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Assessing and Counseling Older Drivers

Assessing and Counseling Older Drivers

HCIS Senior Care Blog

A Fatal Crash Kills a Local Senior and Seriously Injures a Young Family of Four…

Author – Cyndi Siders, RN, MSN, CPHRM, DFASHRM, CPPS
Executive Consultant

October 1, 2018

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

The Facts…

“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

“Involvement in fatal crashes, per mile traveled, begins increasing among drivers ages 70‒74 and are highest among drivers ages 85 and older.” Aging related decline in functioning (e.g., vision and hearing) and decline in physical condition are significant contributing factors for fatal crashes.³

Seniors are at increased risk for crash mortality, related to medical comorbidities associated with aging and increased susceptibility to injury, particularly chest injury.­4

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.”5

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.6   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.

Warning Signs

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:7,8

  • New scratches or dents or side mirrors damaged or knocked off; fender benders that can’t be recalled.
  • 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 conditions.
  • 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:
    • History of falls
    • Impaired ambulation
    • Vision and/or hearing impairment
    • Decreased ability to turn the head to fully visualize an area
    • Decreased short-term memory
    • Decreased or impaired way finding
    • Inability to recognize unsafe situations9
  • 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.10
  • 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.11
  • “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.”12
  • 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” https://dps.mn.gov/divisions/ots/older-drivers/Documents/TCB-insert.pdf.
  • 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.

Sources:

  1. American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Washington, DC: National Highway Traffic Safety Administration. The American Geriatrics Society retains the copyright. https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/812228_cliniciansguidetoolderdrivers.pdf (September 27, 2018)
  2. Ibid.
  3. Centers for Disease Control and Prevention, Older Adult Drivers. Page last reviewed November 30, 2017. https://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people/2016 (September 27, 2018)
  4. Insurance Institute for Highway Safety Highway Loss Data. Older Drivers [May 2018] http://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people/2014 (September 27, 2018)
  5. Ibid.
  6. American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Washington, DC: National Highway Traffic Safety Administration. The American Geriatrics Society retains the retains the copyright. (June 8, 2016) https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/812228_cliniciansguidetoolderdrivers.pdf (September 27, 2018)
  7. Guide One Risk Resources for Health Care. Sample Policy – Identifying Unsafe Resident Drivers. http://www.goriskresources.com/Newsletter/2013/3q_al.htm   (September 27, 2018)
  8. AAA, Department of Public Safety State of Minnesota and Mobility of Minnesota’s Aging Population.  A Roadmap for Driving Later in Life. [2015] https://dps.mn.gov/divisions/ots/older-drivers/Documents/TCB-insert.pdf (September 27, 2018)
  9. American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Washington, DC: National Highway Traffic Safety Administration. The American Geriatrics Society retains the copyright. (June 9, 2016) https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/812228_cliniciansguidetoolderdrivers.pdf (September 27, 2018)
  10. Ibid.
  11. Ibid.
  12. Ibid.

AARP and AAA offer many resources for Senior Drivers – a few examples include:

  • How to Help An Older Driver, A Guide for Planning Safe Transportation.   https://seniordriving.aaa.com/download/how-to-help-an-older-driver-brochure/
  • Check Your Own Performance https://seniordriving.aaa.com/download/drivers-65-check-your-own-performance/
  • Does Your Car Fit You and Getting a Driving Health Check-Up.  http://seniordriving.aaa.com/

Resources –

  • American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Washington, DC: National Highway Traffic Safety Administration. http://www.nhtsa.gov/staticfiles/nti/older_drivers/pdf/81222…
  • AARP – Online Seminar Talking with Older Drivers
  • Module 1 The Meaning of Driving
    • Learn what driving means to older adults and the emotions involved with having to give it up.
  • Module 2 Observing Driving Skills
    • Learn to observe skills objectively and talk about alternatives to driving.
  • Module 3 Planning Conversations
  • Learn how to have “the talk” and identify alternative transportation to help a loved one stay connected and remain independent.  http://www.aarp.org/home-garden/transportation/we_need_to_talk
  • AAA, Department of Public Safety State of Minnesota and Mobility of Minnesota’s Aging Population.  A Roadmap for Driving Later in Life. [2015] https://dps.mn.gov/divisions/ots/older-drivers/Documents/TCB-insert.pdf
  • Guide One Risk Resources for Health Care – Sample Policy – Identifying Unsafe Resident Drivers http://www.goriskresources.com/Newsletter/2013/3q_al.htm

Driving Laws for Seniors –

North Dakota: North Dakota Driving Laws for Seniors and Older Drivers

  • License Renewal Rules for Older Drivers
  • Possible License Restrictions
  • How to Request an Unsafe Driver Investigation in North Dakota
  • How to Get Parking Placards or License Plates for a Disabled Driver

http://www.nolo.com/legal-encyclopedia/north-dakota-driving-laws-seniors-older-drivers.html

South Dakota: South Dakota Driving Laws for Seniors and Older Drivers

  • License Renewal Rules for Older Drivers
  • Possible License Restrictions
  • How to Request an Unsafe Driver Investigation in South Dakota
  • Reporting for Doctors
  • South Dakota Driver Improvement Programs (specifically developed for older drivers)
  • How to Get Parking Placards or License Plates for a Disabled Driver

http://www.nolo.com/legal-encyclopedia/south-dakota-driving-laws-seniors-older-drivers.html

Minnesota: Minnesota Driving Laws for Seniors and Older Drivers

  • License Renewal Rules for Older Drivers
  • How to Request an Unsafe Driver Investigation in Minnesota
  • How to Get Parking Placards or License Plates for a Disabled Driver

http://www.nolo.com/legal-encyclopedia/minnesota-driving-laws-seniors-older-drivers.html

  • Minnesota Office of Traffic Safety – Older Drivers

https://dps.mn.gov/divisions/ots/older-drivers/Pages/default.aspx

This blog, which does not reflect any official policy or opinion for Vaaler Insurance, Inc. or Siders Healthcare Consulting, LLC, is provided for informational purposes only. It is not intended to provide legal or medical advice, nor is it intended to be an exhaustive list of all risks that need to be addressed for a healthcare organization. While every effort is made to provide accurate information, changes may occur and inaccuracies happen despite best efforts.  This information is not a substitute for individual consultations with professionals in these areas and should not be relied on as such. Please work with your legal counsel and business advisor(s) for a plan that is specific to your organization. © 2016-2018 Vaaler Insurance, Inc.

 

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