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    Older driver guide offers positive solutions

    Physicians now have a guide to help them identify problem conditions in older drivers and treat those conditions in an effort to keep patients driving safely. The Physician's Guide to Assessing and Counseling Older Drivers was created by the American Medical Association and the National Highway Traffic Safety Administration to help physicians address preventable injuries-particularly those incurred during motor vehicle crashes.

    Take Home Points
    "I think physicians in general want to keep our patients safe and healthy doing the things they do every day; and an important activity of daily living is driving," said John Armstrong, MD, a trustee for the American Medical Association. "Physicians are well positioned to address issues of driver safety regardless of [patient] age. The issue of safe driving is really a matter of function rather than age per se, and it just so happens that as we get older we tend to lose some of our functions," he said.

    The guide includes a "Physicians' Plan for Older Drivers' Safety" algorithm that leads physicians through appropriate courses of action that can be taken based upon an initial patient screening. The algorithm is designed to help physicians answer the question, "Is the patient at risk for medically impaired driving?"

    Another tool included in the guide to help physicians answer this question is a list of red flags for medically impaired driving. These red flags include acute events such as MI and stroke; patient or family member concerns about the patient's driving; history of chronic medical conditions that may impair driving, such as diseases affecting vision and musculoskeletal disabilities; and medications.

    "To drive safely patients need to have good sight, hearing, tactile senses, grip strength, and joints that are not stiff," said Dr. Armstrong, assistant professor of surgery, Uniformed Services University of Health Sciences, San Antonio, TX. "The functional assessment begins by watching the patient enter the exam room and move around the exam room, and putting what you observe into the context of someone behind the wheel," he said.

    Physicians are encouraged to ask questions specific to driving, including:

    • How much do you drive?
    • Do you have any problems when you drive?
    • Do you ever get lost while driving?

    The answers can help physicians determine the level of intervention that is required.

    The assessment of medical conditions and driving abilities can be used to help patients drive more safely. If cessation of driving is necessary, the guide encourages the use of the term "driving retirement" as a positive way to help normalize the experience. In addition, patients should be included in the decision to stop driving by being involved in discussions about why the patient's driving safety is at risk and how the patient's needs and concerns can be addressed. Finally, alternative options for transportation should be discussed (eg, walking, rides from family and friends, public transportation, volunteer drivers, etc.) so that the patient does not feel trapped by no longer being able to drive.