Navigating the Road Ahead: How Mild Cognitive Impairment Can Affect Older Drivers and How to Stay Safe

Navigating the Road Ahead: How Mild Cognitive Impairment Can Affect Older Drivers and How to Stay Safe

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If you or a loved one experiences mild cognitive impairment you’d appreciate that it’s the unexpected events when driving that can be particularly challenging. The big question for many folks is what can I drive with Mild Cognitive Impairment (MCI) and if so what can I do about it?

We’ve heard this a lot in our OT Driving Assessment clinic.

In this article you'll learn:
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    How does mild cognitive impairment impact driving performance?

    Imagine a warm summer day, the sun is shining brightly, and the wind blowing gently through your hair.

    You’re driving on a familiar road, one that you’ve travelled many times before. Suddenly, a child runs out from behind a parked car, and you have to swerve to avoid hitting them. Your heart races as you come to a stop, and you realize that you just narrowly avoided a tragic accident.

    The cognitive domains of processing speed and higher level thinking skills, called “Executive Functions” appear to be commonly impacted by mild cognitive impairment.

    For example, difficulty with problem-solving is one of the many ways that mild cognitive impairment can affect a person’s ability to drive safely.

    Identifying and responding to unexpected situations on the road requires quick thinking and the ability to make sound decisions, both of which can be impaired by cognitive decline.

    You see, as we age, our cognitive function can start to decline, which may make it harder on the road.

    How it affects one person will be different to the next.

    In summing up, cognitive health changes can be an issues for senior drivers, but is there an increase in risk of vehicle accidents?

    Well, it depends, here’s why….  

    Picture of a car accident

    Is there an increased risk of motor vehicle accidents?

    According to the state of the research you could be forgiven to think that there isn’t an increased risk.

    Austroads suggests: “Driving studies examining the effects of MCI found limited evidence of increased driving error rates, concluding that MCI does not significantly impair driving.”

    The problem with epidemiological and larger sample studies is that it misses the individual experience. 

    In contrast, a 2016 study found “The driving performance of individuals with mild cognitive impairment (MCI) is suboptimal when compared to healthy older adults”

    A 2018 study also found that specific cognitive skill changes were strongly associated with driving retirement in older adults living with MCI.

    Another  2018 study involving over 2,500 older adults without dementia, observed “older licensed drivers without dementia, poorer cognitive function was associated with greater risk of motor vehicle crash risk

    Cognitive changes can be small to major and no doubt can affect a person’s safe driving performance.  Reduced abilities can present as:

    • Impaired judgment
    • Slower reaction time
    •  Difficulty with maintaining the car’s on road position in relation to other vehicles
    • Less attention and recall of objects and cars about them whilst driving.

    So, in short,  it’s vital for older adults, their families and GPs to be aware of these potential cognitive issues, early.

    Older men playing chess in the park

    A person’s independence is under threat

    It’s clear that driving is super important to most people as it represents independence and it allows people maybe much like you to connect with activities that are important and meaningful, that add value to your life. In an Royal Australian College of General Practitioner’s study describes this as ” Maintaining Agency” or simply “maintaining control over one’s life”.

    If you’re to write what are the key activities you’d commonly do with driving it would likely range from shopping, the dentist, visiting friends and family and more. You see, these life routines are instrumental activities which form your experience of independence.

    Don’t Let Mild Cognitive Impairment Take Away Your Independence.

    Regular monitoring and support can keep you on the road safely.

    While MCI symptoms can increase the risk of collisions, it doesn’t mean that all drivers with dementia should have their licenses revoked.

    It’s important to stay on top of the memory and thinking changes and make informed decisions about driving. 

    With the right support and management, you can continue to enjoy the freedom of the open road.


    Steering wheel with little person cartoon

    Self regulation: Taking control of driving safety starts with this

    It’s clear, adult drivers with mild cognitive impairment (MCI) can face a variety of challenges which can impact safe driving performance as well as everyday function.

    These can include types of driving errors:

    • difficulty multitasking, such as monitoring traffic and adjusting the radio or navigation system;
    • difficulty with spatial awareness and perception, such as judging distances and identifying road signs;
    • difficulty with decision making, such as knowing when to yield or change lanes;
    • and difficulty with memory, such as remembering the route to a destination or recalling traffic laws.

    The driving tasks a person encounters daily can vary.  And it’s the predictable and reliable driving skill performance to meet these changes which can be eroded by mild cognitive impairment and other conditions that cause memory changes as seen with drivers with dementia.

    So, for older drivers living with cognitive decline it’s a critical skills that they can assess their own personal abilities and limitations and have accurate judgements about what to do “when I feel like X I do this”.

