Transportation—Driving safety One of the most difficult subjects for the healthcare worker to discuss with the older adult, yet an impactful topic for self and others is autonomous driving. Driving is the leading cause of injury-related deaths in the 65- to 74-year-old population and is the second leading cause (behind falls) in the 75- to 84-year-old population (Promidor, 2019). The cessation of driving privileges is inevitable for everyone. Each older adult interaction is an opportunity for the healthcare worker to assess for prevention. Knowing when and how to approach the older adult about driving safety is imperative. Preventing driving disability with properly timed interventions can impact lives. There are acute and chronic medical conditions that should be strong indicators of safety for the older adult client. Cessation of driving privileges should be reviewed when the conditions in Tables 2 and 3 manifest or the medications in Table 4 are prescribed in the older adult and until they are medically evaluated by their primary care provider. The healthcare worker meeting mental health needs of the older adult will need to be in contact with the primary care provider about medical conditions and medications outside of their scope of practice. Table 2. Acute Medical Conditions That Require Immediate Driving Cessation • Acute myocardial infarction. • Vertigo. • Seizure. • Surgery. • Delirium from any cause. • Newly prescribed sedating medications or those that can cause confusion or dizziness. • Acute psychiatric diseases impairing cognitive function or decision making. Note. Reproduced with permission (Promidor, 2019). Table 3. Chronic Medical Conditions That Require Investigation for Driving Safety Medical Condition Examples Disease/conditions affecting vision • Cataracts • Acute stroke or other traumatic brain injury. • Arrhythmia (e.g., atrial fibrillation, bradycardia). • Lightheadedness, dizziness. • Orthostatic hypotension. • Syncope or presyncope.
Table 3. Chronic Medical Conditions That Require Investigation for Driving Safety Medical Condition Examples Psychiatric disease • Mood disorders. • Depression. • Anxiety disorders. • Psychotic illness. • Personality disorders. • Alcohol or other substance abuse. Metabolic disease • Type 1 and type 2 diabetes mellitus
(especially with hypoglycemic attacks or severe swings in blood glucose). • Arthritis and foot abnormalities. • Contractures and decreased range of motion. • Inflammation. • Pain.
Musculoskeletal disabilities
Respiratory disease • Chronic obstructive pulmonary disease. • Obstructive sleep apnea. Chronic renal failure • End-stage renal disease. • Hemodialysis. Cancer and chemotherapy • Weakness and extreme fatigue. Medication side effects. Insomnia • Sleep apnea. • Restless leg syndrome.
• Anxiety/depression/pain contributing to insomnia.
Note : Reproduced with permission (Promidor, 2019).
Table 4. Medications that can Impair Older Adults and Increase Driving Risk
• Anticholinergics. • Anticonvulsants. • Antidepressants. • Antiemetics. • Antihypertensives. • Antiparkinsonian agents. • Antipsychotics. • Benzodiazepines and other sedatives/anxiolytics. • Hypoglycemic agents. • Muscle relaxants. • Narcotic analgesics.
• Stimulants. • Hypnotics. • Marijuana. • Alcohol. • Over-the-counter agents with anticholinergic adverse effects such as sleeping agents or allergy/ cold medications, which are often first-generation antihistamines.
• Diabetic retinopathy. • Macular degeneration. • Glaucoma. • Retinitis pigmentosa. • Field cuts. • Low visual acuity even after correction.
Note. Reproduced with permission (Promidor, 2019). The healthcare worker should check for routine driving safety of the older adult and can refer to the CDC when planning interventions that maximize safe independence. Interventions should be individualized and performed in collaboration when necessary. The healthcare worker can help the older adult maintain their autonomous driving with proper identification of and interventions addressing clinical deficits. The most common disturbances are vision, cognitive, and motor/sensory (CDC, 2022a). The healthcare worker can evaluate the older adult or refer the older adult for prompt assessment of any notable organ systems, acute or chronic conditions, and medication(s) that interfere with safe driving. Intervention and rehabilitation can keep the older adult safely behind the wheel. The healthcare worker can utilize referrals and other resources to help the older adult client maximize restoration of functioning, leading to safer driving. The healthcare worker can contact case management and other specialty areas to collaboratively form a holistic care plan that meets all the needs of the driving older adult.
Cardiovascular disease, especially when associated with presyncope, syncope, or cognitive deficits
• Unstable coronary syndrome. • Arrhythmias. • Palpitations. • Congestive heart failure. • Hypertrophic obstructive cardiomyopathy. • Valvular disease.
Neurologic disease • Dementia.
• Multiple sclerosis. • Parkinson’s disease. • Peripheral neuropathy. • Brain injury. • Spinal cord injury.
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Book Code: PYFL4024
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