Should Doctors Decide When a Patient Is Too Old to Drive?

Gregory A. Hood, MD

Disclosures

January 23, 2019

In This Article

Should Physicians Make the Call?

Typically, family members want the clinician to become involved in the conversation and to assume a role of authority because of medical knowledge. They may also hope to place the responsibility (or "blame") for taking their loved one's freedom away on "the doctor's decision."

Unfortunately, there is no course in medical school that teaches medical students about safe driving evaluations. With the exception of when the patient is also a family member, it is very rare for a physician to take a road test with a patient.

When making a judgment, physicians are forced to weigh cognitive, perceptual, and/or physical issues without having directly observed the senior's driving performance.

Even when structured tools such as SIMARD MD (Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers) are used in the visit, there is room for debate about the conclusions.[2,3,4] These are often highly charged office visits and the consequences can affect a patient's future health management; if a clinician recommends against driving, then the patient may feel betrayed and refuse to return for other health issues.

Clinicians may recommend independent driving evaluations[4,5] which can provide objective data to shift the conversation in a beneficial direction. In many states, the Department of Motor Vehicles (DMV) will offer—or in some cases, require—driving evaluations by state officials. State laws vary widely, so check your own state DMV's website to know what is required and what services are available.

Reassessments and Driving Restrictions

Keep in mind that reassessments are possible and often are necessary. Patients, of course, will be worried about reassessments, but they also may have the opportunity to improve their performance. For example, a patient who does poorly on an assessment after having spent weeks or months in a physical rehabilitation facility may be subject to restrictions but may have a different result in the future upon re-evaluation.

If there are concerns about driving, then restrictions can be useful, such as no driving when lighting (especially at night) or road conditions are poor or during bad weather.

Donald Redelmeier, a doctor and scientist at Sunnybrook Hospital, has conducted several research studies aimed at reducing vehicle collisions, the single biggest killer from birth to middle age. He thinks "how the individual driver is compensating" for changes in physical or cognitive function should be taken into account. Senior drivers tend to avoid driving at night or long distances, for example, which explains that even though seniors have far more collisions per kilometer driven than people in their thirties, they don't get into more accidents overall than that age group.[6]

Confining driving to the most familiar, least complicated, and less traveled routes may be helpful, but it is important to keep in mind that such roads may be in residential areas, which have their own risks for sudden surprises, such as children darting out into the street after a pet or ball. If driving performance is truly suspect, then there isn't always a good opportunity to make such restrictions.

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