Talking to older patients about driving is a challenge for docs

Many people expect, or hope, that the family doctor will intervene to help take away the car keys from an unsafe older driver, but doctors and clinic staff say these are hard conversations to have and they need more resources.

“Doctors are often called on to help make decisions about driving, because they understand a person’s medical conditions and medications and how these affect driving,” but many older adults prefer to hear advice from family, friends or driving specialists, said lead author Dr. Marian E. Betz of the Department of Emergency Medicine at the University of Colorado School of Medicine in Aurora.

“Ultimately, only a licensing bureau can revoke a license – but doctors, family, and others can help an older adult decide when it’s time to stop driving,” she told Reuters Health by email.

On the whole, older drivers are generally safe drivers and do not pose a menace to the community around them, she stressed. “Driving is key for mobility and independence, and driving cessation has been linked to depression and even early death,” Betz said.

Talking about stopping driving can be very emotional, which is why doctors and family members may be reluctant to bring it up, Betz said.

“It’s also hard to talk about if there aren’t great alternatives to offer – either because there aren’t good transportation alternatives or because the doctor or family doesn’t know where to find them,” she said.

Betz and her coauthors interviewed 10 doctors, two nurses, a medical assistant, a social worker and a front-desk staffer who worked at a geriatric clinic or a general internal medicine clinic in Colorado.

Each person talked for up to an hour about their own role in working with older drivers, experiences they have had with impaired older patients, and their recommendations on how to implement an older driver assessment in a way that would be accepted by providers and drivers.

The 15 interviewees talked most about their inadequate resources to support older drivers, a lack of education for providers and patients about driving safety and how complex their own roles are in the primary care office setting.

Providers in both clinics said they knew talking about driving safety was their responsibility, but it was not a role they enjoyed.

“I don’t know if I would say hesitant . . . I would say dread maybe,” one doctor told the researchers. “More like I know it’s important to do. I know we have to do it, but we don’t like it.”

One doctor, trained in palliative care, said he would rather have the "end of life" discussion than an end of driving discussion. Taking away driving rights can be more contentious since it involves taking away freedom and autonomy, he said.

Doctors expressed that a better sense of evidence-based recommendations would help them make decisions about how to talk to older drivers, and what to say.

The doctors were often unsure of what community resources were available for driving evaluation or rehabilitation, but they did know that those programs are usually not reimbursed by insurance.

Comprehensive driving evaluations including both in-office tests and a behind-the-wheel session on the road are available at some VA centers.

The sole social worker felt she was most informed about options for driving assessment and alternative transportation, and the doctors in both clinics considered her a key resource, the authors write in the Journal of Injury Prevention.

“As we get older we do become more prone to a variety of health concerns like dementia that can undermine your ability to safely drive a motor vehicle,” and it is the doctor’s responsibility to detect these conditions, said Dr. David Hogan, a geriatrics expert at the University of Calgary.

But that can be difficult to do, Hogan told Reuters Health by email.

“Even when a physician can evaluate the potential impact of a diagnosis in an office setting, they are not directly observing the person’s driving skills on the road, which is the most relevant issue when assessing driving safety,” he said.

Doctors may need easier access to local information, a link to a social worker, or embedded questions within electronic medical record templates to make these conversations easier, Betz said.

“Early and routine conversations about driving can help bring up the topic in a nonthreatening way and can help older adults prepare for future changes,” she said. “These conversations can happen in doctors’ offices but also around the kitchen table at home.”

“While there’s no set age when a person becomes unsafe, 65 might be a good target to start routine conversations,” Betz said.