By Karen D. Sullivan, Ph.D., ABPP

If you are a caregiver to someone with dementia or living with memory loss yourself, you know there are many important decisions to make along the way. One of the most important decisions is knowing when to stop or limit driving. Most people will struggle with balancing two important issues: the freedom and independence of the individual vs. the responsibility to protect personal and public safety.

People with dementia are 3-5 times more likely to be involved in a car accident than their peers without dementia. There is a general agreement that those diagnosed with moderate to severe dementia should not drive. Recommendations for individuals with mild dementia are much less clear with no “one size fits all” answer.

Given that a common symptom in many dementias is poor awareness of ones own cognitive impairments, family members are often the first to notice a decline in driving ability of a loved one, including the obvious (getting lost in familiar areas, accidents, tickets) and subtler warning signs (aggressive driving habits, new difficulty parking, “riding” the brake). Knowing how and when to express concerns about driving to a loved one is not an easy task. Here are a few ideas to prepare for this difficult conversation:

Communicate your concerns to a trusted medical professional: In a perfect world, the person with dementia would transition from the role of driver to passenger on their own. This does happen but it is rare. Talking with a trusted medical professional can help base this delicate conversation on objective evidence via in-office testing and out of the realm of one person’s opinion, which can be easily disputed. Recommendations about driving can then be reinforced by a non-family member, taking family and caregivers out of the role of “bad guy.”

Consider a driving evaluation: A behind the wheel evaluation is the safest option for determining a person’s ability to safely drive. Anyone, including doctors, can submit a written request to the North Carolina DMV that a driver be evaluated; anonymous requests are not accepted. If restrictions are found to be warranted, they can range from having ones driving privileges revoked completely to restricted, limiting the person to daylight driving only, no interstate driving or driving limited distances (to and from the doctor, church, grocery store).

Do your research and be prepared: The Hartford Financial Services Group, Inc., and the Massachusetts Institute of Technology (MIT) AgeLab have developed an excellent resource guide called, “We Need To Talk” to help conversations about driving safety go smoothly. The Warning Signs Checklist included in the guide is particularly helpful and can be found online.

Put your best foot forward: Conversations about driving can be emotionally loaded and stressful for everyone. Be ready to discuss a pattern of driving concerns, not one or two isolated events, in a respectful tone that conveys your genuine concern for his or her feelings and duty to safeguard everyone’s safety on the road, including your loved one.