Quitting driving: Families key but docs have role
A few weeks ago, Benson surprised his family by giving away the car, and he says he’s faring fine so far.
“Most people in our age group know that it’s inevitable and play around with the idea that it’s going to come and the only question is when,” Benson said. “I didn’t want to be pushed into it.”
Unlike in most of the U.S., doctors in much of Canada are supposed to report to licensing authorities patients with certain health conditions that may impair driving. Ontario in 2006 began paying doctors a small fee to further encourage that step _ and researchers used the payments to track 100,075 patients who received those warnings between April of that year and December 2009 (out of the province’s more than 9 million licensed drivers).
They compared the group’s overall rate of crashes severe enough to send the driver to the emergency room, before the warnings began and afterward, and found a 45 percent drop, reported lead researcher Dr. Donald Redelmeier, a University of Toronto professor. While the study included adult drivers of all ages _ for conditions ranging from epilepsy to sleep disorders, alcoholism to dementia _ most were over age 60. A small percentage of the province’s licensed drivers have received warnings, Redelmeier stressed, and licenses are suspended by authorities between 10 percent and 30 percent of the time.
His study highlighted one reason physicians don’t like to get involved: About 1 in 5 of the patients who were warned changed doctors. There also was an uptick in reports of depression.
Doctors aren’t trained to evaluate driving ability, and the study couldn’t tell if some drivers were targeted needlessly, noted Dr. Matthew Rizzo of the University of Iowa. Yet he called the research valuable.
“The message from this paper is that doctors have some wisdom in knowing when to restrict drivers,” said Rizzo. His own research shows some cognitive tests might help them better identify who’s at risk, such as by measuring “useful field of view,” essentially how much your brain gleans at a glance _ important for safety in intersections.
Today, the American Medical Association recommends that doctors administer a few simple tests in advising older drivers. Among them:
_Walk 10 feet down the hallway, turn around and come back. Taking longer than 9 seconds is linked to driving problems.
_On a page with the letters A to L and the numbers 1 to 13 randomly arranged, see how quickly and accurately you draw a line from 1 to A, then to 2, then to B and so on. This so-called trail-making test measures memory, spatial processing and other brain skills, and doing poorly has been linked to at-fault crashes.
_Check if people can turn their necks far enough to change lanes, and have the strength to slam on brakes.
Dr. Gary Kennedy, geriatric psychiatry chief at New York’s Montefiore Medical Center, often adds another question: Are his patients allowed to drive their grandchildren?
“If the answer to that is no, that’s telling me the people who know the patient best have made a decision that they’re not safe,” said Kennedy, who offers “to be the bad cop” for families or primary care physicians having trouble delivering the news.
There are no statistics on how often doctors do these kinds of assessment.
“It’s this touchy subject that nobody wants to talk about,” said Dr. Marian Betz of the University of Colorado, whose surveys show most senior drivers don’t think their doctors know whether they drive. She is testing if an advance directive would help get older adults talking with their doctors about how to keep watch on their driving fitness before trouble arises.