Many older people with mild cognitive impairment still drive

The majority of cognitively impaired older adults still drive, despite concerns raised by caregivers and others, a Michigan Medicine study of a South Texas community finds.

Researchers evaluated more than 600 adults over age 65 in Nueces County, Texas, who had cognitive assessments that indicated the likelihood of impairment.

Of these people with cognitive impairment, 61.4% were current drivers and about a third of all carers had concerns about their carer’s driving. The results are published in Journal of the American Geriatrics Society.

“It may be appropriate for some with mild cognitive impairment to continue driving, but for some it may not be,” said senior author Lewis B. Morgenstern, MD, professor of neurology, neurosurgery and emergency medicine at the University of Michigan School of Medicine and professor of epidemiology in the UM School of Public Health.

“Patients and caregivers should discuss these issues with their healthcare providers and consider road driving assessments to ensure safety.”

It is estimated that approximately one in nine Americans age 65 and older, or 6.7 million people, are living with Alzheimer’s disease, and millions more have related dementia.

These conditions can affect neuropsychological and visual skills that reduce the ability to drive safely. A 2017 review of motor vehicle crash risk found that dementia has a moderate to large effect on driving impairment and that people with dementia are more likely to fail their driving test than those without.

The researchers initially set out to examine the prevalence of driving among Hispanic and non-Hispanic white older adults, finding no significant differences between the two populations. However, the more cognitively impaired a person is, the less likely they are to drive.

Just over 35% of caregivers had concerns about their care recipient’s ability to drive safely, although many study participants limited their overall driving and avoided driving at night or in the rain.

Discussions between carers and people with cognitive impairment about driving are difficult, with concerns about loss of autonomy and potential embarrassment. When a person with cognitive impairment stops driving, this can also increase the burden on the caregiver.

Researchers say it’s best to start conversations about driving early, while the care recipient is able to understand and actively participate in the discussion.

Immediate family may have discussions with aging loved ones about advance driving directives. These are agreements between an adult and a loved one to have conversations about stopping driving.”

Louis B. Morgenstern, MD, senior author