Albert Newman drove for 30 miles in the wrong carriageways on the M42, the A42 and the M1 before crashing into a van.
An inquest heard one force had no motorway patrols on duty and another had earlier failed to notice Mr Newman's licence had been revoked.
The coroner adjourned the hearing so officers could answer more questions.
Dementia patient Mr Newman, from Nottingham, crashed his Mazda Premacy into a Transit van near Kegworth, Leicestershire, in October last year, killing passenger Michael Luciw and injuring the driver, Andy Harrington.
The inquest was told that Warwickshire police took the first call about a car on the wrong carriageway on the M42, but officers incorrectly recorded the direction he was heading.
The error was put right, but Mr Newman crossed the county boundary into Leicestershire on the A42, where the specialist roads policing unit had finished work for the night.
This meant the force had no specialist motorway patrols in the county.
Pamela Oxlade, who was travelling towards Birmingham Airport with her husband, told the inquest: "We were fortunately just past a lorry when suddenly, out of nowhere, there were two balls of light.
"It was really quick and it was just unreal because you couldn't see the outline of the car in the dark.
"I dialled 999 and spoke to a gentleman, explained what had happened and he just said they were aware of it.
"We said we were almost half an hour from the M1 and going towards Birmingham. It was such a great relief to hear that he was aware of it."
The inquest was told that about 20 minutes later, Mrs Oxlade spotted signs warning motorists to slow down because of a car travelling in the wrong direction.
Coroner Trevor Kirkman, speaking about Leicestershire police's involvement, said: "It does seem as if the procedure does not seem to be working very satisfactorily.
"This vehicle had travelled a long distance with no intervention."
It emerged at the hearing in Loughborough that Nottinghamshire Police spoke to Mr Newman months before the crash after reports about him driving while showing signs of dementia.
An officer did not check the paperwork before visiting him. That would have revealed his licence had been revoked on medical grounds two years earlier.
Mr Kirkman adjourned the hearing until December to establish whether the force could have seized his car at that time.
At the end of the hearing, a senior officer from Nottinghamshire police offered an apology to the families if there was anything the force could have done to prevent the deaths.

Lizzie Mould, from Bristol University, was challenged by Gloucestershire firm Snow Business to come up with a "green" realistic snow for film and television.
It took her two years and a "few hundred attempts" but now her new snow liquids are being sold to the industry.
Ms Mould, said: "To say that seeing the products on the market is rewarding would be an understatement."
The Stroud-based company which specialises in fake snow and ice effects, has previously worked on James Bond film Spectre, Avengers: Age of Ultron and Star Wars VII: The Force Awakens.
But in a bid to create a "really good snow effect" which was "robust in different climates", environmentally friendly and would not damage people's skin or leave a residue - they approached the university.
"I must have made hundreds of formulations. before we got to where we are today," said Ms Mould, who has now been offered a full-time job with the firm.
"The original plan was just to make one fluid but by the end of my project we had two which both worked really well."
Recently launched to the industry, Paul Denney, from the company, said as far as they know the new liquids are "the most environmentally friendly falling snow products in the world".
"We had looked at developing the product ourselves but the chemistry involved was beyond our capabilities, which is why we approached the University of Bristol," he said.
"We weren't totally sure what Lizzie would be able to do, especially as we had a long wish list of characteristics but she's really come up trumps and surpassed all our expectations."
Police have been criticised for failing to stop an 87-year-old driving the wrong way on major roads before killing himself and another man in a crash.
[NEXT_CONCEPT]
A chemistry student has created "the most environmentally-friendly" fake snow, as part of her research.