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heard one force had no motorway patrols on duty and another had earlier failed to notice Mr Newman's licence had been revoked.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 That would have revealed his licence had been revoked on medical grounds two years earlier.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.
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.