Dementia and Driving Safety: 10 Questions Every Family Caregiver Asks

Introduction: Why This FAQ Exists

Driving is one of the most emotionally charged decisions families face after a dementia diagnosis. The stakes are high: drivers with cognitive impairment are more than twice as likely to be involved in a collision compared to same-age adults without dementia, according to the Safety in Dementia driving FAQ. In 2022, 7,870 adults aged 65 and older died in traffic crashes in the United States — the highest annual figure since federal record-keeping began in 1975, reports the Governors Highway Safety Association. Yet most families navigate the decision about when to stop driving without a single, authoritative reference, relying instead on instinct, argument, and crisis.

This FAQ brings together evidence from the National Institute on Aging, the Alzheimer's Association, the American Academy of Family Physicians, state transportation authorities, and clinical research to answer the ten questions caregivers ask most often. Each response is designed to be immediately useful, with links to deeper guides when you need more detail. For a broader view of what early-stage dementia means for daily routines and planning, see the Early-Stage Alzheimer's Care Guide for Family Caregivers.

1. Can my parent still drive after a dementia diagnosis?

Some people in the very earliest stages of dementia may still be able to drive safely for a limited period, but the window is narrow and risk escalates quickly. Research published in Family Practice Management (AAFP, 2025) found that as many as one in three people with mild dementia fail a behind-the-wheel driving test, and 70% of patients with early vascular dementia do not pass on-road assessments. Most drivers with dementia need to stop driving within approximately three years of diagnosis, according to DementiaCareCentral. The key takeaway: you cannot rely on the absence of obvious incidents to confirm safety. Structured assessment is the only reliable path. For a deeper exploration of how dementia affects driving ability and how to approach the decision, see our dedicated guide: Is It Safe for Someone With Dementia to Drive?

2. What are the warning signs it’s no longer safe?

Family members often notice changes well before a collision occurs. The following signs, drawn from the National Institute on Aging, the Alzheimer’s Association, the Family Caregiver Alliance, and Safety in Dementia, warrant attention — especially if more than one is present:

• Getting lost on familiar routes, such as the drive to the grocery store or a regular doctor’s appointment
• New dents, scrapes, or unexplained damage to the vehicle
• Confusing the brake and gas pedals or mistaking the turn signal for the windshield wipers
• Failing to observe traffic signs, signals, or yield rules
• Driving too slowly or too fast for conditions, or drifting into other lanes
• Difficulty with lane changes, merging, or making left turns across traffic
• Becoming easily distracted or overwhelmed by normal traffic situations“near misses” or close calls that the driver does not seem to notice
• Receiving a warning, ticket, or citation from law enforcement
• Difficulty navigating parking lots or confusion about the layout of familiar places

3. How do I get a professional driving evaluation?

A clinical driving evaluation conducted by a specialist is the most reliable way to assess safety behind the wheel. Both the National Institute on Aging and the Alzheimer’s Association recommend finding a Certified Driver Rehabilitation Specialist (CDRS) through the American Occupational Therapy Association’s national database. These professionals are trained specifically to evaluate medically impaired drivers.

Because dementia is progressive, the Family Caregiver Alliance advises that anyone who passes a clinical driving evaluation should be re-evaluated every six months. Early referral matters: the earlier a specialist can establish a baseline of driving ability, the easier it becomes to track decline and make objective decisions as the disease progresses.

4. What does a driving evaluation involve and cost?

A comprehensive driving evaluation typically includes two components. The first is an office-based assessment that tests vision, reaction time, cognitive function, and physical range of motion. The second is an on-road test conducted in a dual-brake vehicle with the specialist in the passenger seat, evaluating real-world performance in traffic.

Costs vary widely by location and provider. The American Academy of Family Physicians notes that CDRS evaluations may not be covered by insurance, making it important to verify coverage with your insurance provider before scheduling. Some state departments of motor vehicles and local Area Agencies on Aging offer subsidized or sliding-scale assessment programs. It is worth calling your local AAA office and senior center as well — some host low-cost driving refresher clinics that can serve as an initial screen.

5. What are my state’s laws about dementia and driving?

State approaches to dementia and driving vary significantly. According to the Governors Highway Safety Association, 37 states and the District of Columbia have special licensing provisions for older or medically impaired drivers. Some states automatically revoke a license upon a dementia diagnosis; others require a medical report or a driving test. Many states have no specific dementia-related law at all. The table below summarizes the main approaches:

6. Does my state require doctors to report dementia?

Only a small number of states mandate physician reporting. California requires physicians to report a dementia diagnosis to the DMV under Health & Safety Code §103900. If the diagnosis is moderate or severe, the DMV will not permit driving. A mild diagnosis triggers a re-examination that may include a visual test, written test, interview, and driving test. Pennsylvania requires reporting within 10 days of diagnosis, and Illinois requires notification within 10 days as well.

In most other states, reporting is voluntary — but that does not mean families are powerless. California, for example, allows family members within three degrees of consanguinity to submit a written referral requesting a DMV re-examination (SB 335, 2001). Many states have similar provisions. If you believe your parent is unsafe behind the wheel, contact your local DMV to ask about the process for filing a medical referral.

