Driving & Dementia: OT Strategies for Evaluation & Intervention

With the changes the dementia disease process causes in the brain, it is no surprise that the ability to drive would be affected.

Current research related to individuals with dementia and driving indicates that it is not a matter of if they should stop driving, but when they should they stop driving. Therefore, in this population, it is most important to initiate conversations about driving and driving retirement as early as possible to promote a smooth transition to driving retirement and avoid any driving related problems. This can be especially challenging as dementia affects a client’s ability to rationalize and understand the effects of the disease on task performance.

In addition, while driving retirement may be a clear decision for those with moderate to severe dementia, it can be more difficult for the individual with mild dementia who may be able to compensate for cognitive changes with muscle memory. Because of this, objective measures and assessment tools that specifically target elements of executive functioning, like the BCAT, become important.

As the OT, addressing driving for clients with dementia maybe a challenge as you work to balance the impact of the dementia process with the need to promote engagement and preserve the functional abilities that support independence.

To gain confidence in working with this population:

  • Connect with other team members, such as the physician, to better understand the diagnosis and progression of the disease process
  • Review the medications being used to treat dementia
  • Thoroughly assess cognition in conjunction with observations of ADLs & IADLS
  • Take time to understand the client’s current D&CM habits and support system
  • Provide driving retirement support
  • Engage in mentorship with a DRS
  • Provide support and opportunities for having productive, positive conversations for driving transitions
  • Work with families and support groups to identify alternative transportation plans
  • Work with the client over a period of time. Driving retirement is not a single conversation. Just like job retirement is a plan that takes years, driving retirement task time, conversations, and support.

Finally, remember mild cognitive impairment is not dementia, and while it may be a precursor, not all individuals with MCI advance to dementia. Individuals with MCI benefit greatly from occupational therapy services and routine evaluation from a driver rehabilitation specialists

These resources can help guide the education with our clients with dementia and their family members.

Caregiver Resources for Driving Retirement

  • Hartford: Warning Signs for Drivers with Dementia: this is a checklist for client and families to use to identify driving performance that may be a concern
  • Hartford: At the Crossroad – Family Conversations about Alzheimer’s Disease, Dementia & Driving: this resource is geared towards family members and/or caregivers, and will help to support driving retirement conversations
  • Hartford: Conversation Planner (Caregivers): this resource is geared towards family members and/or caregivers, and will help to support driving retirement conversations
  • Am I a Safe Driver?: This resource can also be completed by the family and/or caregiver
  • Hartford: We Need to Talk – Family Conversations with Older Drivers
  • NTSHA Video: Driving with Alzheimer’s Disease
  • Driving Retirement Strategies Specific for Dementia
  • Use Driving & Community Mobility Habits Questionnaire to determine baseline habits
  • Support caregivers in removing the temptation to drive
  • Work with caregivers to provide both planned and spontaneous outings
  • Support with supervised transportation; with this population it is not appropriate to teach a new mode of transportation or to allow them to participate in D&CM independently.
  • Educate caregivers on concerns with wandering

Susie Touchinsky

Susie Touchinsky, OTR/L, SCDCM, CDRS is an occupational therapist and certified driver rehabilitation specialist offering decades of experience, knowledge, and professional support for drivers, families, caregivers, and practitioners.