Interviews with older Australians living with dementia or mild cognitive impairment point to a four-phase approach, starting long before the last drive.

For many older adults, a driver’s licence is more than a permit. It is independence, identity and a lifeline to friends, shops and medical appointments. For people with dementia, giving it up is inevitable. As the disease progresses, it erodes the attention, judgment and spatial skills that safe driving demands. The question is not whether to stop, but when, and how that difficult conversation should happen.

Researchers at Flinders University in Australia set out to answer that question by asking the people most affected. Their study, published in the Australasian Journal on Ageing, draws on interviews with older people living with dementia or mild cognitive impairment (MCI) about how health professionals had handled the subject of driving.

“Our aim was to obtain insights into the needs and experiences of older people with dementia or MCI regarding their health professionals’ management of driving cessation,” said lead researcher Claire Spargo, a PhD student at Flinders’ College of Nursing and Health Sciences.

A system that leaves families exposed

In Australia, people with dementia cannot hold an unconditional licence. They may be granted a conditional licence, which must be reviewed at least once a year. Health professionals assess fitness to drive and explain how a condition may affect it, and under mandatory reporting laws they must notify the licensing authority if they believe a driver poses a danger to the public.

In practice, the burden often falls on families. As cognitive decline advances, relatives frequently take over decisions, yet many feel unprepared and fear being blamed. The task is especially hard when the person lacks insight into their own impairment or strongly identifies as a driver. Families may also hesitate to raise concerns if they cannot offer alternative transport, or if they themselves depend on the person to get around.

The timing is genuinely difficult to judge. Many people in the early stages of dementia or with mild cognitive impairment can still drive safely, and stopping too early carries its own costs. Research on older adults has linked giving up driving to reduced social participation, a higher risk of depressive symptoms and earlier moves into residential care. Stopping too late, on the other hand, puts the driver and others on the road at risk.

Families report receiving conflicting advice about whether their loved one can keep driving, and say the issue is often addressed only after they raise it themselves.

Four phases

From interviews with 12 people aged 65 or older, the researchers concluded that health professionals need a structured, comprehensive approach that unfolds over several phases, followed by better support afterward.

The first phase is to prepare early. Conversations should start soon after diagnosis and continue over time, involving the person and their family. One tool the researchers highlight is an Advance Driving Directive, a document that records the person’s preferences and names who should help make the eventual decision, such as a GP or specialist with input from family or a friend. If the condition is likely to progress, clinicians should explain that stopping will eventually be necessary, and people can begin building new routines and arranging other ways to get around.

The second phase is navigating fitness-to-drive decisions. People should be given information and options, such as a practical on-road driving assessment or voluntarily surrendering their licence, and family should be involved if the person wishes. The authors favour shared decision-making that keeps the person engaged, while clinicians remain responsible for the fitness recommendation itself.

The third phase is delivering the recommendation. That calls for plain language and compassion, framing the decision around safety for both the person and the community, acknowledging how much driving means to them, and discussing the benefits of not driving as well as the losses.

The fourth phase is adjusting to life without driving. Losing a licence can bring loneliness and a sense of lost independence. The researchers point to services such as CarFreeMe, an Australian program offering counselling, transport planning and social support, and note that families also need guidance on the practical and emotional effects.

Who offers the help matters

One finding was unexpected. Help from the clinician who made the recommendation was not always welcome. “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,” Spargo said.

That rings true. The person who delivers difficult news can become associated with the loss, making it hard for them to also serve as a source of comfort. Handing the adjustment phase to someone else, such as an occupational therapist or a dedicated service, may make support easier to accept.

Occupational therapists, in particular, have a long-standing role in driver assessment and rehabilitation, and are often well placed to help people plan practical alternatives, from community transport to arranging lifts with friends and family.

A small study on a growing problem

The study is qualitative and small, with just 12 participants, so its findings are best read as insights rather than measurements. But the challenge it addresses is large and growing. More than 55 million people worldwide live with dementia, according to the World Health Organization, and many continue to drive after diagnosis, especially in the early stages.

The research was released to coincide with the International Day of Older Persons on 1 October, which the United Nations established in 1990 to recognize older people’s contributions and counter ageism. The team hopes its findings will inform tools and resources that help health professionals manage driving safety concerns with people with dementia or MCI and their families.

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Notes

1. Spargo, C., Laver, K., Adey-Wakeling, Z., Berndt, A., & George, S. “Insights From Older People With Dementia and Mild Cognitive Impairment on the Management of Driving Cessation by Health Professionals: A Qualitative Study.” Australasian Journal on Ageing, 11 August 2026. DOI: 10.1111/ajag.70215.
2. Flinders University. “Navigating tough conversations with people who have dementia to stop driving.” EurekAlert!, 30 September 2026. https://www.eurekalert.org/news-releases/1146165.

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