As a health care provider you can play a critical role in preventing common health impairments from leading to functional limitations that affect driving safety in older adults. In addition to identifying ways to improve a seniors ability to drive more safely, you can assist seniors and their families in staying mobile through means other than, or in addition to, driving.
Maintaining health and wellness as one ages is critical to remaining an alert, responsive, and safe driver. Most of the problems older adults have when driving stem from health and functional limitations that become more common with age. Health-related issues that may affect safe mobility include:
Reduced visual acuity, contrast sensitivity, field of view, and other visual issues;
Reduced flexibility and strength;
Reduced cognitive function;
Use of certain medications and multiple medications; and
Chronic health conditions that increase susceptibility to injury.
Do you ever think about how a senior will get to your office and get home? Or about how his or her driving ability will be impacted by a new prescription you are providing? Or the consequences of a newly diagnosed illness?
Even though it might take a bit of extra time, not including driving issues as a regular item to consider in clinical care of older individuals can place patients and others at risk and potentially pose liability concerns for you. There are options beyond reporting your patients to the California DMV.
You can support seniors in their efforts to stay active, independent, and vital members of their communities by:
Letting seniors and their families know that you want to make sure they can drive safely for as long as possible.
Talking to seniors and families about driving and mobility early, while impairments may still be remediated or rehabilitated.
Staying alert to health issues or medications that may h impact driving
Recognizing and screening for impairments that may affect driving and knowing what can be done to remediate them, or where to refer (for an example to an ophthalmologist or an occupational therapist).
Understanding the network of occupational therapists who conduct driving rehabilitation and social services that can support seniors in staying mobile
The American Medical Associations Physicians Guide to Assessing and Counseling Older Drivers discusses ways to talk with your patients about driving safety and other mobility options if appropriate.
It is important to be aware of the various health issues and medications that can affect driving. For example, if the patient has arthritis, ask if they are having problems driving because of pain in their hands, and recommend they visit a trained occupational therapist who can suggest modifications to the vehicle to make it easier to drive safely. Your role as a physician, nurse practitioner, or other front-line provider should be to stay aware, screen if necessary, and refer as appropriate.
The American Medical Association and the American Occupational Therapy Association have recently released several new documents and websites to assist providers in addressing the safety and mobility of their older patients.
Patient Screening Tools
Driving Safety Screening for Health Care Providers [PDF 48KB]
AMA Physicians Guide to Assessing and Counseling Older Drivers
If it is determined that a patient needs further evaluation or remediation, there are a number of referral options:
To another physician for remediation (such as an ophthalmologist);
To social service or other transportation resources in your community; or
To the California DMV if warranted. (Information on referring a patient to California DMV)
California law requires physicians (Heath & Safety Code Section 103900) to report disorders characterized by lapses of consciousness as well as Alzheimers disease and related disorders. They also may report any other condition they believe would affect the patients ability to drive safely. In these cases, it is best to counsel the patient about driving retirement and options, and about your legal obligation to report to the California DMV or state public health office. Note: As this is a public safety issue, HIPAA consent is NOT required when reporting an individual to the California DMV or public health office.
Occupational therapists trained in driving can evaluate a senior and provide mobility training*. Occupational therapists in your facility who do not have training in driving safety can also assist physicians and nurse practitioners in developing a plan for how to address the seniors driving safety.
*Mobility training teaches seniors to ride transit buses and light rail independently. Occupational therapists with advanced training in driving and community mobility may be able to help seniors retire from driving successfully by providing mobility training. Other transportation organizations, such as Paratransit Inc. in Sacramento, also provide mobility training.
Call this statewide toll-free number for information about local services for seniors and adults with disabilities.
Area Agency on Aging (AAA)
AAAs coordinate a wide array of senior services at the community level and serve as the focal point for local aging concerns. Find your local AAA by calling 1-800-510-2020 or find a list of California AAAs online.