An Australian study has identified how clinicians can better navigate these sensitive conversations and support patients through the process.
Driving cessation is often treated as a decision that needs to be made once cognitive impairment makes someone unsafe on the road.
But for people with dementia or mild cognitive impairment (MCI), the transition can involve a series of difficult conversations, decisions, and practical adjustments
Healthcare providers play a central role in driving cessation, such as assessing fitness to drive and communicating with patients about the potential impact of their medical condition on driving capabilities.
While people with diagnosed dementia cannot hold an unconditional licence in Australia, they may qualify for a conditional licence with annual review.
Under mandatory reporting laws, healthcare providers must notify the driver licensing authority if they believe a patient on the road could be a danger to the public.
Many barriers to these conversations exist, including limited confidence in fitness-to-drive assessments, uncertainty about professional responsibilities, concerns about damaging the therapeutic relationship, and time constraints.
These discussions can also be delayed until after a formal diagnosis, despite estimates that 92% of MCI and 62% of dementia cases remain undetected.
A study by Flinders University researchers, based on interviews with older people with dementia or MCI, highlighted a mismatch between the needs expressed by patients and the way driving cessation is often managed in clinical practice.
The study was limited by its small sample of 12 participants, all recruited through a memory clinic at a South Australian tertiary hospital.
Participants were aged 65 years or older, had an MMSE score of at least 20, and were either still driving or had stopped within the previous two years.
Nevertheless, the findings provided insight into what people with cognitive impairment want from health professionals as they approach driving cessation.
The authors said more structured communication and support could help clinicians manage driving safety concerns while reducing the burden on families and ensuring patients are not left to navigate life without driving on their own.
A particularly notable finding was that none of the participants reported receiving follow-up communication or support from their providers after they stopped driving.
The researchers identified four stages in the process and the communication needs that arose at each.
Start the conversation before driving becomes unsafe
Rather than waiting until a patient is no longer fit to drive, researchers said clinicians should introduce the possibility of future driving cessation while the person can still participate meaningfully in planning.
They said that clinicians should explain that driving cessation will likely be necessary at some point and help patients begin planning alternative transport and routines.
These early discussions can help patients and families understand how cognitive impairment may affect driving over time and provide opportunities to document preferences about how future decisions should be made.
The researchers suggested considering an Advance Driving Directive to record the person’s wishes and identify who they would prefer to be involved in decisions about their fitness to drive – such as their GP or specialist, alongside family members or friends.
While this is not a nationally standardised legal document, recording these preferences could help preserve a patient’s sense of control and autonomy and provide a reference point for future conversations about when to cease driving.
Some survey participants had independently begun modifying their driving habits, such as restricting trips to familiar local destinations, while others said conversations with a GP or geriatrician had been their first prompt to reconsider their driving or accept restrictions.
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Guide fitness-to-drive decisions, rather than leaving families to manage them
When concerns about driving ability began to emerge, the researchers said patients required clear information about the available options and guidance on how their fitness to drive would be assessed.
Study participants reported valuing the opportunity to discuss their options and receive clear explanations from healthcare professionals, such as around practical on-road assessments or voluntarily relinquishing a licence.
While many were comfortable with family involvement, most preferred a medical practitioner to guide the decision if they were no longer able to make it themselves.
This professional input was found to be particularly important for families and support persons, who may otherwise be left to initiate difficult conversations and manage the consequences themselves.
Previous research has found that relatives can feel unprepared to make these decisions, particularly when the person with cognitive impairment does not recognise changes in their own abilities.
For clinicians, the process may involve reviewing medical and driving history, considering the person’s driving needs and level of insight, and arranging further assessment.
Be direct when recommending driving cessation
When a patient is no longer safe to drive, clinicians should communicate that recommendation in straightforward language, while acknowledging the emotional impact of the decision, authors explained.
Participants wanted health professionals to be clear rather than ambiguous about whether they should stop driving. They also emphasised the importance of being given time to absorb the information and ask questions.
The researchers recommended framing the discussion around safety – including the protection of the patient as well as other road users – while recognising what driving represents to the individual.
For many older people, driving is closely tied to independence, identity, and the ability to maintain social connections. Losing that capacity can be experienced as much more than a change in transport arrangements and can contribute to isolation and feeling like a burden to others.
A compassionate approach is needed to acknowledge these feelings (rather than treating the decision as a purely clinical or administrative matter), as well as practical planning to help offset the impacts of driving cessation.
Follow up after the person stops driving
The transition does not end when a patient surrenders their licence. People who stop driving may experience reduced independence, loneliness, and difficulty maintaining their usual activities, particularly if public transport is inaccessible or inconvenient.
Participants who had stopped driving described relying on family for transport and emotional support. Even those with alternative transport arrangements reported having less freedom and flexibility than when they could drive.
Notably, none of the participants recalled receiving follow-up communication or support from health professionals after driving cessation.
The researchers suggested clinicians consider connecting patients with services such as CarFreeMe, which provides counselling and practical assistance with transport planning and social support. Families may also need guidance as they take on new transport responsibilities and help the person maintain social connections.
“We have noted that offers of support from a clinician who recommended discontinuation of driving may not always be welcomed, and that engaging another health professional or service may be preferred to support this phase,” said Flinders University PhD student Claire Spargo, who led the research.
