Assessing older driver safety

Physicians can play a major role in helping older patients continue to drive safely -- and telling them when it's time to stop driving.

Editorial. July 14, 2003.

One afternoon last month an 81-year-old North Carolina man got into his Toyota Camry with his wife and began to drive. Their trip ended when he made a left turn in front of an oncoming tow truck. The resulting wreck left him dead and his wife fatally injured, said the account in the Winston-Salem Journal.

Sadly, this type of car crash is all too common. Vision, cognition and motor function difficulties brought on by aging and disease make some older drivers a danger to themselves and others. People 65 years and older constitute 13% of the U.S. population but account for 18% of all traffic deaths. The fatality rate for drivers 85 and older is nine times that of drivers 25 to 69.

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These statistics point to the critical role physicians can play in helping their patients maintain driving safety. By being aware of medical conditions and medications that interfere with driving, doctors can counsel patients accordingly.

For patients with impairments, physicians sometimes can keep them behind the wheel by treating the underlying disease. Other times, the patient needs a referral to a specialist -- such as an occupational or physical therapist -- who can provide the training an older person needs to keep or to regain driving skills.

In some cases, patients' skills are so poor they should retire from driving. Determining when older drivers are so impaired that they should be advised to hang up their car keys can be hard for their physicians, family members and friends. Breaking the news to the elderly person can be just as agonizing, given the loss of personal freedom and pride it represents.

A study by the National Highway Traffic Safety Administration found that many family members of impaired drivers want authority figures, such as doctors, to help convince their loved ones to stop driving. Meanwhile, many physicians want more information to assist families in these situations.

As the baby boomers age, more physicians and families will face this tricky issue. By 2030, one in five Americans will be older than 65.

That's why the American Medical Association is working to help physicians cope with the challenges presented by elderly patients still behind the wheel.

At last month's Annual Meeting, the AMA approved a report by its Council on Scientific Affairs that recommended that physicians:

Increase their awareness of the medical conditions, medications and functional deficiencies that could impair older patients' driving skills.
Familiarize themselves with driver assessment and rehabilitation options in their communities and to refer patients to them when appropriate.
Know and adhere to their states' reporting laws for medically at-risk drivers.
Support continued scientific investigation into ways to assess and manage driving safety in the clinical setting.

These recommendations are just the latest AMA effort in this area. In January 2002, the Association created the Older Drivers Project with support from the NHTSA. The initiative already is bearing fruit. This month, the AMA is making available online the Physician's Guide to Assessing and Counseling Older Drivers. Free hard copies will be released in the fall.

The guide includes an office-based assessment of medical fitness to drive, a reference table of medical conditions and medications that sometimes affect driving, and recommendations for rehabilitation options and counseling strategies for patients at risk for unsafe driving. It also contains a discussion of legal and ethical issues regarding reporting of unsafe drivers and handouts for patients and family members.

Fitting the issue of driving safety into already squeezed office visits can be hard, and telling patients that they need rehabilitation to drive safely or that they should retire from driving is an uncomfortable task for any doctor. But the AMA's guide can help make the job easier and the roads safer for your patients and everyone else.