A Fatal Crash Kills a Local Senior and Seriously Injures a Young Family of Four…
Author – Cyndi Siders, RN, MSN, CPHRM, DFASHRM, CPPS
July 12, 2016
Assessing and Counseling Older Drivers
Mrs. Jones is 85 years young and enjoys the benefits of her assisted living apartment-style home. She has a history of hypertension, congestive heart failure, atrial fibrillation, type 2 diabetes mellitus, macular degeneration, and osteoarthritis. Care providers notice that she is having increasing difficulty walking while using her cane and having challenges reading, with her glasses, while attending activities such as BINGO.1 She still drives to a local church for services and she enjoys shopping at the mall. Is Mrs. Jones a safe driver? Is your facility prepared to have a conversation on driving alternatives and driving retirement?
Assessing And Counseling Older Drivers….
“Motor vehicle injuries persist as the leading cause of injury related deaths among 65- to 74-year-olds and are the second leading cause (after falls) among 75- to 84-year-olds. While traffic safety programs have had partial success in reducing crash rates for all drivers, the fatality rate for drivers over 65 has consistently remained high.” 2
Seniors are at increased risk for crash mortality, related to medical comorbidities associated with aging and increased susceptibility to injury, particularly chest injury.3
Recognizing declining memory and physical condition, many seniors will self-regulate their driving patterns, including not driving at night, driving at times with slower traffic patterns and driving fewer miles. Even with these self-regulating behaviors, “fatal crash rates increase noticeably starting at age 70-74 and are highest among drivers 85 and older.”4
Clinical team members in senior care are in a position to identify seniors at-risk for driving or who have imposed self-restricted driving because of declining cognitive and functional status. Recommending clinical evaluation, driving rehabilitation services and resources for safer driving practices may optimize functional ability for continued safe driving.5 If safe driving is not an option, having a conversation about driving retirement is an important next step. In some cases, the State licensing authority will become involved at the time of licensure renewal or for a referral for an unsafe driving investigation.
Seniors may not recognize, may be in denial or may be defensive about unsafe driving behaviors. Having a trusted family member or friend offer specific examples may be helpful. Here are signs to watch for:6, 7
• New scratches or dents or side mirrors damaged or knocked off; fender benders that can’t
• Tickets for moving traffic violations and accidents.
• Not following standard “Rules of the Road” procedures – not stopping at stop signs; stopping
on green lights; driving through red lights; improper lane changes or weaving in and
out of lanes; having difficulty maintaining lane position; going an improper speed for the
• Getting lost on familiar routes or consistently missing a familiar exit.
• Coordination challenges with the brake and gas pedal or confusing them; difficulty turning
the steering wheel and using turn signals.
• Visual changes that impact night, perception and distance sight.
• Auditory changes that impact the ability to hear safety warnings, such as train warnings.
Recommendations for Healthcare Providers
• Be alert to signs and symptoms of declining physical and cognitive functioning that could
impact driving. Some examples include:
- o History of falls
- o Impaired ambulation
- o Vision and/or hearing impairment
- o Decreased ability to turn the head to fully visualize an area
- o Decreased short-term memory
- o Decreased or impaired way finding
- o Inability to recognize unsafe situations
• A physician’s assessment of physical and cognitive ability is an important element of a
senior’s social and physical history including questions about driving practices and challenges.
Many seniors consider physicians trusted authorities when discussing driving safety.8
• After hospitalization, surgery or a significant change in clinical condition or illness, older
adults are often told not to drive until cleared by their primary physician.9
• “Many nonprescription and prescription medications have the potential to impair
driving ability, either by themselves or in combination with other drugs.” “Medications with
strong potential to affect driving ability include:
- • Anticholinergics,
- • Anticonvulsants,
- • Antidepressants,
- • Antiemetics,
- • Antihistamines,
- • Antihypertensives,
- • Antiparkinsonian agents,
- • Antipsychotics,
- • Benzodiazepines and other sedatives/anxiolytics,
- • Muscle relaxants,
- • Narcotic analgesics,
- • Stimulants,
- • Hypnotics, and
- • Other agents with anticholinergic side effects.”
• Have a respectful conversation with the senior about observations and concerns about
their driving, involve family members (as appropriate). Recognize that stopping driving
may be perceived as a significant loss of independence. “Having the Conversation”
• Offer resources for affordable and accessible transportation options. The cost of car
maintenance, garage fees, and insurance may reflect a cost savings for some seniors even
with new transportation costs.
• Consider developing a list of trusted resources for seniors and family members to use
in evaluating senior driver safety. A few of the many resources offered are referenced in
this blog post.