Dementia and Driving in NSW: The Assessment Process Explained

A dementia diagnosis doesn't automatically mean someone has to stop driving. But it does trigger a process, and understanding that process can make things much less stressful for everyone involved.

This article explains how dementia and driving are managed in NSW, what the OT assessment involves, and what families can expect.

A diagnosis of dementia must be reported to Transport for NSW

In NSW, drivers are legally required to notify Transport for NSW of any medical condition that may affect their ability to drive safely. This includes a diagnosis of dementia or suspected cognitive decline.

In practice, this notification is usually handled by the person's GP or specialist, who completes the Transport for NSW Fitness to Drive form on their behalf. Many people aren't aware of this requirement, so it's common for the doctor to initiate it.

What your doctor decides

When completing the Fitness to Drive form, your doctor will generally choose one of three pathways:

1. The dementia is not currently affecting driving, and the person can continue to drive as normal. This is less common, as most doctors prefer a formal driving assessment to be sure.

2. It's unclear whether the dementia is affecting driving, and an OT driving assessment is recommended. This is the most common outcome.

3. The dementia is advanced and clearly affecting the person's ability to drive safely. The doctor recommends immediate licence cancellation. This is reserved for cases where the dementia is at a later stage and the risks are obvious.

For most people with a recent or mild-stage diagnosis, the doctor will refer for an OT driving assessment.

Why an OT assessment - not just a doctor's opinion?

Driving is a practical skill. Your doctor can assess your cognition in the clinic, but they can't observe you driving. A driver-trained OT bridges that gap, they assess your functional abilities and then watch how those abilities play out on the road.

This is especially important with dementia, because the condition can affect driving in subtle ways that aren't obvious in a clinical setting. Someone might perform well on a basic memory test in the doctor's office but struggle with the divided attention and rapid decision-making that driving demands.

What the OT driving assessment involves

The assessment has two parts and takes approximately 2-3 hours.

Part 1: Off-road (clinical) assessment

This is usually conducted at the person's home. The OT will assess:

Medical and driving history. A conversation about the person's diagnosis, when symptoms started, what they've noticed, their driving habits, and any concerns raised by family. Family members are welcome to be present and provide input, this is often very helpful.

Vision screening. Checks visual acuity, visual fields, and other visual skills needed for driving. Some forms of dementia can affect visual processing even when eyesight itself is fine.

Cognitive assessment. This is the core of the off-road assessment for someone with dementia. The OT uses validated tools to assess attention, concentration, processing speed, decision-making, spatial awareness, and the ability to follow instructions. These are the cognitive skills that underpin safe driving.

Physical assessment. Strength, coordination, range of motion, and reaction time. While dementia primarily affects cognition, the OT still needs to check that physical function is adequate for operating a vehicle.

Part 2: On-road assessment

The person drives for approximately one hour in a dual-controlled vehicle with the OT and a specialist driving instructor, in their local area.

The OT is specifically watching for the signs that dementia may be affecting driving. Common things that show up on road include:

• Confusion at roundabouts or complex intersections

• Driving well below the speed limit without reason

• Delayed responses to changing traffic conditions

• Difficulty navigating familiar routes

• Forgetting to check mirrors or blind spots

• Inappropriate responses to road signs or traffic signals

• Difficulty managing multiple tasks at once (e.g., indicating while changing lanes)

Again, the OT isn't looking for perfect driving. Minor nervousness-related errors are expected. The focus is on whether the dementia is causing consistent, safety-relevant problems.

Possible outcomes

Fit to drive. The dementia is not currently affecting driving, and the OT recommends the person retains their licence. Because dementia is progressive, regular reassessments will be required - usually annually, though the interval depends on the individual and their doctor's advice.

Fit to drive with conditions. The person can drive, but with restrictions such as daytime driving only, local area only, or automatic transmission only.

Driving lessons recommended. Less common for dementia specifically, but possible if the OT identifies specific habits that could improve with targeted lessons.

Not fit to drive. If the dementia is significantly affecting driving safety, the OT recommends licence cancellation. The OT sends their report to Transport for NSW, who makes the final decision.

The reassessment cycle

Because dementia is a progressive condition, even people who pass their assessment will need to be reassessed periodically. Your doctor will continue to complete the Fitness to Drive form, usually annually, and further OT assessments may be recommended over time.

This isn't unusual or alarming, it's simply the process for monitoring conditions that change over time. The goal is to keep the person driving safely for as long as possible, while recognising the point at which it's no longer safe.

When it's time to stop driving

This is the hardest part - for the person with dementia and for their family. Driving is deeply tied to independence and identity, and losing it can feel like losing a piece of yourself.

If the OT recommends licence cancellation, here are some things that can help:

Normalise it as much as possible. Many people stop driving for medical reasons, it's not a personal failure.

Plan alternative transport early. Family members, community transport services, taxis, and rideshare services can all help maintain independence. Some local RSL clubs and community groups also offer transport for older residents.

Arrange home delivery services. Grocery delivery, pharmacy delivery, and online shopping can reduce the practical impact of not driving.

Acknowledge the grief. Losing a licence is a significant life change. It's okay to be upset about it. Support from family, friends, and the person's GP or a counsellor can make a real difference.

A note for families

If you're reading this because you're worried about a parent or loved one's driving, you're not alone. It's one of the most common (and most difficult) conversations families have.

A few things that may help:

Raising your concerns with the person's GP is a good first step. The GP can then assess whether a referral for an OT driving assessment is appropriate. This takes the pressure off you to be the one "taking the keys away."

Try to approach the conversation with empathy. For the person with dementia, being told they may not be safe to drive can feel frightening and confronting. Framing it as a safety check (not a punishment) can help.

The OT assessment is an independent, objective process. If there's disagreement within the family about whether someone should still be driving, the assessment provides a clinical answer.

How to get referred

The referral pathway starts with the person's GP or specialist. They complete the Transport for NSW Fitness to Drive form and refer for an OT driving assessment if needed.

If you already have a referral and you're looking for a mobile OT driving assessment in Sydney, you can start the process at steerdriving.com.au/referral.

This article was written by Elise, an AHPRA-registered Occupational Therapist and Transport for NSW-registered driver assessor. Elise is the founder of Steer Driving, a mobile OT driving assessment practice in Sydney.

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