‘Be Straight Up’: Patients Reveal How Doctors Should Say It’s Time To Stop Driving

Memory Loss Patients Say Doctors Should Talk About Quitting Driving Early, Plainly, and Kindly

Few medical conversations land harder than being told to stop driving. Older adults with memory problems interviewed in Australia had clear advice on how doctors should handle it: say it plainly, say it kindly, and start the talks long before the day arrives.

Afterward, the picture changed. None of the four former drivers interviewed reported any follow-up communication or support from a health professional, though every one of them received emotional support, rides, or both from relatives.

Researchers at Flinders University in Adelaide, Australia, spoke with older adults who have dementia or mild cognitive impairment, a milder form of memory and thinking trouble. Published in the Australasian Journal on Ageing, the small study cannot show how common these experiences are, but it offers a rare look at how patients themselves want driving handled.

Interviews With 12 People Show Dementia and Driving Decisions Unfold in Stages

Between March 2021 and June 2022, a researcher interviewed 12 people aged 65 or older who attended a memory clinic at a hospital in South Australia. Participants volunteered after nurses introduced the study. Nine participants had mild cognitive impairment and three had dementia. All scored 20 or higher on a standard memory screening test, which kept out people with more advanced impairment.

Eight participants were men and four were women, with an average age of 77. Four still drove with no restrictions, four held licenses limited to a set distance from home, and four had stopped driving. Each interview lasted 20 to 40 minutes and covered what participants wanted from health professionals around driving.

All 12 reported having family or social support, so people without that backing were not represented. Their experiences may be even tougher.

Those interviews pointed to four stages: preparing, deciding whether driving is still safe, receiving a recommendation to stop, and adjusting to life afterward.

Patients Wanted Early, Plain-Spoken Talks Before Driving Cessation

Preparation came first. One woman with mild cognitive impairment who still drove said her doctor would not suddenly announce a stop, because the two had been discussing it over time. A man with dementia, whose license limited him to short trips, said the restriction came as a shock but that after talking it over he got used to it, and that if told to quit, “We will learn to catch the bus.”

A lack of guidance frustrated some people in the second stage, when they wanted help deciding whether driving was still safe. One man described a letter arriving “out of the blue” telling him he had to take a driving test, with no earlier discussion with his doctor about whether he should be driving at all. Everything felt done “behind my back,” he said. He and his family decided he would stop instead, and he thought a medical specialist’s involvement might have made that easier.

Most participants wanted a medical practitioner, not a relative, to make the call if they could not. One woman said her family sometimes tries to take over. “I would like the doctor to tell me,” she said.

Third came the recommendation itself. A man with dementia put it simply: “Be straight up.” He asked doctors not to “dance around” the topic. A woman said she would rather hear it plainly than deal with doctors who “ummed and ahhed.” Some participants also preferred in-person visits to video calls for serious conversations about driving. The authors advise doctors to use simple language, stress that safety is the concern, and acknowledge how personal driving is.

Lost Independence and Loneliness Marked Life After Driving Cessation

Fourth came adjustment, which brought loneliness and a sense of lost independence. One woman who had stopped driving only weeks before her interview said she had taxi vouchers and could use them, yet she had given up going to her golf club. “Isn’t that awful?” she said. A man with his wife, his daughter, and plenty of other ways to get around still felt his independence had been “taken away.”

Authors of the paper said the lack of support from health professionals may reflect a broader issue in dementia care, where services can prioritize risk assessment and safety over ongoing support. Lead author Claire Spargo added that support offered by the clinician who recommended stopping may not always be welcome, and that another health professional or service may be a better fit.

To close the gap, the authors pointed to a few ideas. An Advance Driving Directive would let people record their preferences for future driving decisions, and who they want involved, while they still have the mental capacity to decide. Shared decision-making would have doctors lay out options and weigh a patient’s values, although final recommendations would still rest with health professionals. Programs such as CarFreeMe, which address emotional adjustment and transportation planning after driving ends, could also help, but the authors said more funding is needed, particularly in rural and regional areas.

Telling someone to stop driving is hard to do well. Patients here described what doing it well looks like, with early warning, plain words, and compassion, and the authors say support should not end when the keys are handed over. Based on 12 interviews, the stretch after the conversation is the part most in need of attention.

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Disclaimer: This article is based on a single small interview study and is for informational purposes only. It is not medical advice. Anyone with concerns about memory, dementia, or driving safety should speak with a qualified health professional.

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