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4 results

  • Chapter 55 - Driving and the Older Adult
  • from Section IV - Principles of Care for the Elderly
  • Edited by Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Samuel C. Durso, The Johns Hopkins University, Maryland, Christine Arenson, Thomas Jefferson University, Philadelphia, Rebecca Elon, The Johns Hopkins University School of Medicine, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel
  • Book: Reichel's Care of the Elderly
  • Published online: 30 June 2022
  • Print publication: 21 July 2022, pp 675-683
  • View extract

    Summary

    Driving is an essential and highly valued instrumental activity of daily living that becomes increasingly difficult to safely maintain with age-related medical conditions. Health-care providers are uniquely positioned to (1) identify and modify risk factors associated with on-road safety, (2) offer rehabilitation strategies to improve safety and extend driving life, and (3) combine clinical information with resources related to driving to support safe continued community for older patients. Clinicians face myriad challenges in assessing patients' medical fitness to drive, including multiple comorbidities, polypharmacy, and reluctance to address driving issues due to the potential impact on the relationship with the patient, as well as legal/ethical concerns. However, assessment and intervention are important to prevent injury and the potential loss of driving privileges, the latter which may have a negative impact on quality of life. This chapter describes the functional abilities necessary to be a safe driver at any age; acute and chronic medical risk factors for driving impairment; clinical tools to stratify risk of medical impairment to drive; opportunities to intervene or refer patients flagged for impairments; resources to support patients transitioning from driver to nondriver; and ethical and legal concerns for clinicians advising patients on driving.

  • Chapter 51 - Driving and the older adult
  • from Section IV - Principles of care for the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book: Reichel's Care of the Elderly
  • Published online: 05 June 2016
  • Print publication: 23 June 2016, pp 691-701
  • View extract

    Summary

    Driving is an essential instrumental activity of daily living but becomes increasingly difficult to maintain with age-related comorbid medical conditions. Age-related physiologic changes can impact driving along with common medical conditions that have a high prevalence in advanced age. Polypharmacy and sedating medications can impair driving. A comprehensive assessment—including taking a driving history and a targeted physical exam, the Assessment of Driving-Related Skills (ADReS)—is recommended to identify older drivers at risk. Referrals to other health professionals (e.g., occupational therapists, physical therapists, social workers, neuropsychologists, etc.) may be quite helpful in determining driving risk and/or assisting with driving retirement and maintaining key driving destinations. Driving rehabilitation specialists (typically occupational therapists) can assist clinicans with comprehensive evaluations and performance-based road tests. Legal and ethical issues are related to reporting unsafe drivers, and clinicians are advised to seek local counsel in these matters and know their state laws.
  • Chapter 55 - Cultural competence and health literacy
  • from Section IV - Principles of care for the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book: Reichel's Care of the Elderly
  • Published online: 05 June 2016
  • Print publication: 23 June 2016, pp 735-748
  • View extract

    Summary

    Person-centered geriatric care requires attention to the diversity of older patients. The looming ethnogeriatric imperative, when 40% of geriatric patients will be from a minority population, will require health care organizations and providers to meet elders’ unique cultural needs. These include meeting the Culturally and Linguistically Appropriate Standards (CLAS), especially providing language access for elders with limited English proficiency; developing cultural humility and confronting unconscious bias; knowing major health beliefs, special health risks, and the cohort experiences of elders of different populations; and using culturally appropriate assessment techniques, including eliciting elders’ explanatory models of their conditions. Older adults are also more likely to have low health literacy or to experience challenges obtaining, processing, or comprehending health information. As low health literacy has been linked to poor health outcomes, geriatric providers must develop skills to ensure they understand their patients and that their patients understand them
  • 48 - Driving and the Older Adult
  • Edited by Christine Arenson, Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Kenneth Brummel-Smith, Florida State University, James G. O'Brien, University of Louisville, Kentucky, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel, Georgetown University, Washington DC
  • Book: Reichel's Care of the Elderly
  • Published online: 19 May 2010
  • Print publication: 09 February 2009, pp 508-516
  • View extract

    Summary

    “It's getting very hard for me to drive at night. I don't like to go out because I don't think it's safe. Is there something you can do to help me?”

    “You have to talk to Dad about his driving when you go in. He almost hit someone the other day, and I don't feel like he can take the children out anymore.”

    “My neck is so sore from that fender-bender. The emergency room said that I had to come in and see you if the pain didn't go away after a few days.”

    INTRODUCTION

    Almost every health care practitioner who cares for older adults has heard a variation on one of these statements. Driving is an essential instrumental activity of daily living for young and old alike in this highly mobile society, but it becomes increasingly difficult to maintain with normal aging changes and potential comorbid medical conditions. Prevention, detection, and treatment of impaired driving ability is challenging in most health care settings for many reasons, including symptoms that do not fit typical medical paradigms, lack of familiarity with effective assessment techniques, and time constraints. Concerns about significant legal and ethical questions may also deter the health care provider from addressing the issue of driving. Early intervention is important, however, to prevent injury, unnecessary disability, and the potential loss of driving skills/privileges, with ensuing adverse effects on quality of life. With the rapid increase in the population of older adults, it is estimated that 25% of drivers will be older than age 65 by the year 2030.