Describe: Driving Reporting Requirements (4)
- physician-reporting to the Ministry of Transportation is mandatory in all provinces and territories except in Quebec, Nova Scotia, and Alberta, where it is discretionary
- British Columbia, Ontario: must refer for re-test at ≥80 yr
- not an issue unique to geriatrics – any patient may suffer from a medical condition that impairs their ability to drive and should be reported
- in the U.S., varies by state
Name: Key Factors to Consider in Older Drivers (7)
SAFEDRIVE
- Safety record
- Attention (e.g. concentration lapses, episodes of disorientation)
- Family observations Ethanol abuse Drugs
- Reaction time
- Intellectual impairment
- Vision/Visuospatial function
- Executive functions (e.g. planning, decision- making, self-monitoring behaviours)
Name: Conditions that impair driving (14)
- Alcohol
- Blood Pressure Abnormalities
- Cardiovascular Disease
- Cerebrovascular Conditions
- COPD
- Cognitive Impairment/ Dementia
- Diabetes
- Drugs
- Hearing Loss
- Musculoskeletal Disorders
- Post-Operative
- Seizures
- Sleep Disorders
- Sleep Disorders
Describe this condition that impairs driving: Alcohol (3)
- Patients with history of impaired driving and those with a high probability of future impaired driving should not drive until further assessed
- Alcohol dependence or abuse: if suspected, should be advised not to drive
- Alcohol withdrawal seizure: must complete a rehabilitation program and remain abstinent and seizure-free for 6 mo before driving
Describe this condition that impairs driving: Blood Pressure Abnormalities (2)
- Hypertension: sustained BP >170/110 should be evaluated carefully
- Hypotension: sustained BP <90/60; if syncopal, discontinue driving until syncope is treated and preventable
Describe this condition that impairs driving: Cardiovascular Disease (3)
- Suspected asymptomatic CAD or stable angina: no restrictions
- STEMI, NSTEMI with significant LV damage, coronary artery bypass surgery: no driving for 1 mo following hospital discharge
- NSTEMI with minor LV damage, unstable angina: no driving for 48 h if Percutaneous Coronary Intervention (PCI) or 7 d if no PCI performed
Describe this condition that impairs driving: Cerebrovascular Conditions (2)
- TIA: should not be allowed to drive until a medical assessment is completed
- Stroke: should not drive for at least 1 mo; may resume driving if functionally able; no clinically significant motor, cognitive, perceptual or vision deficits; no obvious risk of sudden recurrence; underlying cause appropriately treated; no post-stroke seizure
Describe this condition that impairs driving: COPD (2)
- Mild/moderate impairment: no restrictions
- Moderate or severe impairment requiring supplemental oxygen: road test with supplemental oxygen
Describe this condition that impairs driving: Cognitive Impairment/ Dementia (4)
- Moderate to severe dementia is a contraindication to driving; defined as the “inability to independently perform 2 or more IADLs or any basic ADL”
- Patients with mild dementia should be assessed; if indicated, refer to specialized driving testing centre; if deemed fit to drive, re-evaluate patient every 6-12 mo
- Poor performance on MMSE, clock drawing or Trails B suggests a need to investigate driving ability further
- MMSE score alone (whether normal or low) is insufficient to determine fitness to drive
Describe this condition that impairs driving: Diabetes (2)
- Diet controlled or oral hypoglycemic agents: no restrictions in absence of diabetes complications that may impair ability to drive (e.g. retinopathy, nephropathy, neuropathy, cardiovascular or cerebrovascular disease)
- Insulin use: may drive if no complications (as above) and no severe hypoglycemic episode in the last 6 mo
Describe this condition that impairs driving: Drugs (2)
- Be aware of: analgesics, anticholinergics, anticonvulsants, antidepressants, antipsychotics, opiates, sedatives, stimulants
- Degree of impairment varies: patients should be warned of the medication/withdrawal effect on driving
Describe this condition that impairs driving: Hearing Loss (2)
- Effect of impaired hearing on ability to drive safely is controversial
- Acute labyrinthitis, positional vertigo with horizontal head movement, recurrent vertigo: advise not to drive until condition resolves
Describe this condition that impairs driving: Musculoskeletal Disorders (1)
Physician’s role is to report etiology, prognosis and extent of disability (pain, range of motion, coordination, muscle strength)
Describe this condition that impairs driving: Post-Operative (2)
- Outpatient, conscious sedation: no driving for 24 h
- Outpatient, general anesthesia: no driving for ≥24 h
Describe this condition that impairs driving: Seizures (2)
- First, single, unprovoked: no driving for 3 mo until complete neurologic assessment, EEG, CT head
- Epilepsy: can drive if seizure-free on medication and physician has insight into patient compliance
Describe this condition that impairs driving: Sleep Disorders (1)
If patient is believed to be at risk due to a symptomatic sleep disorder but refuses investigation with a sleep study or refuses appropriate treatment, the patient should not drive
Describe this condition that impairs driving: Visual Impairment (1)
- Visual acuity: contraindicated to drive if <20/50 with both eyes examined simultaneously
- Visual field: contraindicated to drive if <120° along horizontal meridian and 15° continuous above and below fixation with both eyes examined simultaneously
