Specific medical diagnoses may impact vision, function and mobility and consequently affect driving fitness for older adults. Chronic diseases such as diabetes, cardiovascular disease, psychiatric disorders, obstructive sleep apnea, arthritis, and movement disorders should also be evaluated during an examination. (Ladden, Rizzo). While these diagnoses alone do not restrict drivers, all factors related to physical and cognitive health, varying level of disease, and current condition must be integrated when determining fitness to drive. (Mielenz et al. p. 2)
Chapter nine of the Clinician’s Guide (pp. 115-157) contains 13 reference tables of medical conditions that may affect driving safety, including medications that may be used to treat the condition. The specific topics include:
- Vision and Hearing Loss
- Cardiovascular Disorders
- Cerebrovascular Disorders
- Neurologic Disorders
- Psychiatric Disorders
- Metabolic Disorders
- Musculoskeletal Disorders
- Peripheral Vascular Disorders
- Renal Disorders Section
- Respiratory and Sleep Disorders
- Effects of Anesthesia and Surgery
- Cancer Section
- Medications
Each table includes indications for determining restrictions for driving, referrals to other health practitioners or driving specialists, further testing, or assessments, and addressing level of risk, when appropriate. (Clinician’s Guide, p. 116-152)
Medical Professionals are advised to assess and optimize medical conditions and medications to maximize functional ability by treating the underlying medical condition and/or functional deficit to improve the condition/ impairment or limit progression. If the functional deficit is due to an offending agent (e.g., medication with sedating effects, such as some antihistamines), Medical Professionals can remove medication, reduce the dose, or change the medication, when possible. In many cases, the functional deficit can be addressed through compensation or modification (e.g., hand controls, left foot accelerator), and Medical Professionals can refer the older driver for a comprehensive driving evaluation.
When necessary, a clinician may have to advise the older adult about the risks to his or her driving safety and consider referral for assessment of driving performance, recommend driving restrictions or driving cessation, and document the discussion in the health record. For acute or episodic illnesses (e.g., seizure disorder and/or diabetes with hypoglycemia), subspecialist input may be required, in addition to following specific state statutes. The patient can be re-evaluated once a condition has been addressed to determine fitness for future driving, for example, post-surgery recovery or successful use of a CPAP device for sleep apnea. (Vega, p. 24)