You are about to see an 80-year-old man for an annual follow-up visit. Just prior to entering the exam room, the patient's daughter tells you that she wishes you would dissuade the patient from driving. When you inquire as to why, she relates that she doesn't have any specific reason other than his advancing age, he is becoming a little forgetful, and she worries about him driving.
The patient states that he is doing well and voices no new complaints. He denies falls. He has a history of hypertension, hyperlipidemia, gastroesophageal reflux, diminished hearing, and benign prostatic hyperplasia. His current medications include atenolol, hydrochlorothiazide, omeprazole, and a multivitamin. He does not drink alcohol.
The patient lives independently and performs all of his own activities of daily living, including his own shopping. He drives approximately 3-5 times a week for shopping, restaurants, and entertainment. He's had one minor "fender bender" when he backed into a short stationary garbage can that he did not see one year ago. He has not had any moving traffic violations, he denies having any close calls while driving, and he has never gotten lost while driving. He has cataracts but his recent eye exam showed a corrected vision of 20/40 in both eyes and good peripheral vision. His last driver's license renewal was 12 months ago. He relates that he feels comfortable with driving.
His blood pressure is 136/84 mm Hg and pulse is 72/min. His general examination is unchanged. His head and neck mobility are good and his gait is normal. He performs a 'Get Up and Go test' in 14 seconds. His score on a Mini-Mental State Exam is 26/30; he scored 27/30 18 months ago.
What should you tell this patient and his daughter regarding his driving?

Question

You are about to see an 80-year-old man for an annual follow-up visit.  Just prior to entering the exam room, the patient's daughter tells you that she wishes you would dissuade the patient from driving.  When you inquire as to why, she relates that she doesn't have any specific reason other than his advancing age, he is becoming a little forgetful, and she worries about him driving.
The patient states that he is doing well and voices no new complaints.  He denies falls.  He has a history of hypertension, hyperlipidemia, gastroesophageal reflux, diminished hearing, and benign prostatic hyperplasia.  His current medications include atenolol, hydrochlorothiazide, omeprazole, and a multivitamin.  He does not drink alcohol.
The patient lives independently and performs all of his own activities of daily living, including his own shopping.  He drives approximately 3-5 times a week for shopping, restaurants, and entertainment.  He's had one minor "fender bender" when he backed into a short stationary garbage can that he did not see one year ago.  He has not had any moving traffic violations, he denies having any close calls while driving, and he has never gotten lost while driving.  He has cataracts but his recent eye exam showed a corrected vision of 20/40 in both eyes and good peripheral vision.  His last driver's license renewal was 12 months ago.  He relates that he feels comfortable with driving.
His blood pressure is 136/84 mm Hg and pulse is 72/min.  His general examination is unchanged.  His head and neck mobility are good and his gait is normal.  He performs a 'Get Up and Go test' in 14 seconds.  His score on a Mini-Mental State Exam is 26/30; he scored 27/30 18 months ago.
What should you tell this patient and his daughter regarding his driving?

Quizplus · Accepted Answer

11ec193a_9945_83df_853d_3136186546c8_MD0002_00 Family members often request an assessment of driving risk for older individuals. Without a definitive test to assess and determine a person's competency behind the wheel, this becomes a complex issue. Loss of driving privileges by older individuals can result in diminished independence, self-esteem, and quality of life. Advice regarding driving competency must maintain a careful balance between avoiding the endangerment of the general public and patient autonomy. The table above illustrates several "red flags" that should raise concern regarding driving competence. Based on this patient's medical history, systems review, physical examination, performance on an MMSE and a 'Get Up and Go test,' and his recent driving record - all indicate that he is capable of driving (Choices A & E). However, he should be cautioned to limit his driving during poor weather conditions, at night, for long distances, and in heavy traffic. (Choice C) Evaluation of driving with an on-road observed driving evaluation may be the most efficacious way of assessing driving competence, but does not appear to be indicated in this patient at this point in time. (Choice D) Several driving refresher courses (e.g., sponsored by AAA and AARP) emphasize driving safety, but they do not evaluate on-road observed driving performance. In addition, they have not been shown to improve actual driving and would not be indicated in this patient. Educational objective: Assessing driving competence is difficult. Driving history is an important evaluative tool along with the careful evaluation of medical conditions and physical examination. If there is doubt regarding driving competence, evaluation with a directly observed on-road test may be indicated (if available). __________ References: Driving patterns of older adults: results for the second injury control and risk survey. (http://www.ncbi.nlm.nih.gov/pubmed/20670376) Impaired driving from medical conditions: A seventy old man trying to determine if he should quit driving. (http://www.ncbi.nlm.nih.gov/pubmed/21364126)

You Are About to See an 80-Year-Old Man for an Annual