assessment of older drivers
Jump to navigation
Jump to search
[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]
Contraindications
- one episode* of geographic disorientation[13]
* is unlikely that a drivers safety evaluation will provide useful information after a single episode of geographic disorientation[13]
- a MoCA would be indicated if spouse is also worried about memory
- no suggestion is made regarding how many episodes of geographic disorientation would be necessary & sufficient for a drivers safety evaluation[13]
Procedure
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
- care partner concern regarding driving skills is a powerful predictor of driving deficits[13]
* 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]
- these occupational therapists are trained to assess fitness to drive & help with driver rehabilitation
- getting lost while driving a familiar route is not an absolute contraindication to driving in the elderly, but it is a significant red flag that warrants further evaluation
- 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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/10642015
- ↑ Carr DB The older adult driver. Am Fam Phy 61:141, 2000 PMID: https://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/20487078
- ↑ 13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 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
Geriatric Review Syllabus (GRS12) Colburn JL, Westcott AM, Potter JF (eds) American Geriatrics Society. 2025 - ↑ 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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/29444506 https://karger.com/ger/article-abstract/64/3/291/147591/The-Impact-of-Advanced-Age-on-Driving-Safety-in
- ↑ Vander Veen A, Laliberte Rudman D. Rethinking Driving Against Medical Advice: The Situated Nature of Driving After Stroke. Can J Occup Ther. 2022 Dec;89(4):406-416. PMID: https://pubmed.ncbi.nlm.nih.gov/35854415 PMCID: PMC9709544 Free PMC article
- ↑ Unsworth CA, Russell K, Lovell R, Woodward M, Browne M. Effect of Navigation Problems, Assessment Location, and a Practice Test on Driving Assessment Performance for People with Alzheimer's Disease J Alzheimer's Dis. 2019;67(3):1035-1043. PMID: https://pubmed.ncbi.nlm.nih.gov/30776013 https://journals.sagepub.com/doi/10.3233/JAD-181069
- ↑ Eramudugolla R, Huque MH, Wood J, Anstey KJ On-Road Behavior in Older Drivers With Mild Cognitive Impairment. J Am Med Dir Assoc. 2021 Feb;22(2):399-405.e1. PMID: https://pubmed.ncbi.nlm.nih.gov/32698991
- ↑ Barco PP, Wallendorf M, Blenden G, et al. Caregiver prediction of driving fitness in older adults with dementia. Clinical Gerontol. 2021;44(5):520 PMID: https://pubmed.ncbi.nlm.nih.gov/33459209 https://www.tandfonline.com/doi/10.1080/07317115.2021.1872130
- ↑ Chenga YH, Paib MC, Shihd BH, et al. Driving practice effects for older drivers with mild cognitive impairment: a preliminary study. Scand J Occup Ther. 2023;30(4):550-558. PMID: https://pubmed.ncbi.nlm.nih.gov/36905632 https://www.tandfonline.com/doi/10.1080/11038128.2023.2184420
- ↑ Liu Z, Grant J, Simpson S, et al. Driving ability evaluation and rehabilitation for people with Alzheimer's Disease and related dementias. Alzheimer Dis Assoc Disord. 2022;36(4):374-381. PMID: https://pubmed.ncbi.nlm.nih.gov/35984740 https://journals.lww.com/alzheimerjournal/abstract/2022/10000/driving_ability_evaluation_and_rehabilitation_for.18.aspx
- ↑ Toups R, Chirles T, Ehsani J, et al. Driving performance in older adults: current measures, findings, and implications for roadway safety. Innov Aging. 2022;6(1):1-13. PMID: https://pubmed.ncbi.nlm.nih.gov/35028434 PMCID: PMC8752189 https://pmc.ncbi.nlm.nih.gov/articles/PMC8752189/
- ↑ Swain TA, McGwin G Jr, Antin JF, Owsley C. Driving specialist's ratings of on-road performance and naturalistic driving c rashes and near-crashes. J Am Geriatr Soc. 2021 Nov;69(11):3186-3193. PMID: https://pubmed.ncbi.nlm.nih.gov/34245166 PMCID: PMC8595543 Free PMC article
- ↑ 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 https://geriatricscareonline.org/application/content/products/B047/pdf/ https://geriatricscareonline.org/application/content/products/B047/pdf/Clinicians_Guide_to_Assessing_and_Counseling_Older_Drivers_sep_2020.pdf
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