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Aging News & Information
Senior Citizens Driving with Dementia Are Targets of
Training for Physicians
Academy of Neurology says seniors with mild dementia should stop driving
 December 28, 2006 – Physicians and other health
care providers are being provided training to help identify unsafe
senior citizen drivers who are impaired by dementia or other cognitive
impairments linked to aging. The three-hour workshop also offers help in
how to encourage appropriate retirement from driving, which is one of
the most difficult decisions many older people must face.
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Aging News & Information |
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Primary care physicians and other health
professionals often have limited experience in diagnosing dementia and
assessing driving safety, but researchers with the Alzheimer's Disease
Research Center (ADRC) of Washington University School of Medicine in
St. Louis have developed the workshop in hopes of making a difference.
"We don't want to give the message that older
drivers are always unsafe, because that's just not the case," says
Thomas Meuser, Ph.D., research associate professor of neurology at
Washington University.
"But there are health-related changes associated
with aging, including Alzheimer's disease and other forms of dementia,
that impair medical fitness to drive."
In a recent issue of the Gerontologist, Meuser and
colleagues reported on the effects of their workshop after presentations
to health professionals in seven Missouri locations, including a number
of rural cities with large elderly populations. The presentations were
organized with assistance from local chapters of the Alzheimer's
Association and other groups.
"We found a significant change in the willingness
of participants to ask their patients questions about driving and to
document findings and concerns in the medical record," Meuser says.
"There was a real sense among participants that
yes, there is something that I can do."
Debate is ongoing about when in the progression of
dementia a patient becomes ineligible to drive. Most states, including
Missouri, do not have specific prohibitions in this regard, but all
states allow health professionals and others to report persons perceived
as medically unfit to drive due to dementia or other conditions.
In 2001, the American Academy of Neurology
recommended that persons diagnosed with mild dementia stop driving for
reasons of personal and public safety.
Physicians at Washington University use the
Clinical Dementia Rating (CDR) interview to determine the level of
dementia-related impairment.
According to Meuser, a CDR rating of 1,
representing mild to moderate deficits in memory and other cognitive and
functional areas, is a reasonable stage at which retirement from driving
may be initiated.
"Primary care physicians and other health
professionals often have limited experience in diagnosing dementia and
assessing driving safety, but a small amount of additional training can
make a big difference," Meuser notes.
At the workshop, Meuser introduces Alzheimer's
disease and its various stages.
In another section, workshop developer David B.
Carr, M.D., associate professor of medicine and of neurology, explains
an American Medical Association (AMA) recommendation that physicians
risk-stratify their patients, grouping them on the basis of their
clinical observations into safe, unsafe and unsure.
This offers physicians unfamiliar with the
specialized process of CDR testing a framework to help identify patients
who may need to be prohibited from driving.
A 1999 Missouri law allows physicians, family
members and others to notify the state's Department of Revenue when
concerned about an older motorist's ability to drive safely. At the
workshop, participants are shown sample reporting forms and procedures
for filling them out.
"The reporting process is anonymous," Meuser says.
"And the federal Health Insurance Portability and Accountability Act
(HIPAA), which places strict regulations on patient privacy, should not
apply to this, because HIPAA allows for state reporting to protect
public safety and health."
When a report has been filed, drivers are notified
by the Department of Revenue that they have several options for proving
they can still drive safely, starting with a statement from their
physicians. Drivers may also have to retake the standard on-road driving
safety test administered by the State Highway Patrol.
"Officials with the Department of Revenue, with the
State Highway Patrol, and with the Missouri Department of Transportation
have been an absolute joy to work with," Meuser notes. "They are very
concerned about older driver safety and have welcomed us as researchers
with open arms."
Pat Niewoehner, workshop coauthor and a driver
rehabilitation specialist with the St. Louis Veteran's Administration
Medical Center, demonstrates the role of the occupational therapist -
driver rehabilitation specialist in evaluating medical fitness to drive.
Another coauthor, Marla Berg-Weger, Ph.D.,
professor of social work at Saint Louis University, shows physicians how
they can cooperate with family members to eliminate patient access to
driving and seek alternate forms of transportation that allow patients
to continue to lead fulfilling lives. Included is a videotaped
dramatization of a physician working with a demented patient and a
family member.
"It's important for healthcare providers to realize
there are others who can help," Meuser says.
The workshop was created with funding provided by
the National Highway Traffic Safety Administration and the National
Institute of Aging through the ADRC and John C. Morris, M.D., the
Friedman Distinguished Professor of Neurology and ADRC director.
Additional educational efforts and research studies
are or will soon be underway with support from NHTSA, the AAA Foundation
for Traffic Safety, the AMA and the American Society of Aging.
"This is an exciting time for research and
education in support of older driver safety, and there's a role for just
about everyone in these efforts," says Meuser.
"Above all, we must work together to ensure that
older adults can remain mobile and productive even when they have to
give up driving."
Editor's Notes:
Funding from the National Highway
Traffic and Safety Administration and the National Institute of Aging
supported this research.
Washington University School of Medicine's
full-time and volunteer faculty physicians also are the medical staff of
Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine
is one of the leading medical research, teaching and patient care
institutions in the nation, currently ranked fourth in the nation by
U.S. News & World Report. Through its affiliations with Barnes-Jewish
and St. Louis Children's hospitals, the School of Medicine is linked to
BJC HealthCare.
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