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Geriatrics Driving

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Anyone have some wisdom about how to objectively evaluate someone's capability to drive a vehicle and then actually do something about it if needed.. I'm seeing a lot of elderly that need to start getting off the road.  Like my lady who "had a little accident" (leveled her own garage) and still thinks she can drive locally.. 

Muchas gracias. 

 

 

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Always a delicate thing, but be up front and see if they'll voluntarily surrender their license...if not, send in the forms required by state or provincial licensing boards that initiates a medical driving review at the regulatory level.  I worked in a small town where if I started the process, I'd likely notice if they were on the road and inform the police if needed.  It would invariably get around as well and "helpful" people would narc on each other to me about it too :-D.  I ALWAYS informed (and still do in ER) the person concerned that I'm recommending a licensing review +/- suspension/revocation when I send the form in.  These things invariably become an argument about 90% of the time, however it's better to have it then and there than when the person gets even more defensive because the forms arrived in the mail unannounced - you've now lost all trust the person may have had in you at that point.  If there are family in the area, sometimes doing it as a family meeting can help a bit too.

Good luck.

 

SK

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When in doubt, refer to a specialist.  Like, in this case, the DMV process.  If you have a reasonable concern, and you're not able to reassure yourself or disposition it, then be up front about that.  Frankly, there should be more mandatory retesting--I haven't taken a road driving test in 30 years, not counting fire engine driving. :-)  Retesting every 10 years starting at 60, and every 5 years after 80, sounds pretty doggone reasonable to me,.

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Easy. Find your local occupational therapist that does driving evals. 

 

Yes this is a real thing

 

no it is not a road test

 

it is a simulated test to test reaction times. 

 

Very easy to refer. Then based on results you can make recommendations.  I am in a non mandatory reporting stater for elderly drivers so this takes the heat off the PA. 

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Our hospital has a simulated care through occupational therapy that tests reaction time, motor skills. Very, very useful. I've found driving evals to be a very touchy subject....not an easy thing to do.

 

On a different note, what are some medical indications to take a license? The obvious ones would be seizure, syncope, etc. Any specific cut off in your state regarding A1C?

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On 9/23/2017 at 11:15 AM, dchampigny said:

Our hospital has a simulated care through occupational therapy that tests reaction time, motor skills. Very, very useful. I've found driving evals to be a very touchy subject....not an easy thing to do.

 

On a different note, what are some medical indications to take a license? The obvious ones would be seizure, syncope, etc. Any specific cut off in your state regarding A1C?

Id say dementia can certainly be cause for losing driving privileges...

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Interesting that this topic is being discussed.  My stepfather (age 73) called me this week to let me know that he had "passed out" a couple of times that day.  It happened one other time, about 6 weeks prior.  He hadn't sought treatment.  I told him to go and get checked out. Said I didn't want him to drive, and reminded him that running over someone's grandchild should he lose control, wasn't worth it.  Figured that would strike home, since he has some himself.  He and mom live in Canada, I am in Texas, so it's not like I could just run over and check on him.  He called today.  He went to the hospital that day, and was admitted overnight.  On morning rounds, the doctor informed him that he would have to notify the Ministry of Transportation.  Now he's kind of ticked that he likely won't be allowed to drive for a while.  Too bad, Dad.  

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Passing out -- especially due to seizures -- causes you to lose your driving privileges for six months in my state. You can return to driving when you are seizure-free for that long. Fortunately many such events are treatable once the cause is known.

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I was always horrified as a student when I would walk into a room and see a little old lady sitting by herself (not knowing her social hx). Of course they could barely climb up onto the exam table. 

I couldn't help but wonder how they had got to their visit that day...

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1 hour ago, ndpa09 said:

 

I couldn't help but wonder how they had got to their visit that day...

The unbelievably huge Caddilac or Lincoln outside...with Armstrong steering.

SK

 

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Interesting article I read yesterday about a related subject. Short version...elderly gentleman was on chemotherapy for cancer and PCP told him not to drive. 1 year after chemo pt asked PCP if he could start driving again and was told yes. He had an accident because he fell asleep at the wheel. Elderly gent survives (of course) but killed a child in the other vehicle. The parents sue the PCP for not telling the patient not to drive. Courts rule they have standing because he should have told the pt not to drive because of the meds he was taking one of which was oxycodone. PCP maintains he did tell the pt but didn't document it in the chart.  Court further rules that pharmacy advice and warning label on the bottle doesn't isn't adequate notice or adequate warning. My take home from all of that is err on the side of caution if you have driving concerns and document everything. I'm in Texas and we have a form we complete to ask the state patrol to evaluate someone's fitness to drive. I send in 2-3 annually. I tell the patient I am going to. I know it is their freedom and their only way of getting around but safety of everyone on the road is the first concern. It could have been my family in the other car.

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8 hours ago, sk732 said:

The unbelievably huge Caddilac or Lincoln outside...with Armstrong steering.

SK

 

Yup. We had the old fella in the small town where I lived he was so frail and blind he was a danger to everyone. I watched him hit 2 cars 4 times just trying to back out of a parking space. What was he driving? The USS Cadillac. When your skills deteriorate you go buy a 12 foot 7000 pound car so you stay "safe".

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Had to take an old guy to the hospital that had a huge pickup truck who was severely dementing - crashed in my parking lot at work.  Survey said...BAHHHHH!!

SK

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