Identifying and managing the unsafe older driver

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Identifying and managing the unsafe older driver

• C. Frank CCFP

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Objectives

• At the end of the presentation you will be
• Aware of Ontario legislation relating to medical
  fitness to drive
• Be aware of reporting responsibility in Ontario
• Be familiar with the major criteria for driving
  safety for patients with
• Dementia
• Multiple medications
• Stroke/TIA/cardiovascular disease
• Be aware of resources to answer clinical questions

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Should we be concerned?
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Should we be concerned?
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Caught in the headlights

• By 2024, 25 of drivers will be over age 65
• MVAs second leading cause of accidental death
• Per mile driven, crash rate similar to 16-20 age
  group
• Fatality rates 3X higher at age 70 than 20s
• Most older drivers curb their driving habits

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Are the elderly worse drivers?

• No worse per mile driven but
• Greater risk with intersections
• Left turns
• Driving too slowly
• Merging traffic

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More relevant stats

• With dementia
• crash_at_ 5 times higher than other elderly
• Early stage is high risk time
• Up 50 at 2 years post diagnosis
• MMSE does not correlate well
• MDs not good at identification
• MTO road test not great for dementia either

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What did we find at SMOL?

• 16 of patients on Geriatric Inpatient Unit were
  drivers
• At time of discharge, over 50 had recommendation
  of suspension
• Over 50 of transfers from KGH had suspension
  made at SMOL
• Not mentioned in any patient before SMOL

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What are challenges to be aware of?

• Identification
• Benign office presentation
• Thinking of it as an issue
• Once you think of it you see it everywhere!
• Family complicity
• Impact on patient-professional relationship

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What are challenges to be aware of?

• Lack of office-based assessment tools
• Cost to patients
• Understanding the MTO !
• Frequent fliers

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What are your responsibilities?

• Ontario
• Mandatory reporting for physicians
• Decision made by MTO
• Specialists with role include geriatrics
• Specialists may take heat off FP

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What has the CMA done about it?
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How do you get it?

• Buy it from CMA
• Steal it from the web page!
• Address www.cma.ca/staticContent/HTML/N0/l2/public
  ations/catalog/driversguide/

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Examples from the Guide

• Dementia
• Guidance from MMSE lt24/30
• indicates need for more assessment
• Controversial number
• Definitely less than 14/30

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Looking at the guide

• Medications
• Opiates
• Benzodiazepines
• Antidepressants
• Alcohol

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Looking at the guide

• CVS conditions
• Stoke/TIA
• TIA only after medical assessment
• Stroke 1 month minimum
• MI
• 1 month minimum

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Looking at the guide

• The Older Driver
• Not very helpful section

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Getting a useful resource

• Ottawa RGAP
• rgapottawa.com/dementia/task_force_en.asp

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A Safe Driver Checklist

• S Safety record
• A Attention skills
• F Family reports
• E Ethanol
• D Drugs
• R Reaction time
• I Intellectual impairment
• V Vision/ Visuospatial function
• E Executive functions

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What are other resources?

• OT Driver Assessment Centres
• Drive Able
• CanDrive project
• Assessment of cognition
• RGP
• Geriatric Psychiatry
• Memory clinic

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Giving tips to older drivers

• Familiar routes
• Daytime driving
• Avoid the radio
• Especially cautious with intersections
• Avoid talkative companions!
• 55 Alive Course
• Avoid 400 highways in rush hour!

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Summary

• Identification of older patients still driving is
  important
• Be aware of medical conditions affecting driving
  safety
• Remember resources to clarify criteria
• Be aware of reporting responsibilities
• Remember options for assessment

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Any questions?