geriatrics
Medical Assessment of the Older Driver
Therapeutic drugs
Older adults are likely to have multiple comorbidities and may be taking several drugs. A significant number of drugs, typically those affecting the central nervous system (eg, causing confusion, sedation) can potentially impair driving. Many have been shown to impair driving performance during road tests or in driving simulators and have been associated with an increase in motor vehicle crash (MVC) risk. Despite these risks, many of these drugs should not be stopped abruptly and may need to be tapered. Obtaining input from the prescribing physician or pharmacist is important before stopping them. Some drugs that have been shown to increase driving risk include Antihistamines, benzodiazepines, opioids, anticholinergics, hypnotics, antihypertensives, and tricyclic antidepressants, which can cause drowsiness, hypotension, or arrhythmias Antiparkinsoniandopamineagonists (eg,pramipexole,ropinirole), which can occasionally cause acute sleep attacks Antiemetics (eg,prochlorperazine) and muscle relaxants (eg,cyclobenzaprine), which can alter sensory perception Antiseizure drugs, which can cause sedation (alternatives may need to be considered) When starting a new drug that could affect visual, physical, or cognitive function, patients should refrain from driving for several days (depending on the time required to reach a steady state) to be sure no adverse effects occur. 