When should old people stop driving?

Women More Likely to Hang Up Keys Than Men, Even With Subtle Mental Changes

MINNEAPOLIS – For older adults, knowing when it’s time to stop driving can be a difficult and emotional decision. However, a new study by researchers at Washington University School of Medicine in St. Louis suggests that cognitive function, rather than age or even early signs of Alzheimer’s disease, is the most important factor in determining when seniors choose to retire from driving.

The study, published in an online issue of Neurology, the medical journal of the American Academy of Neurology (AAN), followed 283 participants with an average age of 72 who drove at least once a week. Over the course of 5.6 years, the researchers found that those who developed cognitive impairment or performed worse on cognitive tests were more likely to stop driving than those who maintained normal cognitive function.

“Many older drivers are aware of changes occurring as they age, including subjective cognitive decline,” says lead author Ganesh M. Babulal, PhD, OTD, an associate professor of neurology at Washington University, in a media release. “Doctors should discuss such changes with their older patients. If risk is identified early, there is more time to support the remaining capacity and skills, extending the time they can drive safely, and to plan for a transition to alternative transportation options to maintain their independence when the time comes to stop driving.”

Cognitive impairment was measured using the Clinical Dementia Rating (CDR) scale, which ranges from zero (normal cognitive function) to three (severe dementia). The researchers found that even a slight increase in CDR score to 0.5, indicating mild cognitive impairment, made participants 3.5 times more likely to stop driving compared to those who remained at zero.

Additionally, the study used a more sensitive measure called the preclinical Alzheimer’s cognitive composite (PACC) score, designed to detect subtle cognitive changes in people who still score as unimpaired on the CDR. Lower PACC scores were associated with a 30-percent increased likelihood of stopping driving.

“This study provides further validation for the recommendations of the American Academy of Neurology’s 2010 guideline that progressing to mild cognitive impairment based on the CDR scale increases the risks associated with driving and is when people should be counseled to no longer drive,” says Richard M. Dubinsky, MD, MPH, of the University of Kansas in Kansas City, who wrote an editorial accompanying the study and was an author of the 2010 AAN guideline.

An elderly man getting into a car
The researchers found that even a slight increase in mild cognitive impairment made older adults 3.5 times more likely to stop driving. (Photo by Andrea Piacquadio from Pexels)

Surprisingly, the presence of biomarkers for Alzheimer’s disease in the brain and cerebrospinal fluid, such as amyloid plaques and tau tangles, did not predict the decision to stop driving. This suggests that even the earliest stages of cognitive decline, before Alzheimer’s has fully developed, can impact driving ability.

“Alzheimer’s disease develops over a long time—people may have a 10- to 15-year period where they have no symptoms, but the disease process is developing in the brain,” Babulal explained. “We were looking to see whether older adults with signs of early Alzheimer’s would be more likely to stop driving than people without these signs.”

Perhaps the most striking finding was the gender difference in driving cessation. Women were four times more likely to stop driving during the study than men, even after adjusting for other factors like cognitive function.

“We know from past studies that there isn’t a difference in driving ability between men and women,” Babulal explains. “What we have shown in prior work is that women are often more aware of their abilities, are more willing to admit that they are no longer able to safely drive, and plan more in advance to transition out of driving compared to their male counterparts. It is highly recommended that older male drivers talk with their providers about driving and consider stopping driving earlier.”

The decision to stop driving can have significant impacts on older adults’ mental health and independence. Those who give up their keys are more likely to develop depression and become isolated. However, continuing to drive with impaired cognitive function also poses risks, as older drivers are more likely to be killed or seriously injured in crashes.

Babulal suggests that routine cognitive testing, especially the kind designed to pick up the earliest, most subtle declines, could help older adults and their physicians make informed decisions about driving. By starting the conversation early and providing support like driver rehabilitation programs and community resources, seniors can maximize their safety on the road while also planning for a smooth transition to alternative transportation options when the time comes.

“There are things we can do to help people adapt to age-related changes,” Babulal adds. “Ultimately, most people will need to stop driving, but by starting the conversation early, we can better support older adults’ independence and quality of life.”

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