Advanced age, dementia, and driving: Guidance for the patient, family and physician

Laws requiring seat belts and airbags are evidence that driving an automobile at any age is associated with unavoidable risks. The effects of advanced age and illness progressively increase the risk. Older adults often mitigate the risk by changing their driving habits. Many others, despite well thought out plans to retire from the workplace, have no plan to retire from the roadways. When dementia prevents them from realistically assessing the risk to themselves and others family members often ask the physician to intervene. This requires balancing the ethics of both public health practice and patient centered care. Skill and compassion can often forge a safe plan avoiding coercion or contact with the state department of motor vehicles.