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Involve the patient and relatives when counseling elderly drivers
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Elderly Americans are like most Americans – they relate driving with independence. To lose a driver’s license is to lose one’s freedom to visit friends, go grocery shopping and drive to medical appointments.
There comes a time, however, in most patients’ lives where driving may become unsafe because of a decline in vision. We as eye care professionals are sometimes put in a difficult situation by having to educate and counsel elderly patients on their driving skills as it relates to their vision. We have to be sensitive to the anxiety and fear that many elderly patients experience when faced with thoughts of not being able to drive.
However, most optometrists also have anxiety themselves when broaching this subject with a patient. We fear that our relationship with the patient may be permanently altered if the patient thinks we are out to take away their “freedom.” Will the patient find another eye doctor or just stop coming to their eye exams altogether? While this anxiety is normal, we are obligated to our patients and our communities to prevent unsafe drivers from driving before accidents occur.
Ask patients about their own driving
If during the course of an examination I determine that a patient’s vision has declined to a point where driving may be affected, I question him or her on their perception of their driving abilities. I tell the patient that this is not a test, I am just trying to determine visually the best way to keep them safe while driving.
I ask them specific questions such as: “What time of day and how far away from your home do you drive? How close do you have to get to a road sign to read it?” Because most visual impairments occur over time and not instantaneously, most patients have already modified their driving to accommodate their declining vision and comfort.
I then educate them on their vision as it compares to the visual requirements for driving. If they are still legal to drive visually, then I make suggestions to keep their driving safe, such as driving only during daylight hours and to places that are familiar to the patient or possibly referring them to a licensed driver evaluation program.
Involve relatives
It is helpful to have a relative in the room who can also educate the doctor on the patient’s driving abilities. Some patients do not answer truthfully when questioned about their skills and comfort because they are anxious that their license may be taken away. Relatives can not only help the doctor get more honest answers, but they can also help counsel the patient.
If, for example, the patient does not visually meet the requirements for driving, having the relative in the room to hear this can help the doctor when making the recommendation that the patient not drive. Oftentimes the relative has known the patient was not safe to drive; they are just not comfortable telling the patient themselves. Having an optometrist to back them up will help the family make the necessary adjustments to stop the patient from driving.
After giving my recommendations, I educate the patient and family on community resources for transportation as well as make suggestions for other methods of transportation such as church groups and friends.
As the demographics change and the number of elderly drivers increases, eye care professionals will be confronted with this situation even more often. It is not a topic we should shy away from, and it is our obligation to protect the safety of our patients and our communities. As long as we are aware of and sensitive to the situation, as well as caring in our counseling, most patients will respect and understand our concern and recommendations.
For more information:
- Katie Gilbert Spear, OD, MPH, is director of the Visual Performance Center at Panhandle Vision Institute. She can be reached at 5101 North Davis Highway, Pensacola, FL 32503; (850) 438-1277; e-mail: kgilbert77@yahoo.com.