Clinical psychologist Linda Ercoli discusses ways for caregivers to handle driving and dementia, from spotting the warning signs of dangerous driving, to holding family discussions, to planning for alternative transportation.
For many people, the ability to drive offers a sense of freedom. But for those living with dementia, driving at some point becomes unsafe, and family conversations about giving it up can be deeply emotional for all involved. There are, however, strategies to hold meaningful discussions and limit or stop a loved one from driving while staying attuned to their safety and emotions, according to Linda Ercoli, a professor of psychiatry and bio-behavioral sciences at UCLA.
Being Patient sat down with Ercoli to discuss ways to balance a loved one’s sense of independence with safety when it comes to driving with dementia.
1. How do you talk to a loved one about when it might be time for them to stop driving?
Conversations with loved ones about driving can be so difficult, Ercoli said families often avoid these conversations for too long, either allowing a person to continue driving even when caregivers believe it is unsafe, or making the decision to stop an individual from driving without involving them in the discussion at all. Ercoli encouraged people to express their honest opinions and ease into conversations with the individual, keeping in mind that driving is often a source of self-esteem and autonomy for people.
“To tell somebody, ‘You’re really not a safe driver anymore. I don’t want you to drive. It’s time to give it up. Turn in the keys,’ is a real threat to somebody’s independence,” Ercoli said. “It also can be a threat to someone’s dignity.”
People can first go on casual ride-alongs with a loved one, she noted. They should observe the person’s driving behaviors, assess whether there are patterns of poor driving decisions, and discuss their thoughts after the ride-alongs. Isolated or minor incidents don’t necessarily warrant immediate action, but people should consider the frequency and severity of the incidents.
Looking Out For Signs of Dangerous Driving
According to Ercoli, intersections and turns are some of the highest risk situations for a person with dementia who is driving. The individual may turn left into oncoming traffic without yielding the right-of-way, or fail to notice a pedestrian on a crosswalk while turning. Other redflags include driving too slow and failing to keep up with the flow of traffic, getting lost in familiar places and running stop signs. One of the most dangerous signs involves confusing the brake and gas pedals.
Listening To the Voices of Loved Ones and Health Care Professionals
While it is critical for families to voice their concerns and take action, Ercoli said it is equally important to allow the person with dementia to express their sense of their driving abilities and feelings of losing the privilege of driving.
She suggested one way of broaching the topic: “‘Mom, I got really scared the other day when you made that left hand turn and almost got into a head on with someone. Maybe we can have some talks about how you’re feeling about your driving because I wouldn’t want anything bad to happen to you or anyone else.’”
Friends and relatives should share their worries as well, Ercoli said. Recommendations from health care professionals are also critical to help inform the individual about their driving abilities.
Starting Discussions Early On
Ideally, Ercoli said families should begin conversations about driving before a person experiences physical and cognitive impairment. Families could sign an agreement and designate a trusted individual to tell the person, at the appropriate time, that they have to restrict or cease driving. It is not a legal contract, but the contract opens up the opportunity for families to prepare for the future. Ercoli said it can also remind a person, who later develops dementia, about the steps they have agreed to take when they can no longer drive safely.
A helpful resource, she said, is a guidebook by the Hartford Center for Mature Market Excellence and the MIT AgeLab with advice and templates to navigate driving and dementia.
2. When is it time for more drastic action?
According to Ercoli, families should consider taking more extreme measures if the person is unaware that they are a dangerous driver, and unwilling to change their driving habits or stop driving. She said families may resort to confiscating the car key, reporting the person to the Department of Motor Vehicles, or disabling the car.
Another option, Ercoli suggested, involves selling the car and telling a loved one that it’s under repair. While many people are hesitant to tell a white lie, or a ‘therapeutic fib,’ Ercoli said it is sometimes a kinder, more gentle approach for a person with moderate or severe dementia, compared to informing them that the family has confiscated their car keys. She added that families should remember what’s at stake: the person’s life, as well as the lives of others.
“You have to think about the safety of your loved one, first of all, and the safety of other people that may be harmed,” Ercoli said. “We know of really sad and horrible stories of people who drive and shouldn’t be driving. They get into a collision. They get hurt, or kill themselves or someone else, or they could end up lost and end up not being found or being found after they’ve been exposed to the elements.”
3. When driving is no longer safe, what are some transportation alternatives?
As people discuss the issue of driving with a loved one, Ercoli said they should also plan for and present alternative transportation. Friends, family members or neighbors can offer to drive the person with dementia. For those with mild dementia who are familiar with the transit system and live in urban areas, public transportation may be another option. However, Ercoli cautioned that public transportation won’t be appropriate for people who become disorientated easily.
Alternatively, taxis and rideshare services like Uber or Lyft could be reliable forms of transportation. Ercoli suggested using GoGoGranparent, which helps older adults use Lyft and Uber with a phone call instead of an app. Van services provided by Access can also be an option for those living in the area of Los Angeles.
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