[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.157.19.94. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Care of the Aging Patient: From Evidence to Action
Clinician's Corner
April 28, 2010

The Older Adult Driver With Cognitive Impairment“It's a Very Frustrating Life”

Author Affiliations

Author Affiliations: Departments of Medicine and Neurology, Washington University in St Louis, and The Rehabilitation Institute of St Louis, St Louis, Missouri (Dr Carr); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Ott).

JAMA. 2010;303(16):1632-1641. doi:10.1001/jama.2010.481
Abstract

Although automobiles remain the transportation of choice for many older adults, late-life cognitive impairment and dementia often impair the ability to drive safely. However, there is no commonly used method of assessing dementia severity in relation to driving, no consensus on the assessment of older drivers with cognitive impairment, and no gold standard for determining driving fitness. Yet clinicians are called on by patients, their families, other health professionals, and often their state's Department of Motor Vehicles to assess their patients' fitness to drive and to make recommendations about driving privileges. This article describes the challenges of driving with cognitive impairment for both the patient and caregiver, summarizes the literature on dementia and driving, discusses evidence-based assessment of fitness to drive, and addresses important ethical and legal issues. It also describes the role of physician assessment, referral for neuropsychological testing, screening for functional ability, tools to assess dementia severity, driving evaluation clinics, and Department of Motor Vehicles referrals that may assist with evaluation. Lastly, it discusses mobility counseling (eg, exploration of transportation alternatives), because health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance patients' social connectedness and quality of life while meeting their psychological and medical needs and maintaining personal and public safety.

×