A person with dementia will progressively lose the cognitive skills necessary to drive safely. Visual processing, auditory processing, reaction times, way-finding ability, and gross motor skills are required to drive safely. In Mild Cognitive Impairment and the earliest stage of dementia, some people are still driving without risk to themselves or others. But with a degenerative disease, when is it no longer safe to drive, and what is the best way to convince a person to stop driving?

I don’t believe my mother has dementia, but at 87 years of age and hard of hearing, she is running out of road behind the wheel. My sisters and I are concerned about the risks of her continued driving, but she is quite resistant to give up the keys and hire a driver. She is still active and stopping driving would greatly affect her independence and spontaneity.

I recently drove her to her 65^th college reunion. I did all the driving and she didn’t put up much resistance. Which tells me she is aware that the time is nigh. But she seems unwilling to discuss it or admit it. She may equate stopping driving with an admission of cognitive decline, which is a notion she can’t accept. We are trying to discern whether the signals we observe indicate normal aging or something more serious. She’s a little forgetful, but still able to reason just as she always did.

Yet we can’t wait until it’s too late. So I decided to come at this conversation sideways instead of head on. I decided to make it not about her, but other drivers. Let’s face it, Mario Kart did us all a disservice when it taught children that dangerous driving was a game with consequences as unsubstantial as any other video game. The other day I was on the interstate while driving to town. Just as I was about to change lanes to overtake a driver who was going under the speed limit (around Atlanta, it is dangerous to go slower than the prevailing speed of traffic) I glanced in my right side mirror and noticed a car on my right rear quarter panel. In an instant, I saw him disappear! I did not change lanes, just white knuckled my steering wheel as I hoped he would not recklessly hit me. And in the next instant, he had moved into the lane on my left, to overtake me. He was exactly where I was planning to be at exactly the time I had planned to be there! Then he shifted back into my lane before his right rear quarter panel was past my front bumper – doing at least 80 mph.

As I returned home later that day, I witnessed two cars racing up the interstate in rush hour traffic. Dodging and weaving between normal-speed drivers, they must have reached speeds of 85 in places. Making a game of driving endangers everyone. A few miles up the road, three cars were on the right shoulder, with vehicle damage to all. Neither of the racers was on the shoulder, but no police or EMS had arrived yet and so it seemed the wreck had just happened. I suspect the racers caused that wreck.

I told mom the stories as we drove up the interstate to her reunion. I told her about Mario Kart. I told her that I didn’t think she was an unsafe driver, but that I did think she was at risk on the interstate road because of people who went to the Mario Kart “school” of driving. And I pointed out reckless drivers that overtook us.

Later that day, she volunteered that she would re-route her errands to stay on surface roads and avoid driving on the nearby interstate to get around. Rather than pressing her, I gave her the space – and the information – to make the decision for herself.

My takeaway was that making this conversation not about her, but about how bad other drivers are these days. It worked for Mom, she has changed her patterns. She probably should not drive at all, but…baby steps.

I advise my dementia caregiver clients to have a conversation about driving that allows their loved one to be in control. This method asks the loved one in cognitive decline to state, long before the necessary cessation of driving and while they are still able to reason and make good decisions, “At some point, down the road, driving will no longer be practical. How will you know when it’s unsafe to drive anymore? What kinds of events and/or signals should indicate to you that driving has become too risky?” This approach gives them agency and in so doing, is not corrective or demeaning.

Have the loved one ponder this, and either write down or video record their answer(s). This will cement that you’ll be honoring your loved one’s intentions. It will also be useful for dementia caregivers to revisit this documentation periodically so that the loved one can see that it was their decision. If you don’t think their self-determined “end point” to driving is appropriate, try to shift the conversation toward more reasonable, safe end points by taking the approach I used with my mother, and make other drivers the bad guy.

Dementia caregivers who cannot get a loved one to stop driving may hide the car keys, or get a car dealer to provide a different key in the same make and model. Some people disable the car so it is can’t be started. Others simply sell the car. These are last resorts because they take away a loved one’s dignity and create a lot of acrimony in the process. But you may need to go this route in the end, because safety is the most important consideration.

Be prepared to have the driving conversation more than once. And try to be empathetic each time you attempt this difficult topic. Giving up driving is relinquishing independence. No one wants to do that.