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Authors

  1. Watters, Carol

Article Content

Carr, D. B., Duchek, J. M., Meuser, T. M., & Morris, J. C. (2006). Older adult drivers with cognitive impairment. American Family Physician, 73(6), 1029-1034, 1035-1036.

 

Driving a car is one of the most important functions for an older adult. It is also a sign to the adult and others that independence is still maintained. The loss of a driver's license is a huge threat to the older person, but safety of the public must also be a priority if the patient is judged to be cognitively impaired. It is wonderful when the older person can decide on his or her own that driving is no longer a task he or she wishes to continue. Gerontologist can assist orthopaedists to assess the capabilities of the older adult with cognitive impairment relevant to safe driving.

 

The number of older adult drivers is estimated to increase from 13 million to 30 million by 2020 (p. 1030). Driving permits the older adult to have contact with others and forestall social isolation. Even with another person driving the elder, isolation is a threat because daily contacts with others are limited by the availability of the other driver. The nurse, especially the orthopaedic nurse who cares for individuals with decreased mobility, can play a key role in assessing the need for driving cessation in older adults. Nurses can assist families and physicians in discussing the need for a thorough assessment of cognitive and physical function and medications that would preclude the older adult's driving. Options for the older adult can be to have a battery of tests that include visual acuity, hearing, gait, and range of motion examinations. The American Medical Association recommends the Clock Drawing Test and the Trails B test, which are reliable predictors of decreased executive function, memory, and visual acuity. This article recommends that further evaluation is needed besides the tests mentioned, so the older adult does not face the loss of a license on the scores of these tests alone.

 

Because a physician office visit is often short, the nurse is a key person in the assessment of cognitive changes over time. The use of the Clock Drawing Test, when given at each office visit, may help to demonstrate to the family and the patient that a reduction in executive cognitive function has progressed over time. This test is an illustrative example, especially if compared from one visit to the next and may be more easily accepted by the patient if there is resistance to cease driving.

 

This article cites several means by which driving ability can be tested. There is a listing of common indicators of unsafe driving, such as dents on the car, difficulty in understanding road signs, or getting lost in familiar territory. Driving cessation tips are also listed. The role of the physician is identified, and resources that the physician and the nurse can use to further an assessment of safe driving are given.