    This helps ensures people are driving safely and responsibly. But what does this practically look like,? What are helpful strategies for drivers living with memory and thinking changes?

    Strategies for staying safe on the road

    Fortunately, there are strategies and steps that older drivers with mild cognitive impairment can take to remain safe on the road and maintain their independence.

    • Avoid driving at night, in inclement weather, or on complex or unfamiliar roads as much as possible.
    • Drive when at your energetic best
    • Get an eye health assessment (not limited to just vision) yearly. Having regular eyesight tests can assist with improving detection of road signs for example and support other skills like judgment of distance between vehicles.
    • Self check ” How am I feeling today? How is my health?” being mindful of how your symptoms or mental clarity can appear in your life can help you make more informed decision to improve your safety as well as reduce your crash risk.
    • Planning ahead and allowing extra time for their trip can help them cope with any decision-making difficulties they may encounter.
    • Get an assessment of Cognitive Fitness To Drive so that you can get a tailored and personalised program to help you stay sharp behind the wheel.
    • Adaptive equipment, such as hand controls or special mirrors, can also be used to improve safety while driving.
    • Taking a driving refresher course or doing a practical skills review with a qualified instructor or professional can also help evaluate older drivers’ abilities and determine if they need to modify their strategies accordingly.
      • Helps improve overall awareness, increase focus on essential details such as motor speed control, quickly recognize hazards ahead.
    • Additionally, older drivers should refrain from any distractions while driving, such as using their phone or eating, and have a passenger or caregiver accompany them whenever possible to help with navigation and decision-making.
    • Looking to buy a new car?  Consider a car with increased level of automated safety features. Yes, it is a wonderful new learning exercise and with continued use people can learn how to use a new vehicle with more advanced features.

    Finally, older drivers should be willing to stop driving if they notice that their cognitive impairment is affecting their ability to drive safely. By following these strategies, they should be able to continue enjoying the freedom of the open road.

    Older person being told bad news by doctor

    When it’s no longer safe to drive

    The emotional impact of having to give up driving can be profound.

    You, your loved one or client likely depend on their car for maintaining independence and sustaining social connections are now at risk of isolation and depression.

    Programs like our “Mobile For Life” help ease this transition from driving so when it’s time to hang up the keys there is clear path to protecting independence and importantly helping people experience meaning and purpose in life beyond the car.

    It’s for people who are

    • Living with mild cognitive impairment and are considering retirement from driving
    • Family members who want to be proactive to protect a loved one’s independence especially when you’ve observed unsafe driving performance.
    • For people who have been recommended to stop driving by their medical professional.

    The value of these programs can’t be underestimated as the risk of a major fall and prematurely mortality increases after driving retirement. Stop driving doesn’t mean life stops and the Mobile For Life program shows you how.

    Family members or caregivers can often feel in the dark about how to best help, or know what’s out there. That’s why the Mobile For Life program exists, takes the guesswork out and offers you a straight forward path to help a person be independent as possible.

    Older man getting an in clinic assessment

    7 signs for a Cognitive Driving Assessment

    Signs that a person may need a cognitive driving assessment include:

    1. There’s unexplained dents and scuff marks on the car, indicating potential driving errors
    2. Appears to take longer to do standard driving trips and is unable to explain why this is happening.
    3. Uncharacteristic traffic infringements which may have resulted in a fine or conversation with a police officer.
    4. Concerns raised by loved ones or friends about their driving performance
    5. Missing traffic signals or difficulty with maintaining correct speed
    6. Confusing the brake and accelerate pedals
    7. The family doctor has recommended modifying a person’s licence.

    Getting a Memory Check- Up: Cognitive Driving Assessment

    If you’re concerned about Mild Cognitive Impairment and driving safety, a cognitive fitness to drive assessment is likely to help.

    You can access this service at Occupational therapy Brisbane.

    A senior therapist will evaluate a person’s cognitive abilities, as well as their physical abilities, and observe a person performance with driving simulators so that they can provide recommendations:

    • How to improve these skills. A systematic review and meta-analysis demonstrates evidence “continued practice of using driving simulation and targeted cognitive exercise helps reduce driving errors and improves stopping reaction time”.
    • Offers practical advice as to whether a person should continue to drive or not.

    This is especially helpful for G.P.s who are seeking advice regarding their clients.

    You’d appreciate that if you’re living with mild cognitive impairment it’s vital to be aware of the potential driving challenges you may face and to take the steps to maintain your independence and continue driving safely.

    To get a cognitive driving assessment, call Occupational Therapy Brisbane today at 1300 783 200 and get clear on how to take control of your cognitive fitness. 

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