Identifying medically at-risk drivers

Most older adults consider driving critical for their independence. Therefore, medical professionals should ask themselves “What can be done to help the older adult prolong their time behind the wheel while assuring safety for themselves and others?”

Often, a medical professional’s observation is the first step in assessing whether a patient is at risk for driving unsafely. Medical professionals can identify medical conditions or symptoms, changes in motor skills, medications, and functional changes in older adults that may affect their ability to drive. These changes could put older drivers, other drivers, or pedestrians in danger.

If a medical professional identifies risk early on, primary prevention and interventions can help prevent or slow down the loss of driving ability. Secondary prevention efforts include the continuous monitoring of chronic illness to restore those skills, for example, referral to a physical therapist for range of motion problems or adjusting medications. Tertiary prevention involves recommending alternatives to driving when loss of driving skills appears irreversible.[1],[2]

Members of a clinical team can take the following steps to identify warnings in older drivers:

Listen to the Patient and Family Members/Caregivers

Older 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 risk. Therefore, self-reports may need to be confirmed with caregivers, partners/spouses, or others familiar with the older adult’s driving ability.

If caregivers are particularly concerned, they can review the Fitness-to-Drive Screening Measure. Questions are related to making left-hand turns, hazard detection, and lane changes classify the driver as being at-risk, routine, or accomplished. The responses can help start a safe driving conversation between the patient and caregiver, who can offer information to the medical professional during 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 and 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.
  • Change in functional abilities (post-surgery or after a fall).
  • Following a care transition (for example, acute care to subacute care or home setting or 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. The HRA should include the following:

  • Daily alcohol intake,
  • Daily medication management concerns,
  • Use of sedating medications,
  • History of falls,
  • Use of seat belt,
  • Sleep history, and
  • 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 identify 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.[3]
Decide Next Steps
  1. Treat reversible conditions such as recommending surgery for cataracts, physical or occupational therapy for frailty, and diabetes control for hypoglycemia.
  2. Refer patients to other medical specialists for further evaluation or treatment or to social workers or home-health nurses for other areas of support.
  3. Refer patients to a driving rehabilitation specialist (DRS) for additional assessment and consultation to determine the individual’s fitness to drive.
  4. Assess medications; change prescriptions or use lower doses of medications that have the potential to affect driving or cognition.
  5. Recommend alternatives for transportation until the patient has been cleared to drive again. Use the ChORUS Older Driver Transportation Planning Tool as a resource for your patients to start their transportation planning process.
  6. Use the Clinical Assessment of Driving-Related Skills (CADReS) for a comprehensive evaluation of driver-related functional skills in older adults who have been identified at increased risk for unsafe driving.1 This tool is described in further detail in Assessing Functional Abilities for Driving.

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

[2] Carr, D.B., Duchek, J.M., Meuser, T.M., & Morris, J.C. (2006). Older adult drivers with cognitive impairment. Am Fam Physician, 73(6), 1029-34.

[3] Pomidor, A. (2019). Clinician’s guide to assessing and counseling older drivers (4th edition, pp. 19-24). The American Geriatrics Society.