Download Health Disparities Program

Assessing and Counseling Older
Drivers
Identifying and Assessing the
Medically Impaired Driver
AMA House of Delegates

1925 - Recommended that drivers receive
a physician’s certificate of medical fitness
to drive.
 1930 - Recommended that prior to
licensure, applicants undergo an exam to
determine physical and mental capacity to
drive.
 1938 - Section on ophthalmology issued
”Visual Standards for Operating a Motor
Vehicle.”
AMA Committee to Study Problems of
Motor Vehicle Accidents
(1930’s-1950’s)

1939 report classified conditions influencing
driving as:
– Permanent deficiencies
– Transitory deficiencies
– Brief or self-inflicted deficiencies

This report stated that alcohol causes
impairment at a blood level of 0.05%.
Report - 1963
“Age per se should not be a limitation
once the individual reaches licensing
age, rather the functional capacity and
ability of each individual should be the
determining factor.”
“Too Old” to drive?
Numerical age is not the problem
 Impaired function is the limiting
factor

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AMA report, 1963
Physician’s Guide to Assessing and
Counseling Older Drivers
Provides
physicians with
the tools
necessary for
assessing older
patients for
medical fitness to
drive.
What functional abilities are
important to driving?
 Vision
 Cognition
 Motor
function
Physician’s Plan for Older Driver Safety



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
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Screen to determine if patient is potentially at
risk
Assess driving related functional skills (ADReS)
Treat underlying causes of functional decline
Refer for further evaluation and/or adaptive
training
Counsel on safe driving behavior and alternative
options
Follow-Up for signs of depression, isolation and
compliance
How can physicians screen patients
for medically impaired driving?
Be alert to Red Flags:
Any medical condition, medication
or symptom that can impair driving
skills
Red Flags

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
Acute events
Patient’s or family member’s concern
Medical history
– Chronic medical conditions
– Unpredictable/Episodic events
Medications
Review of systems
Prescription & OTC drugs
alcohol
 antihistamines
 antidepressants
 benzodiazepenes
 opiod analgesics
 muscle relaxants
 antipsychotics

If Red Flags are present

Ask health risk assessment/social history
questions
– How did you get here today?
– Has another treating physician brought up
driving issues?

Gather additional information
– Do other drivers on the road cause you
distress?
– Have you had any recent problems when you
drive?

Understand your patient’s mobility needs
How can physicians assess for
deficits in function?
Assessment of Driving Related Skills

ADReS is a brief, function-based, inoffice assessment of driving-related
skills
 ADReS does not assess patient’s
performance on driving task

ADReS does not predict crash risk
Assessment of Driving Related Skills
Vision
Visual fields by confrontation testing
Snellen E Chart
Cognition
Trail-Making Test, Part B
Clock Drawing Test
Motor Function Rapid pace walk
Manual test of motor strength
Manual test of range of motion
Interpreting ADReS results
Recommended scoring limits to
evaluate patient’s performance
 The goal is to identify and correct
any functional deficits that may
impair driving performance
 Recommendations are subject to
state reporting laws and DMV
requirements

Three courses of action
If patient performs well, continue driving
without further work-up or treatment
 If patient performs poorly, pursue
medical treatment and necessary
evaluation
 If patient’s poor performance can not be
medically corrected, refer patient to a
Driver Rehabilitation Specialist

Certified Driver Rehabilitation
Specialists have expertise in:
Targeted clinical assessment
 Functional on-road assessment
 Prescribing and training clients in the
use of adaptive equipment
 Counseling and advising on driving
concerns and mobility alternatives

Physicians can help maximize older
driver safety
 Continue
medical treatment &
preventive care
 Counsel patients on health and driving
 Identify at-risk patients & help manage
deficits
 Discuss driving retirement
 Abide by state reporting laws
Legal considerations

Protecting the patient
– Case law illustrates that failure to advise
patients on medical conditions and
medications is negligent behavior
– Case law also illustrates the health care
system can be liable for breaching
confidentiality

Protecting the public
– Legal precedents demonstrates that
physicians may be held liable for third-party
injuries
Legal protection for patient
reporting
Immunity- exempts physicians
from liability for civil damages
Anonymity/Legal protectionprotects physicians from civil
actions for damages caused by
reporting in good faith
Policy Issues

Impaired function determines driving
safety not age.
 On the road test essential to see how
patient compensates for impairments
 No immunity for physicians who report
their concerns in many states.
 National need for legislation to allow
good faith reporting by physicians and
other health professionals.
www.ama-assn.org/go/ olderdrivers
American Medical Association
www.nhtsa.dot.gov
National Highway Traffic Safety
Administration