This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility: At some point, all people with dementia must stop driving due to the impact of cognitive impairment on skills critical for safe driving—but when is the right time, and how should this sensitive matter be best approached? Flinders University researchers have investigated the reactions of people with dementia and mild cognitive impairment (MCI) to driving cessation, in the hope of finding a process that best supports the person with dementia.
The research, "Insights from Older People With Dementia and Mild Cognitive Impairment on the Management of Driving Cessation by Health Professionals: A Qualitative Study," has been published in the Australasian Journal on Ageing. "Our aim was to obtain insights into the needs and experiences of older people with dementia or MCI regarding their health professionals' management of driving cessation," says Flinders University doctoral student Claire Spargo, who led the research with colleagues from Flinders' College of Nursing and Health Sciences. In Australia, people with dementia cannot hold an unconditional license but may qualify for a conditional license that is subject to review at least annually.
Health professionals assess a person's fitness to drive, advise the person about the potential impact of their medical condition on driving capabilities and, under mandatory reporting laws, must notify the driver licensing authority if they believe the driver may present a danger to the public. However, what happens if cognitive impairment worsens significantly? Family members must often assume decision-making roles, despite many saying they feel unprepared, lack expertise and fear blame, particularly when the individual lacks insight into cognitive impairment and strongly identifies as a driver.
A family member's willingness to raise concerns may also be constrained by their limited capacity to provide alternative transportation or reliance on the individual for their own mobility. Family members say they often receive conflicting advice from health professionals about a person's suitability to continue driving or that driving cessation is only considered after someone in the family raises concerns. To help find a solution that will address this delicate situation, the researchers interviewed 12 people age 65 or older with dementia or mild cognitive impairment (MCI).
The findings highlight a need for structured and comprehensive communication by health professionals over several phases leading up to driving cessation, followed by improved support for people with dementia and their families. Prepare the person before driving is unsafe: There is great value in health professionals initiating early and ongoing discussions with people and their families about driving cessation. A collaborative decision-making approach should involve an Advance Driving Directive to document the person's preferences for future decision-making about their fitness to drive, including their preferred decision-makers—a GP or medical specialist, with input from family or a friend.
A memory or cognitive clinic can provide a formal assessment if there is no existing diagnosis. If the cause of the cognitive impairment is likely to be progressive, the health professional should advise the person that driving cessation will be necessary in the future. Support early planning to ease the transition to not driving, such as developing new routines and using alternative transportation.
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