The most effective approach to limit or stop driving involves progressive steps and a combination of strategies that fit the family's circumstances, resources and relationships. For people in the early stages of dementia, driving is best reduced over time rather than all at once. Families can help by finding ways to let others drive or reduce the need to drive. Caregivers and families should be sure to address the important social needs of the person with dementia that were met through driving. When possible, include the person with dementia when planning ahead to limit driving.

Fortunately, in many cases, people with dementia begin limiting where and when they drive. The following signs indicate that a person with dementia is modifying his or her driving behavior:

• Driving shorter distances.
• Driving on familiar roads.
• Avoiding difficult unprotected left-hand turns.
• Avoiding driving at night, in heavy traffic, on heavily traveled roads or during bad weather.

Keep in mind that driving even short distances in good weather can pose a risk if driving skills are impaired. Most accidents happen close to home.

Let Others Do the Driving
When a person with dementia limits or stops driving, the responsibility for providing or finding transportation usually falls on the family. The worksheet Getting There: Using Alternative Transportation can be used to explore all transportation options-from public transportation to informal arrangements with relatives and friends.

Public Transportation
This option may work for people with mild dementia who live in urban areas and are already accustomed to using these methods. Public transportation is often too complicated for those with more advanced dementia.

Taxis can be a cost-effective alternative, especially when fares are compared to the expense of gas, insurance, taxes, repairs and car payments. Taxis could be used for people in middle to later stages of dementia if:

• There are no behavioral problems.
• The driver has explicit directions.
• Someone is available to meet the person at the beginning and end of the trip.

Some taxi companies will set up accounts for family caregivers so a person with dementia has easy access to transportation without worrying about payment.

Friends and Relatives
Friends, neighbors, relatives or caregivers can offer to drive the person with dementia to appointments or other social events. Other family members will be more likely to assist with the driving if caregivers make specific requests and schedule appointments at times that work for those requested to help.

Co-Piloting Is Not The Answer
Some caregivers act as co-pilots to keep a person with dementia driving longer. The co-pilot gives directions and instructions on how to drive. By chance, this strategy may work for a limited time. But in hazardous situations, there is rarely time for the passenger to foresee the danger and give instructions, and for the driver to respond quickly enough to avoid the accident. Finding opportunities for the caregiver to drive and the person with dementia to co-pilot is a safer strategy.

• Arrange to have prescription medicines, groceries and meals delivered, reducing the need to go shopping.
• Have hairdressers make home visits.
• Schedule people to visit regularly, either as volunteers or for pay.
• Arrange for friends to take the person with mild dementia on errands or to social or religious events.

The following questions can help families and caregivers identify the social needs and develop ways to address them to ease the transition to not driving.

• Where does the person with dementia go? When and how often (e.g., grocery store, barbershop, appointments, library or religious activities)?
• What services can be brought to the home (e.g., groceries delivered or in-home barber)?
• Who can offer to provide transportation (e.g., neighbors running errands, relatives for doctors' appointments or a friend going to religious services)?
• Can visits from family or friends include outings (e.g., eating out or going to a park)?

Early Planning to Limit Driving
When possible, include the person with dementia in the planning process. People are better able to respond to appeals to safety during the early stages of Alzheimer's Disease or other kinds of dementia.

The Agreement with My Family about Driving document can help you initiate a conversation about options for when the person must limit and eventually stop driving. This informal agreement does not restrict driving at the moment of signing, but designates a responsible person to take necessary steps to ensure driving safety in the future. It respects the individual's dignity by focusing on the disease, not the individual, as the reason for driving restrictions and cessation.

The agreement is not a legal contract, but is a document to help plan for the future. Like plans made for medical and financial decisions, the form allows families to discuss matters and agree on a course of action before a crisis and while the loved one is capable of making decisions.

This document does have limitations. Not everyone with dementia will grant advance permission for someone to stop him or her from driving. The signed statement does not address when driving should stop, and it does not ensure that the person with dementia will comply once the disease progresses. However, it is a tool that family caregivers can use.

Build Social Support
Caregivers can reduce stress and increase chances for success by relying on others for emotional support, transportation assistance, financial help or to meet other needs. A grandchild or neighbor might be able to run an errand or pay a visit. A long-distance relative might be willing to pay for an occasional driver or taxi. Someone else might be able to observe driving ability and habits.

The activity Not Going It Alone: Who Can Offer Support? can be used to identify and expand the circle of support.

Other Opportunities to Limit Driving
With some foresight, family members can create natural, non-confrontational ways to make driving less appealing or necessary. For example, if a person with dementia is moving to an area that has more support services, you can discuss transportation alternatives at the new location-particularly because people with dementia are more uncomfortable and at higher risk of accidents when driving in unfamiliar places. Relocation may encourage the individual with dementia to limit or stop driving.

In addition, family members can use financial issues to initiate a change, such as building a case for selling the car by itemizing the many costs of operating a car.

Take the Keys as a Last Resort
Taking away the car keys or a driver's license, or selling or disabling the car should be a last resort. To the family member in the early stages of the disease, such actions seem extreme, disrespectful and punitive. And people with mild dementia can ignore, undo or maneuver around those strategies by driving without a license, enabling the disabled car or buying a new car to replace one that was sold. As one person with dementia noted, "If they disabled my car, I would call someone to fix it."

Once a person has stopped driving, caregivers must decide whether taking away the keys, license and car will help the person adjust or make it more difficult. Some caregivers remove the keys or the car from sight to avoid having the driving issue resurface. Others allow people to keep their keys, car and license to help them maintain a sense of dignity. Some people with dementia stop driving but carry their license as photo identification.