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‘Red Flags’ and Elderly Drivers

June 14, 2013
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Older drivers are more open to talking about ‘driver retirement,’ study says

It’s a fact of life that everyone’s reflexes slow down with age, and most of us lucky enough to live to advanced age and still have a driver’s license eventually will need to consider giving up the privilege of driving. After all, driving is intertwined with all kinds of effects of aging—not only slower reflexes but poor eyesight, inability to make quick decisions, or side effects of medications. According to a recent study, clinicians are often the first to bring up the topic with elderly drivers of handing over the car keys, and I think healthcare IT can play a role in helping drivers make the transition.

Anyone who has tried to bring up the subject with an elderly family member knows it is an emotional topic, and one that is sometimes regarded as taboo by the drivers themselves. That’s why I was interested in a recent study by the University of Colorado (CU) School of Medicine and the CU School of Nursing. The study, which has been published by the Journal of General Internal Medicine, notes that clinicians, who are often the first to raise the subject of elderly drivers handing over their car keys, often wait too long before bringing up the issue with elderly patients—this despite the fact that many of those patients may be open to having those discussions earlier.

“These conversations often don’t happen until clinicians see a “red flag,” which could mean an accident or some physicial problem that makes driving more difficult for the elderly,” said Marian Betz, M.D., M.P.H., at the CU School of Medicine and lead author of the study in a prepared statement. “But what’s interesting is that most elderly drivers we spoke with said they were open to having earlier discussions.”

The study involved focus groups and interviews with 33 drivers over age 65 and eight healthcare workers, including physicians, nurses and physician assistants. The research was done at three clinics at the CU School of Medicine, and drivers were recruited from a local senior center and senior living community.

While the clinicians reported that the conversations were unpleasant, the elderly drivers said they were open to the discussions, and generally saw their medical providers as “fair minded.” At the same time, the majority said they didn’t believe their providers were aware of their driving status or ability. The elderly also tended to see a smaller role for family members in conversations about when they should stop driving.

According to Betz, most people outlive their ability to drive safely by more than six years. She thinks that providers should start conversations with elderly drivers earlier, perhaps at age 65, when Medicare benefits kick in. That way they can be thinking about it years before having to make the decision.

One of the main themes of the study is the importance of improved communication about driving safely, and the study found that both clinicians and patients supported the idea of regular questioning about driving as a way to make it an easier topic, since patients may be more receptive if they have heard the topic once before. The researchers recommended a practice known as “anticipatory guidance,” in gently preparing drivers by monitoring physicial and mental changes, for the day when they can no longer operate a vehicle safely.

What role can healthcare IT play in this? It can certainly help to improve communication between patient and caregiver, as well as help identify potential physical and mental conditions that can interfere with driving ability. I think specific questions related to driving can be built into the electronic health record, and patient portals can certainly be an effective communication tool to alert providers and patients about relevant health issues. This would give the provider a tool to alert the patient or his or her family members about the driving issue, and hopefully convince the driver to hand over the keys.

Unfortunately, this often does not work. The truth is, this problem has been around for years, and the Departments of Motor Vehicles need to step up to the plate, which they have not done so far. How is it possible that a 92-year-old driver can renew his driver's license for another eight years by simply reading an eye chart? (It happens!) Privacy laws would certainly prevent personal health information from being shared with DMVs. It's time for the DMVs to raise the bar on driver's tests in certain age brackets. 

Getting back to healthcare IT, while all generations will have to deal with this issue sooner or later, it’s interesting that some 10,000 baby boomers are turning 65 each day. The timing may be right for this generation to be a sort of test-bed. For many, laptops, iPads and smart phones are already facts of everyday life and health, and in the not-too-distant future, may help many of today’s drivers consider giving up the keys long before the issue becomes a red flag. Here's an idea: How about computer games that drivers can use to test their reflexes in the privacy of their own homes? This could be a good opportunity for game developers!