Keeping Older Drivers Safe

Medscape Medical News from the Gerontological Advanced Practice Nurses Association (GAPNA) 30th Annual Conference An Expert Interview With David Carr, MD Elizabeth McGann, DNSc, RN September 30, 2011 — Editor's note: Older drivers are generally considered safe drivers, in contrast to drivers who have specific medical impairments. More education geared toward older drivers and healthcare professionals is needed. Attention must be directed toward proper assessment and interventions to promote driver safety among older Americans. A podium presentation, entitled Driving the Older Adult: State of the Science, was featured at the Gerontological Advanced Practice Nurses Association (GAPNA) 30th Annual Conference, held September 14 to 17 in Washington, DC. To find out more about older driver safety, Medscape Medical News interviewed David Carr, MD, who is associate professor in the Department of Medicine and Neurology at Washington University at St. Louis, Missouri. He is a board-certified internist and geriatrician, and medical director of The Rehabilitation Institute of St. Louis. He has assisted in the development and operations of the driving connections clinic there. His research interests are in medical conditions that affect driving, especially issues of assessing driving safety and cessation in the older drivers with dementia and stroke. Medscape:What are the data for national crash and injuries in older drivers? Dr. Carr: Older drivers have the lowest rate of crasher per year, compared with any other age group. However, they have an increased crash rate per miles driven, which approaches that of the teenaged driver. Therefore, for the amount of time they are on the road, they are at an elevated risk, compared with middle-aged drivers. They are at increased risk for injury and death regardless, when you look at this statistic per licensed driver or based on exposure. Medscape: What is the current state of the science related to older drivers? Dr. Carr: Older drivers are, in general, a very good risk behind the wheel. Age should not be an indicator for driving retirement, nor for mandatory testing during licensure. The focus should be on the medically impaired drivers. We need more education for all types of health professionals to be comfortable discussing, evaluating, and counseling older drivers who have age-related medical diseases. Medscape: What are the best approaches to assess impaired older drivers? Dr. Carr: The best approaches will use a good history of driving behavior and any changes in driving habits that may have occurred related to a chronic medical illness. The physical examination should focus on visual acuity, visual fields, muscle testing, joint range of motion, and various cognitive abilities such as processing speed, reaction time, attention, judgment, and visuo-spatial ability. Medscape: What are some of the instruments used to assess risk? Dr. Carr: Some of the commonly used instruments are the clock drawing task, Trail Making Test A and B, maze completion tests, the useful field of view measure, the motor-free visual perceptual test, and a measure of contrast sensitivity. Medscape: What resources are available to older drivers and healthcare professionals? Dr. Carr: There is a variety of online resources for providers and older drivers. The American Medical Association has an online resource called the Physician's Guide to Assessing and Counseling Older Drivers, developed in cooperation with the National Highway Traffic Safety Administration. The American Automobile Association offers an online program called Roadwise Review, designed to allow senior drivers to test their functional abilities related to driving. There is also an online driver safety program sponsored by the American Association of Retired Persons. Medscape: What major challenges do providers and families face when getting the older driver to give up driving? Dr. Carr: There may be resistance because of a lack of insight from an underlying dementing illness. In general, many older adults will give up driving voluntarily if they believe they are putting themselves or others at risk while driving. Of course, this depends on viable alternatives to driving, which may not be readily available or accessible to older adults, especially in rural communities. Medscape: What are the 2 most significant aspects of your presentation? Dr. Carr: The 2 most important take-home messages are that older adults, in general, are safe drivers, and the focus should be on medically impaired drivers; and that instruments are being developed for the clinician to use in the office that can be useful in determining driving safety. Dr. Carr reports relationships with the National Institute on Aging, the Missouri Department of Transportation, the American Medical Association, and Advanced Drivers Education Products & Training, Inc. (ADEPT).