On the Road Again: Majority of Older Adults With Cognitive Impairment Still Drive

Senior Driving Concept Art

Despite concerns from caregivers, the majority of older adults with cognitive impairment continue to drive, according to a study by Michigan Medicine. The research emphasizes the importance of discussions about driving capabilities between caregivers, healthcare providers, and patients. It advocates for early dialogues, potentially guided by Advance Driving Directives, and recommends on-road evaluations for safety.

Researchers highlight the importance of caregivers having conversations with care recipients and healthcare professionals about driving.

The majority of older adults with cognitive impairment continue to drive, despite concerns raised by caregivers and others, according to a study conducted by Michigan Medicine in a South Texas community.

More than 600 adults over the age of 65 in Nueces County, Texas, were assessed. All of them had cognitive assessment scores indicating a likelihood of cognitive impairment.

The research showed that 61.4% of these cognitively impaired individuals were still active drivers. Furthermore, around one-third of all caregivers expressed concerns about their care recipients’ driving capabilities. The study’s findings are published in the Journal of the American Geriatrics Society.

Researcher Insights

“It is likely appropriate that some with mild cognitive impairment are still driving, but for some, it may not be,” said senior author Lewis B. Morgenstern, M.D., professor of neurology, neurosurgery and emergency medicine at University of Michigan Medical School and professor of epidemiology at the U-M School of Public Health.

“Patients and caregivers should discuss these issues with their health care providers and consider on the road driving evaluations to ensure safety.”

Cognitive Conditions and Driving

An estimated one in nine Americans aged 65 and older, totaling around 6.7 million people, are believed to live with Alzheimer’s disease. Millions more have related dementias.

These conditions can compromise neuropsychological and visual skills essential for safe driving. A 2017 review of motor vehicle crash risk found that dementia had medium to large effects on driving impairment and that people with dementia have an increased likelihood of failing a road test compared to those without the condition.

Driving Prevalence and Caregiver Concerns

The study initially aimed to compare the driving prevalence among older Latino and non-Latino white adults. No significant differences were found between these two groups. However, they discovered that the more cognitively impaired an individual was, the less likely they were to be driving.

Just over 35% of caregivers expressed concerns about their care recipient’s ability to drive safely. These concerns persisted even though many study participants voluntarily limited their driving and avoided hazardous conditions, like night-time or rainy weather.

The Importance of Early Conversations

Discussing driving capabilities with individuals who have cognitive impairment is challenging. The discussion is often fraught with concerns over the loss of autonomy and potential embarrassment. In addition, the cessation of driving can increase the workload of a caregiver.

However, researchers recommend initiating conversations about driving early on. This allows care recipients to understand and participate actively in the discussion.

“Close family may have discussions with aging loved ones about Advance Driving Directives,” Morgenstern said. “These are agreements between an aging person and a loved one about having conversations about driving cessation.”

Click here for more information from the NIH on safe driving for older adults.

Reference: “Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals” by Madelyn Malvitz BS, Darin B. Zahuranec MD, MS, Wen Chang MS, Steven G. Heeringa PhD, Emily M. Briceño PhD, Roshanak Mehdipanah PhD, MS, Xavier F. Gonzales PhD, MS, Deborah A. Levine MD, MPH, Kenneth M. Langa MD, PhD, Nelda Garcia BA, Lewis B. Morgenstern MD, 29 June 2023, Journal of the American Geriatrics Society.
DOI: 10.1111/jgs.18493

Additional authors include Madelyn Malvitz, Darin B. Zahuranec, M.D., Wen Chang, Steven G. Heeringa, Ph.D., Emily M. Briceño, Ph.D., Roshanak Mehdipanah, Ph.D., Deborah A. Levine, M.D., Kenneth M. Langa, M.D., Ph.D., Nelda Garcia, all of University of Michigan, and Xavier F. Gonzales, Ph.D., of Texas A&M, Corpus Christi.

This research was supported by the National Institute of Neurological Disorders & Stroke and the National Institute on Aging at the National Institutes of Health (grants R01NS100687, R01AG069148, and P30AG024824)

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Kenneth M. Langa receives grant funding from the NIA and Alzheimer’s Association and consults on NIH-funded projects related to identifying dementia in population-based studies. Lewis B. Morgenstern, Emily M. Briceño, Roshanak Mehdipanah, Deborah A. Levine, Darin B. Zahuranec, and Steven G. Heeringa receive grant funding from the NIH.

1 Comment on "On the Road Again: Majority of Older Adults With Cognitive Impairment Still Drive"

  1. William Readling | July 25, 2023 at 7:33 pm | Reply

    In most of the US, it’s impossible to live on your own without automotive transportation, whether you drive, or someone drives for you. Giving that up, and moving to some sort of “home” is a hard pill to swallow.
    Even in cities it’s hard to not drive, because of zoning. The idea of having residential areas, and separate commercial areas is ageist!

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