Decreasing risks through interventions

Patients can be referred for additional testing if you have any concerns about their driving fitness. In some situations, you could choose to adjust medications to decrease risk or refer the patient to a driving rehabilitation specialist (DRS) for further testing or adaptive equipment recommendations, such as larger mirrors or a pedal extender.[1]

If the older adult performs well in all clinical areas, you can communicate to them and a caregiver that no medical constraints exist to safe driving. Offer guidance about health maintenance and future transportation planning (see also the ChORUS Older Driver Transportation Planning Tool). Follow up on driver safety at the next office visit.

If the older adult's performance is rated poor in any of the clinical areas, the patient can be referred to a specialist for further evaluation. The specialist will 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 (for example, until a cataract is removed or extensive physical therapy enables a 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 area is not medically correctable or you do not anticipate the potential for improvement with medical interventions, the older adult can be referred to a driving rehabilitation specialist (DRS). A DRS can provide testing (see also the handout: What to Expect When you are Referred to a Driving Rehabilitation Specialist?). You may restrict driving until test results have been reviewed. Ultimately, you may decide that driving retirement is mandatory and suggest the older driver plan for alternate transportation. Include the recommendation for driving cessation in the patient’s medical record.

[1] Pomidor, A. (2019). Clinician’s guide to assessing and counseling older drivers (4th edition, pp.56-57). The American Geriatrics Society.