Patients should be referred for additional testing if you raise concerns about their driving fitness without any clear indications that he or she must stop driving. In some situations, you could choose to adjust medications to decrease risk, refer the patient to a DRS for further testing or information on adaptive equipment be added to the patient’s car, such as larger mirrors or a pedal extender. (CG, p.56-57 and Hill, 1587)
If the older adult performs well in all clinical areas, you can communicate to him or her and a caregiver that no medical constraints exist to safe driving. Offer guidance about maintenance of health and transportation planning (see also the ChORUS Older Driver Transportation Planning Tool) for the future and follow up on driver safety at the next office visit.
If the older adult performance is rated poor on any of the clinical areas, the patient can be referred to a specialist for further evaluation to ascertain if the causes of poor performance are medically correctable. Medical treatment and intervention should be pursued until the older adult’s function has been remedied enough for driving. The older adult may need to be counseled to restrict driving as treatment proceeds (e.g., until a cataract is removed or extensive physical therapy is completed to allow for better range of motion). The level of improvement should be assessed until the patient performs well in all areas.
If the poor performance in any of the areas is not medically correctable or if you do not anticipate potential for improvement with medical interventions, the older adult can be referred to a driving rehabilitation specialist (DRS) who can provide testing (see also the handout: What to Expect When you are Referred to a Driving Rehabilitation Specialist? You may want to restrict driving until test results have been reviewed. You may ultimately decide that driving retirement is mandatory and suggest planning for alternate transportation. The recommendation for driving cessation should be included in the patient’s medical record.