Driving Cessation

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Driving Cessation - #43

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Resources available for facilitating driving cessation.

Assessment

Safe Driving Requires….

  • Adequate hearing
  • Adequate motor and cognitive response time
  • Adequate vision, Visual perception, visual processing, and visuospatial skills
  • Concentration
  • Executive function
  • Memory
  • Mental flexibility/multitasking
  • Physical strength, coordination, and flexibility
  • VALID DRIVERS LICENSE

 

Concern of impaired driving by "informant" (patient, family member, friend…):
 

  • History of traffic crashes, near misses, tickets, and/or episodes of getting lost while driving
  • Caregiver’s perception of impaired driving skills

Ask your patient:

  1. Do other drivers honk or pass you frequently, even when traffic is moving relatively slow?
  2. Do you become nervous or anxious when approaching intersections?
  3. Do you arrive at a location and not remember how you got there?
  4. Do you notice dents and dings on your vehicle and do not know how they got there?
  5. Have you found yourself in more close calls and near misses on the road?
  6. Do family or friends comment negatively on your driving habits? 

Ask the family/friend:

  • Would you feel safe riding with….?
  • Would you allow your children/pet to ride with ….? 

Once an Individual is found to be at risk for unsafe driving….

  • Identifying and warning impaired drivers is a public health imperative that must be performed before there is a poor outcome. Physicians are required in some states to report unsafe drivers and in others it is up to their discretion. The American Medical Association views this as an ethical dilemma facing physicians and has issued an opinion statement that encourages physicians to identify unsafe drivers and attempt to rehabilitate conditions that are amendable, and follow state legal requirements regarding reporting impaired drivers. Best practice for vulnerable elders newly diagnosed with dementia is that they should be told to not drive, sent to the DMV for testing or sent to a driver’s safety course.

On-line Resources for Facilitating Driving Cessation

Websites provide resources to find driving specialists in different parts of the US

  1. http://www.driver-ed.org
  2. http://myaota.aota.org 

Comprehensive guide

AMA’s guide for physicians to counsel older drivers; Includes difficult conversation templates and templates for letters to send to the DMV                                                                                                                         

Methods to Facilitate Driving Cessation:

  • Explain to your patient why it is important to stop driving
  • Discuss available transportation options early in the conversation
  • Reinforce Driving Cessation
  • Provide written prescription informing patient to no longer drive for their safety
  • Use altruistic and economic arguments
  • Contact the DMV

PEARL: The assistance of family/friends should be sought when addressing driving cessation. Sometimes families will need the physician to take a hard stance on the subject because they’ve been unsuccessful with the patient in the past or are concerned with ruining their relationship.

Context

Elderly patient whom you suspect has impaired driving ability

Action

Evaluate for risk factors for impaired driving and facilitate driving cessation.

Incidence / Prevalence

According to both AAA and AARP, most people currently driving should expect to outlive their driving ability by 5-10 years. Per mile driven the fatality rate for drivers over 85 years old is 9 times greater than all other age groups except teenagers and young adults. In 2010, drivers over age 65 accounted for 17% of all traffic fatalities and 8% of all people injured in traffic accidents. In fact, motor vehicle injures are the leading cause of injury –related deaths in adults older than 65.

Underlying Sciences

There are several components of normal aging that can make it difficult for your patients to safely drive. These include presbyopia (thickened lens, pupillary miosis), presbycusis, and decreased reaction time, strength and coordination. Lower bone mineral density increases the risk of serious fracture in an automobile crash.

Science Principles

Behavioral & Social Sciences including Bioethics

Objectives

  1. Review the basic medical requirements for safe driving
  2. Illustrate methods and list available resources for facilitating driving cessation

Keywords/Tags

References

  1. Physician’s Guide to Assessing and Counseling Older Drivers. Carr DB, Schwartzberg JG, Manning L, Sempek J. editors. American Medical Association. 2010. http://geriatricscareonline.org/ProductAbstract/physicians-guide-to-assessing-and-counseling-older-drivers/B013
  2. Carr DB. The Older Adult Driver. Am Fam Physician. 2000; 61:141-146.
  3. Edwards JD, Bart E, O’Connor ML, Cissell G. Ten Years Down the Road: Predictors of Driving Cessation. The Gerontologist. 2009; 50:393-399.
  4. Edwards JD, Lunsman M, Perkins M, Rebok GW, Roth DL. Driving Cessation and Health Trajectories in Older Adults. Journal of Gerontology A Biol Sci Med Sci. 2009; 64:1290-1295.
  5. http://www.cdc.gov/Motorvehiclesafety/Older_Adult_Drivers/adult-drivers_factsheet.html
  6. http://www-nrd.nhtsa.dot.gov/Pubs/811640.pdf
  7. http://www.nhtsa.gov/people/injury/olddrive/safe/safe-toc.htm
  8. http://www.alz.org/care/alzheimers-dementia-and-driving.asp
This GFF ___ my competence in geriatrics.

Authors

Jennifer Carnahan, MD and Jessica Kuester, MD

Author Affiliation

Medical College of Wisconsin

Copyright

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