assessment of older drivers
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Introduction
Risk factor assessment:
- transportation history
- caregiver's perception of driving skills (most important)[13]*
- patient's self-assessment of driving skills not useful[13]
- crashes, tickets, near misses, or getting lost driving
- driving < 60 miles/week
- use of seat belt, cell phone
- review of medical history
- cardiac disease/arrhythmias
- diabetes
- pulmonary disorders/sleep apnea
- alcoholism
- arthritis
- visual or hearing impairment
- dementia
- history of CVA/TIA/syncope
- Parkinson's disease/neuromuscular disease
- seizure disorder
- medication use
- opioids
- benzodiazepines
- antidepressants (TCAs or other sedating antidepressants)
- antihistamines
- glaucoma agents
- antipsychotics
- alcohol
- antidepressants (including SSRI & SNRI), sedatives or hypnotics, & NSAIDs or acetaminophen are associated with a higher risk of failing a road test[26]
- no associations of anticholinergic or antihistamines with poor performance[26]
- evaluation of perception
- visual acuity: should be 20/40 or better (corrected)
- visual field testing: by confrontation, horizontal field should range from 100-140 degrees
- loss of central vision due to macular degeneration impairs ability of older drivers to see pedestrians[10]
- contrast sensitivity: reading progressively fainter letters off the chart (eg. Pelli-Robson chart)
- peripheral sensation, esp pinprick & position
- evaluation of cognition
- attention: digit span, A test
- visual-spatial function
- clock test
- copying pentagons
- clinical dementia rating
- evaluation of motor response:
- trunk & neck mobility: turn to look
- strength: at least 4/5 muscle strength in right lower extremity & both upper extremities
- coordination
- evaluation of mood
- impulsivity, agression, emotional lability
- occupational therapist can evaluate patient & vehicle[13]
- adjustments or adaptive equipment (mirrors) to compensate deficits
Other factors:
- driving as a form of independence
- cost of alternative transportation
- history of hospitalization for critical illness[24]
- most don't drive; some who do have evidence of cognitive impairment
* according to ref[11], relatives of elderly living independently qualify as caregivers
Management
- if in doubt regarding safety of elder driving, refer to DMV for formal driving assessment[8][11][13]
- occupational therapist engaged in driver safety programs can help elderly continue to drive[13][18]
- driver safety course with component of 'on road' instruction*
- speed of processing & reasoning training lower risk of at-fault motor vehicle accidents in older drivers[9]
- older drivers with multiple (>= 4 risk factors) should be advised to stop driving[11]*
- referral to health department as required by state
- dementia is a reportable disorder in many states
- referral to health department as required by state
- in-person license renewal reduces incidence of hospitalized drivers with dementia age 60-69 but not 70-79[20]
- vision testing reduces incidence of hospitalized drivers with dementia age 60-60 but not 70-79[20]
- road testing reduces incidence of hospitalized drivers with dementia age >=80[20]
* seems to be procedure of choice
Notes
- a policy amendment March 2017 for cognitive screening of older drivers at driver's license renewal resulted in decrease in motor vehicle collisions as drivers & an increase in road injuries as pedestrians & cyclists among older people[25]
More general terms
Additional terms
References
- ↑ Marottoli RA, Cooney LM Jr, Wagner R et al Predictors of automobile crashes and moving violations among elderly drivers. Ann Intern Med. 1994 Dec 1;121(11):842-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/7978696
- ↑ Cable G et al Knowledge, attitudes, and practices of geriatricians regarding patients with dementia who are potentially dangerous automobile drivers: a national survey. J Am Geriatr Soc. 2000 Jan;48(1):14-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10642015
- ↑ Carr DB The older adult driver. Am Fam Phy 61:141, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10643955
- ↑ Carr DB et al Characteristics of motor vehicle crashes of drivers with dementia of the Alzheimer type. J Am Geriatr Soc. 2000 Jan;48(1):100-2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10642016
- ↑ Dubinsky RM et al Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2000 Jun 27;54(12):2205-11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10881240
- ↑ Martoli RA. In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw Hill, New York, 2000
- ↑ Miller DJ & Morley JE Attitudes of physicians toward elderly drivers and driving policy. J Am Geriatr Soc. 1993 Jul;41(7):722-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/8315181
- ↑ 8.0 8.1 Iverson DJ et al Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010 Apr 20;74(16):1316-24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20385882
- ↑ 9.0 9.1 Ball K, Edwards JD, Ross LA, McGwin G Jr. Cognitive training decreases motor vehicle collision involvement of older drivers. J Am Geriatr Soc 2010; 58(11):2107-2113. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21054291
- ↑ 10.0 10.1 Bronstad PM et al. Driving with central field loss I: Effect of central scotomas on responses to hazards. JAMA Ophthalmol 2013 Jan 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23329309 <Internet> http://archopht.jamanetwork.com/article.aspx?articleid=1557937
- ↑ 11.0 11.1 11.2 11.3 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012. 2015, 2018.
