Interventions

If patients with significant functional deficits decide to limit or stop their driving, the role of health care practitioners is largely supportive. If evaluation identifies potentially correctable deficits and the patient acknowledges the deficits but still wishes to continue driving, practitioners can offer treatment that may partially or completely correct the deficits or impairments. However, if elderly patients deny or are unaware of their limitations or if deficits do not respond to treatment, practitioners may need to be more proactive. In these situations, practitioners should discuss issues relevant to the driver's transportation needs and safety with the patient and family members. Alternative transportation options should also be suggested (see Supplemental Transportation Programs Listing by State provided by www.seniordrivers.org). Family members can be directed to resources for additional information about having conversations with elderly drivers at Family Conversations with Older Drivers provided by thehartford.com.)

If a patient's abilities are questionable, practitioners can formally request on-road testing by a driving rehabilitation specialist through the state Department of Motor Vehicles or through referral at The Association for Driver Rehabilitation Specialists or The American Occupational Therapy Association. Referrals should be made judiciously because the breadth and depth of testing is variable and testing is expensive. Typically, private or government insurance does not cover the cost, but the Veterans Health Administration does. Testing may lead to recommendations for driving restrictions that can result in social isolation and functional decline. The specialists who conduct on-road testing assess the patient's driving skills, including reaction times, physical flexibility, and decision-making skills. They assess on-road risk and can make recommendations for interventions to improve patient safety, such as driver safety or refresher courses (eg, AARP Driver Safety course) or driver assistive devices. Assistive devices include a spinner knob on the steering wheel to facilitate control for drivers with limited shoulder or arm mobility (eg, due to stroke or severe arthritis), wide-angled mirrors, hand controls for operation of gas and brake pedals, low-effort power steering devices, chest restraints, and swivel automotive seats to assist with egress and ingress.

If the driver's functional limitations or medical status seems to warrant driving cessation, health care practitioners should report the findings and recommendations to the state Department of Motor Vehicles. Before making a report, the practitioner should balance the benefits of safety to the patient and other drivers against the risks of social isolation, worsening functional status, impaired quality of life, and clinical depression. For some patients (eg, those with severe dementia), the benefits of driving restriction clearly outweigh the risks.

Medical information can be legally disclosed if a patient's driving impairment might jeopardize public safety; health care practitioners who do not notify appropriate authorities may be legally liable for injuries that result. About 30% of states mandate the reporting of impaired drivers; in most of these states, statutes protect the practitioner's anonymity or provide immunity to the practitioner. Nevertheless, before notifying the state, practitioners should make every attempt to persuade the patient to cooperate with driving restrictions. Such discussion should include why the patient's limitations may make driving unsafe and why the practitioner is obligated to report.

This topic was last updated July 2005.