Driving Safety and Dementia Survey

Information about you:

Gender

Age

Do you live in Nova Scotia?

Is your home located in an urban (city) or rural (country) area?

Has the person you care for been diagnosed with dementia (such as Alzheimer’s disease or another dementia)?

Have you recently seen a public service announcement about the dangers of driving with a dementia?

Did you know that you can find Nova Scotia specific information about driving and dementia from the website www.notifbutwhen.ca?

Have you ever worried that the person you care for may not be safe to drive a motor vehicle because of their dementia?

Have you ever shared with this person your concerns about their driving safety?

Have you ever shared your concerns with a health care professional (doctor, nurse, or other health care employee)?

Has this person ever been told by a health care professional (such as doctor, nurse or other health care employee) that they should not drive?

Have you ever taken steps to prevent this person from driving?

If you answered YES to the last question, please check any of the items below that you have done or helped to do:

If this person has stopped driving, when did they stop? Approximate month & year