Early-stage dementia and driving: what do older adults want to happen when driving is no longer safe?

Driving cessation in older adults with dementia is associated with reduced independence, social isolation, and accelerated cognitive decline, yet determining fitness to drive remains challenging. This qualitative study explored older adults' attitudes toward driving safety decisions and their preferred responses if informed that they may no longer be safe to drive. Twenty-two older adults, including individuals with mild cognitive impairment (MCI) at risk for dementia and cognitively healthy controls, participated in walking-talking interviews following cognitive and hazard perception screening assessments. Interviews explored participants' views on what should happen next if test results suggested they were unsafe to continue driving. Audio-recorded interviews were transcribed verbatim and analysed using thematic analysis. Six themes and sixteen codes were identified. Participants with MCI demonstrated greater acceptance of driving cessation, and sought confirmatory assessments, whereas healthy control participants prioritised transparency about test results, openness to remediation through lessons or vehicle adaptations, and preservation of independence. These findings highlight the importance of personalised interventions and the potential for non-invasive in-car technologies to support safe driving in individuals with early-stage dementia. This study highlights the value of qualitative methods in understanding the nuanced perspectives of older drivers and informs future strategies for managing driving cessation in cognitively impaired individuals at risk for dementia.