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Elderly Drivers with Cognitive ImpairmentAka: Dementia Evaluation in Older Adult Drivers

Epidemiology
1. Dementia doubles crash risk (esp. fatal crashes)
2. Drivers license active in 30% with Dementia
  1. Lloyd (2001) Can J Occup Ther 68:149
History suggestive of unsafe driving
1. Crashes, near-crashes, or dents in the car body
2. Disoriented in familiar neighborhoods
3. Missed or misinterpreted street signs
4. Lack of awareness of surrounding traffic
5. Misjudging speed, distance, or driving situations
6. Frequent traffic violation citations or tickets
Risk Factors: Medications that impair driving ability
1. Benzodiazepines
2. Opioid Analgesics
3. Antihistamines
4. Drugs causing Hypoglycemia (e.g. Insulin, Sulfonylurea)
5. Ray (1993) Clin Geriatr Med 9:413
Evaluation
1. Sensory evaluation
  1. Visual Acuity
  2. Hearing acuity
2. Motor evaluation
  1. Get Up and Go Test
  2. Motor strength and range of motion
3. Cognitive Testing
  1. Clock Drawing Test
  2. Trails B Test >180 seconds
  3. Clinical Dementia Rating Scale (CDR)
Other evaluation tools
1. Indications
  1. Initial evaluation of driving safety
  2. Repeat testing every 6-12 months in high risk patient
2. Evaluators
  1. Road Testing
  2. Occupational Therapy
  3. In-person driver's license renewal
    1. Referral to department of motor vehicles
Resources
1. American Occupation Therapy Association
  1. http://www.aota.org/olderdriver
2. American Medical Association
  1. http://www.ama-assn.org/go/olderdrivers
3. NTSA Injury Prevention in Older Road Users
  1. http://www.ntsa.dot.gov/people/injury/olddrive
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.