geriatrics
Overview of the Older Driver
Assessment
Health care practitioners become involved in driving decisions when deficits are identified during routine examination, a serious medical condition or illness manifests, patients solicit advice, family members express concern, or law enforcement cites unsafe driving behaviors. The role of practitioners is to do detailed Functional Assessment of the Older Driver and National guidelines on driving and dementia include 8 evidence-based observations and recommendations ( References ): Caregiver concerns should be taken seriously. Diagnosis of dementia alone is not sufficient to withdraw driving privileges. Individuals in the moderate phase of dementia are unlikely to be safe drivers. People with dementia with progressive loss of 2 or more instrumental activities of daily living (IADL) due to cognition decline (but no loss of basic activities of daily living) are at higher risk of driving impairment. People with deficits in IADL due to cognitive decline should have a formal assessment and ongoing monitoring of driving if they wish to continue to drive. Abnormalities on cognitive screens may indicate an at-risk driver who is in need of further assessment; however, no in-office test or battery of tests including global cognitive screens (eg, Mini-Mental State Exam [MMSE], Montreal Cognitive Assessment [MoCA]) have sufficient sensitivity or specificity to be used as sole determinants of driving ability in all cases. People with dementia who are deemed fit to continue to drive should be re-evaluated every 6 to 12 months (or sooner if indicated). Driving history should be reviewed; details of driving habits and past violations, MVCs, close calls, or getting lost may point to general or specific impairments. Because older drivers with cognitive impairment may have poor insight, a significant other should be involved in this review. Caregiver reports (especially from an adult child) have been shown to be helpful indicators of driving performance, especially in older drivers with dementia ( References , Forgetting how to locate familiar destinations Not obeying traffic signs Making slow or poor decisions while driving Driving at an inappropriate speed Becoming angry or confused while driving Hitting curbs Not keeping within lanes Making errors at intersections Confusing the gas and brake pedals Returning late from a routine drive Forgetting the destination during a drive Some impairments may obligate practitioners to refer a patient to the state Department of Motor Vehicles for additional testing or driving restrictions. A review of current state license renewal laws reveals varying renewal cycles and testing requirements (see also the Insurance Institute for Highway Safety/Highway Loss Data Institute'slicense renewal procedures by state). 