Table 2. Acute Medical Conditions That Require Immediate Driving Cessation • Acute myocardial infarction.
Table 3. Chronic Medical Conditions That Require Investigation for Driving Safety Medical Condition Examples Insomnia • Sleep apnea. • Restless leg syndrome.
• Acute stroke or other traumatic brain injury. • Arrhythmia (e.g., atrial fibrillation, bradycardia). • Lightheadedness, dizziness.
• Anxiety/depression/pain contributing to insomnia.
• Orthostatic hypotension. • Syncope or presyncope.
• 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
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 inter- ventions that maximize safe independence. Interventions should be individualized and performed in collaboration when necessary. The healthcare worker can help the older adult maintain their au- tonomous driving with proper identification of and interventions addressing clinical deficits. The most common disturbances are vision, cognitive, and motor/sensory (CDC, 2022a). The health- care 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 driv- ing. 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 collabora- tively form a holistic care plan that meets all the needs of the driv- ing older adult. The healthcare worker is faced with a complicated decision ma- trix when it comes to addressing the older adult’s driving privi- lege; there are personal, clinical, ethical, and legal ramifications. The healthcare worker is often consulted about the safety of the older adult who drives and is faced with the weight of the older adult’s needs and safety versus the safety of society. The health- care worker is encouraged to refer to state laws associated with reporting of unsafe driving and prescribed revocation of driving privileges in addition to the information provided. Social support system (Isolation) An important part of the social history is the social connected- ness of the older adult. The older adult is capable of being physi- cally and mentally healthy and maintaining autonomy. However, the inescapability of mortality often pushes the older adult living away from friends, family, and possibly their partner. An increased sense of isolation can cause symptoms of depression (Sadock et al., 2015). The healthcare worker can assess the social support system the older adult utilizes on a daily/weekly/as needed basis to better understand any deficits of care in the social history sec - tion of the psychiatric interview. Where the older adult resides is an important consideration for social support. The healthcare worker might work along with the long-term care facility team in coordinating the social needs of the older adult. Social isola- tion and loneliness have negative effects on the mental health for the older adult. They increase the risk for negative health conse- quences such as obesity and smoking as well as shorten life span
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.
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.
Page 17
Book Code: RPTX3024
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