Mentally unfit to drive? Most older adults with cognitive impairment are still on the road

ANN ARBOR, Mich. — Troubling new research suggests doctors and caregivers alike should be having far more stern conversations with older adults dealing with cognitive impairment when it comes to their driving habits. Scientists at the University of Michigan report most older adults with signs of cognitive impairment continue to drive, even when the people in their lives voice concerns.

These conclusions are based on an analysis of over 600 adults more than 65 years-old in Nueces County, Texas, all of whom had cognitive assessment scores indicating at least a likelihood of impairment. Among those with cognitive impairment, 61.4 percent were still driving on a regular basis. Moreover, roughly one-third of all caregivers expressed concerns about their care recipient driving.

“It is likely appropriate that some with mild cognitive impairment are still driving, but for some it may not be,” says senior study author Lewis B. Morgenstern, M.D., professor of neurology, neurosurgery and emergency medicine at University of Michigan Medical School and professor of epidemiology at the U-M School of Public Health, in a university release.

“Patients and caregivers should discuss these issues with their health care providers and consider on the road driving evaluations to ensure safety.”

Roughly one in nine Americans over the age of 65, or 6.7 million people, are living with Alzheimer’s disease, the most common type of dementia, according to estimates. Millions more have been diagnosed with other forms of the disease.

Such conditions affect neuropsychological and visual skills, consequently reducing one’s capacity to drive safely. The researchers report that a 2017 review of motor vehicle crash risk determined that dementia had “medium to large” effects on driving impairment. That same project also reported people with dementia have an increased likelihood of failing a road test in comparison to those without.

An elderly man getting into a car
(Photo by Andrea Piacquadio from Pexels)

Study authors initially wanted to study the driving prevalence of older Latino and non-Latino White adults but found no notable difference between the two populations. However, the more cognitive impairment any person displayed, the less likely they were to be driving.

Just over 35 percent of caregivers in the study shared concerns about their care recipient’s ability to drive safely, despite many study participants limiting their total amount of driving and avoiding driving at night or in the rain.

Discussions between caregivers and people with cognitive impairment about driving are often difficult. Older individuals don’t want to lose their autonomy, and the prospect of giving up on driving may seem embarrassing to many. Also, when a person with cognitive impairment stops driving, it usually means more work for their caregiver.

The research team recommends that it’s best to start conversations surrounding driving as early as reasonably possible. That way, the care recipient will be able to understand and actively participate in the discussion.

“Close family may have discussions with aging loved ones about Advance Driving Directives,” Dr. Morgenstern concludes. “These are agreements between an aging person and a loved one about having conversations about driving cessation.”

The study is published in the Journal of the American Geriatrics Society.

YouTube video