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Conversations about safe driving can be more effective if you start early, consider functional dependence, and tailor recommendations to the patient's stage and type of dementia.

Fam Pract Manag. 2025;32(2):11-15

This content conforms to AAFP criteria for CME.

Author disclosures: no relevant financial relationships.

safe driving

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.

KEY POINTS

  • Start conversations about driving safety at the earliest signs of dementia to help ensure that patients, rather than their surrogates, are part of the decision-making process.

  • Consider whether to refer a patient for a driving assessment, whether your state requires you to report concerns about a patient's driving ability, and whether your language is empathetic when speaking with patients about driving cessation.

  • Compile resources ahead of time to help patients and their caregivers prepare for driving restrictions and the associated grief.

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