Primary care clinicians are often asked to assess older patients' fitness to drive but may feel underprepared for these assessments.¹ When patients have a dementia diagnosis, the guidelines are seemingly straightforward: Those with moderate or severe dementia should no longer drive.^2,3 But putting the guidelines into practice can still be challenging. For patients with mild cognitive impairment or early-stage dementia, the guidelines allow them to drive, but as many as one in three may still fail a behind-the-wheel driving test.⁴ Those patients may benefit most from in-depth assessment and counseling about their driving safety. In the later stages of dementia, patients are less likely to have insight into their driving ability and may not remember past conversations about driving cessation.

Navigating these complex conversations starts with gathering focused information about the patient's dementia stage, type, and impact on driving and then applying four key considerations when discussing driving safety.