A recent study in the Journal of General Internal Medicine suggests that physicians may wait too long to have a discussion with elderly patients about their driving abilities.
Focus groups found that many care providers wait for a 'red flag,' such as a recent automobile crash or a new medical condition that might impair eyesight, cognitive abilities or other functionality crucial to safe driving, before broaching the topic with their patients.
Driving ability is not only a patient safety issue but could be a legal issue for hospitals as well. "I could see some liability [for the hospital] in a case where clearly the patient should not be driving and their doctor does nothing," saysAlan G. Gilchrist, a partner at The Health Law Partners. Driving abilities of patients should be of some concern to hospitals, he says. "This probably is an issue where the administrators should enforce guidelines," he says.
Yet many physicians are hesitant to discuss driving with their patients. "These conversations can be very emotional and difficult," says the study's lead author Marian Betz, MD, of the University of Colorado School of Medicine. "There are also many competing priorities for time" when a physician is with a patient, she says. "It can be tough to fit one more question in."
However, researchers found that elderly drivers were receptive to having conversations about their driving abilities with physicians, viewing physicians as both knowledgeable and fair-minded. This suggests that earlier discussions about driving abilities are both important and likely to be well-received, says Dr. Betz.
"The majority of people will outlive their ability to drive safely," says Dr. Betz. "It's an inevitability for most people." She recommends having conversations regarding driving when discussing other lifestyle changes, such as retirement or any medical issue that might begin to limit a patient physically. "These conversations should begin before the patient starts having issues with driving," she says.
To help facilitate both discussions and decisions involving driving, Dr. Betz recommends using an advance driving directive, or a written form filled out with the help of a physician that details the kind of testing desired and who should help make the hard decisions should driving safely become an issue. The directive is "a non-legally-binding document that would help facilitate conversations now and plan for health changes in the future," she says.
While keeping unsafe drivers off the road is a real and pressing issue, care should be taken not to take a patient's license too soon, says Dr. Betz. "There's a definite idea that older drivers are unsafe, even though most older drivers are safe," she says. Removing a senior's independence and mobility too early has been associated with depression, worsening mental health, declining physical health and even premature death, she says. "Driving has lots of important benefits for these patients that should not be ignored," she says.
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