Ask older patients to bring all their medications with them to the office visit. You and the medical team should review both prescription and over-the-counter medications, as well as herbal supplements regularly. Special attention should be paid to those with anticholinergic or sedating properties that may alter consciousness or physical function and impair or affect driving safety, such as opioids, benzodiazepines, antihistamines. You can counsel patients about the risks and adverse effects of specific medications, their interactions, the physiologic changes associated with aging, and, when relevant, the legal implications of driving under the influence of a controlled substance. (Hill, p. 1585).
Work closely with patients who are taking PDIs, particularly when a new PDI medication is prescribed or the dosage has been increased:
- Explain to the older adult and caregiver the effects of any new medication so that they will self-monitor for any adverse events that may affect driving.
- Ask the older adult and caregiver to take the first doses in a safe, non-driving environment to see if there are adverse effects, especially drowsiness, lightheadedness, or other conditions that may impair driving.
- Inform the older adult and caregiver about adverse effects that may diminish insight, or the ability to gauge a danger, without the older adult recognizing it.
- Educate patients about the risks of alcohol and other substances while driving and the effects of using them with certain medications.
- Emphasize adherence to critical medications even though there may be effects on driving when the medication is essential for the patient’s health, while counseling cessation from driving until safety is assured. (Marotolli slides and CG, p. 148-149). You can also refer patients to enroll in driver safety courses that review rules of the road and the impact of medications and medical conditions on driver safety. Higher risk patients, such as those on antipsychotics or prescriptions for Parkinson’s can also be referred to a driver rehabilitation specials (DRS).
The U.S Food and Drug Administration advises patients and doctors to talk about the effect medications can have on driving safety before they start taking any new medication. The FDA provides a list of medications that should not be taken if operating heavy machinery (including motor vehicles). You and your patients can go over this article Some Medicines and Driving Don’t Mix to see how prescription drugs and over-the-counter medication affect patients driving ability.
You can also provide your patients a fact sheet from the CDC, “Are Your Medicines Increasing Your Risk of a Fall or a Car Crash?” that gives them basic information about the relationship between medications and driving. Patients and caregivers also can download other fact sheets that ask for a list of medicines and a personal action plan to guide a conversation with a doctor or pharmacist at least once each year or when they change medications.