- ↑ O'Connor MG, Kapust LR, Lin B, Hollis AM, Jones RN. The 4Cs (crash history, family concerns, clinical condition, and cognitive functions): a screening tool for the evaluation of the at-risk driver. J Am Geriatr Soc. 2010 Jun;58(6):1104-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20487078
- ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Adler G, Rottunda SJ. Mandatory testing of drivers on the basis of age and degenerative diseases: stakeholder opinions. J Aging Soc Policy. 2010 Jul;22(3):304-19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20589556
- ↑ Meuser TM, Carr DB, Irmiter C et al The American Medical Association Older Driver Curriculum for health professionals: changes in trainee confidence, attitudes, and practice behavior. Gerontol Geriatr Educ. 2010;31(4):290-309. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21108097
- ↑ Boot WR, Stothart C, Charness N. Improving the safety of aging road users: a mini-review. Gerontology. 2014;60(1):90-6. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23989044 Free PMC Article
- ↑ Hunt LA, Arbesman M. Evidence-based and occupational perspective of effective interventions for older clients that remediate or support improved driving performance. Am J Occup Ther. 2008 Mar-Apr;62(2):136-48. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18390008
- ↑ 18.0 18.1 Stav WB. Occupational therapy and older drivers: research, education, and practice. Gerontol Geriatr Educ. 2008;29(4):336-50. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19064470
- ↑ Hollis AM, Duncanson H, Kapust L, et al. Validity of the Mini-Mental State Examination and the Montreal Cognitive Assessment in the prediction of driving test outcome. J Am Geriatr Soc. 2015;63(5):988-92 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25940275
- ↑ 20.0 20.1 20.2 20.3 Agimi Y, Albert SM, Youk AO, Documet PI, Steiner CA. Dementia and motor vehicle crash hospitalizations: Role of physician reporting laws. Neurology. February 27, 2018; 90 (9). Online 2018 Jan 31; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29386271 <Internet> http://n.neurology.org/content/90/9/e808
- ↑ Aronson L Don'Ruin My Life - Aging and Driving in the 21st Century. N Engl J Med 2019; 380:705-707, Feb 21, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30786184 https://www.nejm.org/doi/full/10.1056/NEJMp1613342
- ↑ Hill LJN, Pignolo RJ, Tung EE. Assessing and counseling the older driver: a concise review for the generalist clinician. Mayo Clinic Proc. 2019;94(8):1582-1588 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31378232 https://www.mayoclinicproceedings.org/article/S0025-6196(19)30312-X/fulltext
- ↑ Betz ME et al. "Is it time to stop driving": A randomized clinical trial of an online decision aid for older drivers. J Am Geriatr Soc 2022 Jul; 70:1987. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35441700 PMCID: PMC9283277 (available on 2023-07-01) https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17791
The Ottawa Hospital. Patient Decision Aids https://decisionaid.ohri.ca/AZsumm.php?ID=1342 - ↑ 24.0 24.1 Potter KM et al. Return to driving after critical illness. JAMA Intern Med 2023 Mar 27; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36976554 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802804
- ↑ 25.0 25.1 Inada H et al Association between mandatory cognitive testing for license renewal and motor vehicle collisions and road injuries. J Am Geriatr Soc. 2023 Apr;71(4):1145-1155. Epub 2023 Jan 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36695020 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18157
- ↑ 26.0 26.1 26.2 Carr DB, Beyene K, Doherty J et al Medication and Road Test Performance Among Cognitively Healthy Older Adults. JAMA Netw Open. 2023;6(9):e2335651 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37773496 PMCID: PMC10543136 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809967
- ↑ Gish J, Vrkljan B, Grenier A, et al. Driving with advanced vehicle technology: a qualitative investigation of older drivers' perceptions and motivations for use. Accid Anal Prev. 2017;106:498-504 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27499110 https://www.sciencedirect.com/science/article/abs/pii/S0001457516302238
- ↑ Moon S, Ranchet M, Akinwuntan AE, et al. The impact of advanced age on driving safety in adults with medical conditions. Gerontology. 2018;64(3):291-299 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29444506 https://karger.com/ger/article-abstract/64/3/291/147591/The-Impact-of-Advanced-Age-on-Driving-Safety-in
- ↑ AMA Physician's Guide to Assessing and Counseling Older Drivers http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety/assessing-counseling-older-drivers.shtml
Pomidor A, ed. Clinician's Guide to Assessing and Counseling Older Drivers, 4th ed. New York: The American Geriatrics Society; 2019. https://geriatricscareonline.org/ProductAbstract/clinicians-guide-to-assessing-and-counseling-older-drivers-4th-edition/B047
Websites:
National Institute on Aging Older Drivers https://www.nia.nih.gov/health/older-drivers
DMA http://www.dmv.ca.gov
Alzheimer's Association http://www.alz.org
American Medical Association. Code of Medical Ethics: Physicians & the Health of the Community; Impaired Drivers and their Physicians. https://www.ama-assn.org/delivering-care/ethics/impaired-drivers-their-physicians