Helping older patients decide to stop driving

Ethics Forum. Feb. 2, 2004.

Scenario: How do you encourage a patient to surrender the car keys?

Any advice for talking to older patients about driving safety and alternatives to driving?

Reply:

Telling a patient that he or she should no longer drive is, at best, an uncomfortable task for most physicians and a dreaded one for many. Without specific training to assess driving skills and without clear guidelines on when driving is no longer safe for an individual, it is not surprising that doctors often lack the confidence to deliver this news, which will have a major impact on a patient's life. The physician may also be concerned that if a patient gives up driving he or she may experience diminished quality of life, depression or isolation, and may refuse to comply with recommendations or fail to return for basic medical care out of anger.

Despite these concerns, doctors are being asked to address driving safety with older patients more frequently, and in a significant minority of cases physicians' opinions will be the deciding factor. Physicians can take a number of steps to make this important duty manageable and effective.

It is essential to know your state's law regarding driving as it relates to medical conditions. For example, all states have mandatory revocation of driving privileges for significant vision impairment. On the other hand, the laws concerning driving with dementia are quite variable. Some states have mandatory reporting of people with dementia, while others offer no specific guidelines. A working knowledge of these laws and their prescribed procedures will help structure the physician's work.