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Discuss driving with elderly patients
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Swati C. Modi, OD, FAAO, stressed the importance of optometrists assessing driving habits in older patients.
“Driving privileges, for many patients, represent a level of independence," Modi said in an interview with Primary Care Optometry News.
“In older patients, losing driving privileges has a significant psychosocial impact related to fear and anxiety that can lead to social isolation,” she said.
In Texas, House Bill 84, known as Katie’s Law, eliminates the opportunity for renewal by mail, Internet or telephone for applicants 79 years or older.
A good resource for eye care professionals for issues related to driving in older adults, as well as for a listing of vision requirements per state, is the American Geriatric Society’s Clinicians Guide to Assessing and Counseling Older Drivers, a 2016 update to the American Medical Association’s guide, Modi said at the Envision Conference in September.
Many aging issues can impact driving ability: vision, slower response times, motor skills/coordination, hearing loss, cognitive function, multiple medical conditions and risk-taking behavior, she continued.
Motor vehicle accidents are the leading cause of injury-related deaths among those 65 to 74 years old, Modi said. After falls, driving is the second leading cause of injury-related deaths in those 75 years and older. Further, older drivers are considerably more fragile. By age 80, male and female drivers are four and three times more likely, respectively, than 20-year-olds to die because of a motor vehicle crash.
The fatality rate for drivers 85 years and older is nine times higher than the rate for drivers 25 to 69 years old, Modi explained.
“Vision is just part of the equation in assessing a patient’s safety for driving,” she said. “Cognition and motor function also contribute significantly to an older patient’s driving performance. Although older patients tend to self-regulate driving, it is important to discuss driving with patients and their family to determine qualifications and if rehabilitation and/or alternatives to driving need to be explored.”
Modi suggests involving the patient (or family) in the decision-making process and acknowledge that safe mobility is a priority. Develop an alternative transportation plan to alleviate depression and loneliness.
“Ultimately, if an older patient’s potential driving performance is still in question, assess performance by enlisting the help of occupational therapists and certified driving rehabilitation specialists, despite whether the patient’s visual acuity and/or visual field meets the state driving guideline,” Modi concluded. –by Abigail Sutton
Reference s:
American Geriatrics Society and National Highway Traffic Safety Administration. Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Posted December 2017. Accessed Feb. 2, 2017.
American Medical Association. Physician’s guide to assessing and counseling older drivers.
Posted June 6, 2003. Accessed Feb. 2, 2017.
Ball K, et al. J Am Optom Assoc. 1992;63:71-79.
Modi S. Driving and older adults. Presented at: Envision Conference; Sept. 7-10; Denver.
Tanabe S, et al. Invest Ophthalmol Vis Sci. 2011;52(7):4177-4181. doi: 10.1167/iovs.10-6264.