Caregivers who have wrestled with driving and transportation issues were asked: "If you could do it over, what would you do differently? What advice would you give others who are in similar situations?" They revealed four basic principles that can help caregivers and people with dementia manage driving and transportation decisions.

1. There is no easy answer; no right way.
Caregivers need to consider the personality and the abilities of the person with dementia when making decisions over the course of the disease. They must take into account the roles and relationships within the family that affect decisions and their outcomes. Each family must select strategies that will work within its unique situation.

2. Begin discussions and planning early and involve the person with dementia.
Ideally, a person with dementia should make the transition from driver to passenger over a period of time. The Agreement with My Family about Driving can serve as the starting point for meaningful discussions about driving. Open, early and continual communication can help the person with dementia and the family to agree on a course of action before a crisis occurs.

3. Base decisions on driving behavior observed over a period of time.
Regular monitoring and assessing of driving helps caregivers respond appropriately. A diagnosis alone may not be sufficient reason for a person to stop driving. However, when it clearly is no longer safe for a person to drive, caregivers must not delay in taking necessary steps. In hindsight, many caregivers regret permitting a loved one to drive longer than it was safe. The result was prolonged anxiety for caregivers and placing others at risk.

4. Get support when making and implementing decisions about driving.
It is not healthy for the caregiver, the person with dementia or the family as whole, when one person shoulders all of the responsibility for making and implementing decisions about driving and dementia. Caregivers can make reasonable requests of family members and those outside the family. Neighbors, friends and relatives can contribute by providing for the emotional, social and transportation needs of the person with dementia.

Doctors, lawyers, care managers, financial planners and local Alzheimer's support groups offer information, guidance and perspective. People in authority outside the family can reinforce the family's efforts to ensure the safety and dignity of a person with dementia. The more people who are asked to help, the less any one person has to do and the greater the likelihood that the person with dementia will get the best support.