For the majority of older adults, driving is an important means of mobility. Driving is a highly complex task drawing upon a multitude of cognitive, sensory, and physical factors. Individuals with MCI experience cognitive deficits in one or more domains which may, depending on the nature of their deficit, put them at increased risk for collision. Because some individuals with MCI may become unsafe to drive because of the nature and severity of their cognitive deficits, a diagnosis of MCI should alert the healthcare professional to consider the need for a further in-depth evaluation of fitness to drive and/or for ongoing monitoring of driving capacity. A number of cognitive assessment instruments are available to aid professionals’ decision making related to fitness to drive including the Trail Making Test, Clock Drawing Test, driving simulation, and on-road assessments. Given the potential for individuals with MCI to convert to dementia, professionals should monitor their patients for further cognitive decline that could impact driving fitness. While the negative outcomes associated with driving cessation have been well documented in the literature, there are a number of ways that professionals can offer support throughout the stages of cessation. The goal is for the former driver to safely remain mobile within and connected to their community.

The issue of driving with cognitive impairment, including MCI and dementia, is a public safety issue that cuts across numerous practice domains involving physicians, counselors, OTs, and support workers. To offer fair and transparent assessment of drivers with MCI and mild dementia, as well as to support individuals as they cease driving, interdisciplinary collaboration with the goal of striking a balance between safety and mobility is paramount. The needs of this population may also be addressed within communities by making decisions that increase the availability of targeted resources to promote continued mobility, which includes designing and implementing appropriate transport options. There remains limited availability of clinical interventions to specifically support individuals with cognitive impairments to improve their driving skills or to cease driving and retain mobility, which suggests opportunities for public health research and practice [see 131]. The safety and mobility of individuals with cognitive impairment is particularly relevant given the aging population in many parts of the world, highlighting the need to develop best practices to address the safety and mobility needs of this population.

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