American Occupational Therapy Association. (2024). "Driving and Community Mobility." Available at: https://www.aota.org/practice/productive-aging/driving
- Iverson, D. J., et al. (2010). "Practice Parameter Update: Evaluation and Management of Driving Risk in Dementia." Neurology, 74(16), 1316-1324.
- Molnar, L. J., et al. (2013). "Driving Cessation in Older Adults: A Systematic Review." Transportation Research Record, 2318(1), 1-9.
- Family Caregiver Alliance. (2024). "Dementia and Driving." Available at: https://www.caregiver.org/resource/dementia-and-driving/
- Adler, G., & Kuskowski, M. (2003). "Driving Cessation in Older Men with Dementia." Alzheimer Disease & Associated Disorders, 17(2), 68-71.