7. Will insurance still cover my parent if they have dementia?

Insurance coverage for drivers with dementia is a gray area with limited public data. According to DementiaCareCentral, insurance companies may refuse to pay claims if a dementia diagnosis has not been reported to them but should have been disclosed. Conversely, if the diagnosis is on record and the insurer continues to cover the driver, a claim denial may still be possible after an at-fault collision on the grounds that the driver was medically unfit.

8. How do I talk to my parent about stopping driving?

The conversation about stopping driving is often harder than the decision itself. The following strategies, drawn from the Alzheimer’s Association, the American Academy of Family Physicians, and the Family Caregiver Alliance, can reduce resistance and preserve your relationship:

• Start early. The AAFP recommends a “warning shot” approach — mention the possibility of stopping months or even a year before you think it will be necessary. Early-stage patients who are still aware of their diagnosis may welcome a planned transition.
• Use a driving contract. The Alzheimer’s Association suggests asking the person with early-stage dementia to sign an agreement that gives the family permission to help them stop driving when the time comes.
• Frame it around health and safety, not age or failure. Phrases like “I need you to be safe” or “The doctor is concerned about your reflexes” are less likely to trigger defensiveness than “You’re not safe to drive.”
• Try the “co-pilot” technique. The Family Caregiver Alliance suggests asking your parent to navigate as a passenger on familiar routes. This lets you observe skill deficits without putting anyone at risk.
• Involve a trusted third party. A physician, occupational therapist, or driving specialist can deliver the message with clinical authority that takes the emotional burden off the family.

For step-by-step conversation scripts and detailed guidance on handling the emotional dynamics of this discussion, see our full guide: How to Talk to Your Parent About Stopping Driving

9. What if my parent refuses to stop driving?

When persuasion and professional evaluations are not enough, you may need to take firmer action to prevent a tragedy. The Family Caregiver Alliance outlines several last-resort steps, each with different levels of finality:

• Report your concerns to the DMV. Most states allow family members to submit a written request for a driving re-examination. The DMV may then require a vision test, written test, and road test.
• Hide the keys. Simple, but often effective in the short term. The key is consistency — if the keys are always “lost,” the pattern may be accepted over time.
• Disable the vehicle. Remove the battery cable, install a kill switch, or disconnect the ignition coil. A mechanic can advise on the safest method for your specific vehicle.
• Sell or relocate the car. Removing the vehicle from the household entirely eliminates the option and the temptation.“It’s in the shop” can serve as a temporary explanation while a longer-term plan is put in place.
• Consult your physician about a medical report to the DMV. In voluntary-reporting states, a doctor’s letter may carry enough weight to trigger a formal review.

10. What transportation alternatives are available?

Stopping driving does not have to mean stopping life. The following alternatives can help your parent maintain independence, social connection, and access to medical care:

• Paratransit services. Many public transit agencies offer door-to-door or curb-to-curb service for seniors and people with disabilities. Service eligibility and booking processes vary by county.
• Ride-sharing services. Uber and Lyft both offer options for seniors, including phone-based booking and family-account features that let you schedule rides remotely for your parent.
• Volunteer driver programs. Local senior centers, places of worship, and Area Agencies on Aging often coordinate volunteer drivers for medical appointments and grocery trips.
• Family and friend schedules. A shared calendar among siblings, neighbors, and trusted friends can distribute the transportation load without any single person bearing the full burden.
• Medicaid HCBS waivers. In many states, Home and Community-Based Services (HCBS) waivers include non-emergency medical transportation as a covered benefit for eligible individuals.
• Delivery services. Grocery delivery, meal services, and pharmacy delivery can reduce the total number of trips needed each week.

Two national resources can help you find local options: the Eldercare Locator at 800-677-1116 (a service of the U.S. Administration on Aging) and Rides in Sight at 855-607-4337, a national database of senior transportation programs. For longer-term planning as your parent’s needs evolve, the Middle-Stage Alzheimer’s Care: A Planning Guide for Family Caregivers covers care coordination, home safety, and daily routines for later stages.

Resources and next steps

The decision about driving is not a single event — it is a process that unfolds over months or years as dementia progresses. The key principles are straightforward: start the conversation early, seek a professional driving evaluation, know your state’s reporting requirements, and build a transportation plan before a crisis forces the issue.

The following organizations and resources can support you at every stage:

• Alzheimer’s Association 24/7 Helpline: 800-272-3900 — confidential support and local resource referrals
• Eldercare Locator: 800-677-1116 — connects you to local senior services including transportation programs
• Rides in Sight: 855-607-4337 — national database of senior transportation options
• National Institute on Aging: Driving Safety and Alzheimer’s Disease — government-reviewed guidance on warning signs and evaluation
• American Occupational Therapy Association — national database of Certified Driver Rehabilitation Specialists
• Family Caregiver Alliance: Dementia and Driving — practical strategies for assessment, limitation, and cessation

You are not alone in this. Millions of families have walked the same road, and the evidence shows that planning ahead — difficult as it is — leads to safer outcomes and less regret than waiting for a crisis to make the decision for you.