Physician's Guide to Assessing and Counseling Older Drivers. Second edition.

Abstract

This excellent work was created by the American Medical Association (AMA) with support from the National Highway Traffic and Safety Administration (NHTSA) to help physicians address preventable motor vehicle injuries, because “Currently, motor vehicle injuries are the leading cause of injury-related deaths among 65-to-74-year-olds and the second leading cause (after falls) among 75-to-84-year-olds” (p. ix). The so-called “silver tsunami” of aging Americans will only exacerbate these alarming statistics. The AMA and NHTSA see this as a tool for physicians “to forge a link between public health and medicine” (p. ix) by assessing and counseling older drivers to enhance driving safety and “ease the transition to driving retirement if and when it becomes necessary” (p. ix). This comprehensive work has an excellent format, is highly readable, and includes relatable patient vignettes. Beginning with an overview of “Safety and the Older Drive with Functional or Medical Impairments” and including the “Physician's Plan for Older Drivers' Safety (PPODS)” chart (p. 6), ten chapters cover everything from performing a thorough physical and mental assessment of patients to broaching the issue of driving and “Counseling the Patient Who Is No Longer Safe to Drive.” The text states that “For most of us, driving is a symbol of independence and self-esteem. When an individual retires from driving, he/she not only loses a form of transportation, but all the emotional and social benefits derived from driving” (p. 49). The “Ethical and Legal Responsibilities of the Physician” regarding counseling of patients who are no longer safe to drive and legal ramifications of reporting unsafe drivers, including maintaining patient confidentiality, are discussed at length. Chapter 8, “State Licensing and Reporting Laws,” offers a detailed state-by-state list of motor vehicle licensing and reporting requirements and contacts. Chapter 9 outlines “Medical Conditions and Medications that May Affect Driving,” and Appendix A offers current procedural terminology (CPT) codes. A chapter is devoted to “The Driver Rehabilitation Specialist,” a specialized occupational therapist who can offer adaptive driving instruction and suggest vehicle modifications. These specialists are still fairly rare. The book's final chapter, “Moving Beyond this Guide: Future Plans to Meet the Transportation Needs of Older Adults,” includes among its recommendations “increased availability and affordability of driver rehabilitation” (p. 187). Appendix B, “Patient and Caregiver Educational Materials,” offers four patient and caregiver self-assessment tools and recommendations, and it includes a list of resources that offer additional information. Older drivers often find it very difficult to honestly assess their abilities to operate motor vehicles as health issues arrive. Loved ones and caregivers find it equally difficult to broach this subject. This work offers physicians excellent guidelines and recommendations to assist their older patients and families in assessing these issues and making lifestyle changes as needed. It is up to the individual library to determine if an actual copy of this work should be in the collection, but certainly physicians should be made aware of it.