Most older adults consider driving to be critical for their independence. One of the key questions that Medical Professionals can ask themselves is “What can be done to help the older adult prolong their time behind the wheel while assuring safety for themselves and others?”
A Medical Professional observation is the first step in assessing whether a patient is at risk for driving safely. The Medical Professional can identify medical conditions or symptoms, changes in motor skills, medications, and functional changes in older adults that may affect their ability to drive and could put them, other drivers, or pedestrians in danger of injury.
If the Medical Professional identifies risk early on, primary prevention and interventions can help prevent or slow down the loss of driving ability. Secondary prevention efforts require the continuous monitoring of chronic illness to restore those skills, for example, referral to a physical therapist for a range of motion problems or adjusting medications. Tertiary prevention involves recommending alternatives to driving when loss of driving skills appears to be irreversible. (Carr or Pomidor)
Members of a clinical team can take the following steps to identify “red flags’ in older adult patients related to driving:
Listen to the Patient and Family Members/Caregivers
Older adult patients may present having decreased short-term memory, being easily distracted, unable to learn new information as quickly as in the past, getting lost while driving, or feeling anxious or uncomfortable while driving. Older drivers or their caregivers may also describe the patient’s inability to recognize unsafe situations or a tendency to confuse gas and brake pedals. Some older adults do not recognize some of these indicators of driving risks. Therefore, self-reports may need to be confirmed with caregivers, partners/spouses, or others who may be familiar with the older adult’s driving ability.
If caregivers are particularly concerned, they can review the Fitness-to-Drive Screening Measure. Questions include situations such as making left-hand turns, hazard detection, and lane changes and classify the driver as being at-risk, routine, or accomplished. The responses can help start a conversation about driving safety between the patient and caregiver who can offer information to the Medical Professional at the next visit.
Know When to Screen an Older Adult for High Risk
Screening for safe driving can be routinely integrated into the care plan during office visits, including annual wellness visits, as well as in the following specific situations:
A new diagnosis or change occurs in any condition that can impair driving; New medication is prescribed or the dosage of a current medication is changed; Report of change in functional abilities (post-surgery or after a fall); and Following a care transition (e.g., acute care to subacute care or home setting; home setting to a continuing care retirement community or assisted living). When a patient presents with a situation or when a Medical Professional /caregiver raises concerns (and every year thereafter);
Conduct A Health Risk Assessment (HRA)
Following initial questions about driving habits and conversation with the family member/ caregiver, the Medical Professional can conduct a health risk evaluation for the older driver to include the following:
- Daily alcohol intake
- Daily medication management concerns
- Use of sedating medications
- History of falls
- Use of seat belt
- Sleep history
- Physical activity and diet history
Review Clinical Risk Factors for Impaired Driving
Medical Professionals can refer to several charts in the Clinician’s Guide to assist in identifying typical risk factors for driving: Table 2.1, “Clinical Risk Factors for Impaired Driving” provides signs and symptoms for risk factors that include physical capabilities, cognitive abilities, and driving abilities. Table 2.3, “Chronic Medical Conditions that May Impair Driving,” lists conditions ranging from vision problems and cardiovascular disease to psychiatric disease and chronic renal failure. Table 2.4, “Organ Systems and Symptoms,” describes “red flag” symptoms for a range of major organ systems, from respiratory to musculoskeletal. (Clinician’s Guide, pp. 19-24).
Decide Next Steps
- Treat reversible conditions such as recommending surgery for cataracts, physical or occupational therapy for frailty, and diabetes control for hypoglycemia.
- Refer patients to other medical specialists for further evaluation or treatment or to social workers or home-health nurses for other areas of support.
- Refer patients to a Driving Rehabilitation Specialist (DRS) for additional assessment and consultations to determine the individual’s fitness to drive.
- Assess medications; change prescriptions or use lower doses of medications that have the potential to adversely affect driving or cognition, where possible.
- Recommend alternatives for transportation until the patient has been cleared for driving again. Use the ChORUS Older Driver Transportation Planning Tool as a resource for your patients to start their transportation planning process.
- Use the Clinical Assessment of Driving-Related Skills (CADReS) for a more comprehensive evaluation of driver-related functional skills in older adults who have been identified at increased risk for unsafe driving. (CG, p.) This tool is described in further detail in Assessing Functional Abilities for Driving.