You may want to start integrating driver safety into office visits by asking older patients to complete the Driver History Questionnaire. Patients can complete this simple questionnaire when they arrive for their annual wellness check – or other appointments as deemed necessary. The answers to these questions may prompt a conversation with the patient and indicate that you will want to conduct additional screening.
You can use screening/ assessment tools that currently exist to determine if an older driver is fit to drive safely such as those discussed in Medscape’s Older Driver Safety Training. You can also suggest that an individual and/ or their caregiver complete a self-assessment. However, before administering any tests, it will be important to explain to the older adult that safety is the key issue while considering the individual’s need for transportation. The conversation can begin by exploring reasons for the patient to continue driving; noting that screening and assessment can help find solutions to keep older adults on the road; and exploring current technology, driver rehabilitation, and clinical interventions for someone at risk. This discussion should start early (ages 60-65) before a patient is in crisis. The conversation can be framed around working with the older adult to continue to drive as long as they can drive safely. The ChORUS Older Driver Transportation Planning Tool provides a mechanism to empower patients to take steps early to plan for when their capabilities diminish.
Assessing Functional Abilities for Driving offers details on methods you will want to incorporate into patient visits as the patient ages. An assessment of five key domains using valid tools can help you determine the level of risk for older patients. These domains include cognition, vision, motor/sensory function, current medical comorbidities, and medications. (Hill, 1582) and are typically a part of a wellness visit or other encounter. Impairment in any of these areas has the potential to increase the older adult’s risk of being involved in a crash, getting lost, and endangering others.
The assessment results allow you to decide if: 1) more information is needed in any of these areas; 2) the clinician can correct underlying medical conditions that allow the patient to continue driving safely; 3) a referral to a medical specialist is warranted for further evaluation or treatment; or 4) an occupational therapist or driving rehabilitation specialist can help an older adult continue to drive safely. You may also recommend driving cessation and alternate transportation resources if the assessment results indicate that the older adult is unfit for driving. You can provide tools and resources for the patient and caregiver to develop a transportation plan that addresses a patient’s need for independence, quality of life, and self-esteem.