You’ve all been there – the elderly couple shuffles into your office, peering through oversize glasses, slightly disoriented but helping each other out. Did you ever stop to think how they got to your office? They almost certainly drove – but should they? Shouldn’t it be their children’s job to tell them to stop?? Focus groups have shown that it’s the physician they look to for guidance (sigh).
Luckily, there are excellent resources to guide you in evaluating driving impairment and to let you know what the laws are in your state. Google “AMA older driver safety” for a wealth of information. It’s free and you don’t have to be an AMA member to access it. There are even disease-specific recommendations from areas as diverse as ophthalmology, cardiology, and neurology. The AMA also has an ethical opinion on impaired drivers and charges the physician with recommending driving restrictions and, if needed, reporting impaired drivers to the Department of Motor Vehicles (DMV).
Dr. Karen Cross recommends a 6-step approach. (1) Identify patients at risk of impaired driving; (2) find out if the patient is still driving; (3) assess their driving skills; (4) make recommendations with referral for a driving evaluation – try www.aded.net for resources; (5) counsel the patient about transportation alternatives; and (6) if all else fails, report the driver to the DMV.
A little more on identifying patients at risk of impaired driving. Driving requires vision, both peripheral and focal. It requires physical activity – from opening the car door to moving one’s foot from the gas to the brake. Reaction time is also important, along with memory and the ability to concentrate, especially when distracted. Many of these skills can be evaluated in the office or home setting. A driving evaluation may be useful when there is conflict over the patient’s abilities. Unfortunately, these are not covered by Medicare or most insurers and can be expensive.
Restricting a patient’s driving can be life altering, resulting in depression, social isolation, and impaired self-esteem. There’s even an increased risk of long-term-care placement if an elderly person can no longer drive to meet their daily needs. On the other hand, there is the risk of injury to themselves or others. It is a physician’s responsibility to make the tough call and recommend driving restrictions when they are needed. Remember to check the AMA website for state-specific tools to support your recommendations.