Importance of Addressing Driving with Older Adults in Primary Care and the Role of Occupational Therapy.

Abstract

To the Editor: Driving is an instrumental activity of daily living (IADL) that supports engagement in meaningful occupations and a sense of independence,1 yet motor vehicle accidents are the leading cause of injury-related deaths in individuals aged 65–74 and the second leading cause (after falls) in those aged 75–84.2 Changes in vision, hearing, cognition, and motor skills affect driving safety as people age. Physicians have reported considerable discomfort with discussing driving safety in routine office visits, largely because they do not know how to approach the subject or how to manage an agitated patient.3 In addition, time, resources, training, and education on regulations and referral information about older adult drivers are not always available to physicians. As part of the healthcare team, occupational therapy practitioners are often certified driver rehabilitation specialists who have expertise in providing comprehensive driving evaluations and possess a unique combination of training and perspective to support physicians when determining an older adult's driving fitness.4 The purpose of this study was to determine how aware physicians are of resources and driving assessment tools available to them. A Likert scale survey was distributed to physicians at local hospitals and clinics in California that asked five questions related to mandated reporting, awareness of resources, comfort level with discussing driving, and making final decisions about cessation of driving. Each participant was given information on websites where physicians could access various driving assessment tools and a laminated “red flag” card that provided information on resources for local driving assessment programs that occupational therapists who are certified rehabilitation specialists offer. The red flag card listed concerns to look for during routine office visits that can cue a physician to refer for a driving assessment. Forty-seven surveys were collected from physicians. A majority of physicians stated that they were aware of the mandate of the California Department of Motor Vehicles to report medically at-risk drivers. When asked whether they were aware of the resources available to provide support when addressing driving with medically at-risk drivers, only 30% reported being aware. For the question, “How comfortable are you discussing driving with your patients?” the majority reported being strongly comfortable or comfortable. Forty-seven percent of participants were uncertain or not aware of the final decision-making process for cessation of driving of at-risk older adults. Many physicians appear to have knowledge about mandated reporting requirements for medically at-risk drivers in the state of California. In addition, many physicians seem to be comfortable discussing driving with older adults. This is somewhat inconsistent with research reporting that discussions of driving are not being targeted out of fear of harming the patient–physician relationship. Despite this, many physicians are uncertain of how to help people retire from driving. There seems to be some disconnect between physician willingness to discuss driving and their knowledge of how to do so. Creation of the red flag card was aimed at helping physicians easily access the top problems necessitating a referral to a driving specialist and how to reach certified driving specialists in their communities. Geographical area and small sample size were limitations of this study. Further research is needed to investigate the benefits of collaboration between occupational therapists who are certified driving specialists and primary care physicians as a first step in keeping older adults safe on the road. The authors would like to thank Dr. Marian Betz and the participants of this study. Conflict of Interest: The authors have no conflict of interest. Author Contributions: Karia: study concept and design, acquisition of subjects and data. Davis: analysis and interpretation of data, preparation of first draft and final manuscript. Gonzalez, Kerby: acquisition of subjects and data, preparation of first draft. Mezher, Smith: acquisition of subjects and data, preparation of first draft. Sponsor's Role: There was no sponsor for this study.