Physicians can ensure that older drivers stay safe

Taking away someone's car keys has been likened to taking away that person's independence. And when the issue arises, whether due to health reasons, substance abuse problems or other concerns, losing the ability to drive is typically met with resistance. It's a privilege most people take for granted.

Perhaps the most sensitive scenario involves older drivers. They have logged years behind the wheel, but age has affected how some of them navigate the road before them. Their reaction time may have slowed. Their vision may be worse, perhaps even because of diseases such as glaucoma and macular degeneration. Cognitive skills may have been hindered by medical conditions and medications.

Such impairments can make older drivers susceptible to motor vehicle crashes and traffic fatalities. These motorists are more fragile than younger drivers. Vehicular injuries are the main cause of injury-related deaths among Americans age 65 to 74. They are the second-leading cause of injury-related deaths (after falls) in those 75 to 84. Drivers 85 and older are nine times more likely to die in a crash than are people 25 to 69.

An aging U.S. population certainly won't lower these statistics, as growing numbers of baby boomers reach their golden years and life expectancy increases. In 2006, there were 30 million licensed U.S. drivers 65 and older -- an 18% increase from 1996, according to the National Highway Traffic Safety Administration. By 2030, the number of Americans older than 65 will more than double to about 70 million -- 20% of the total population, the U.S. Census Bureau estimated.

Physicians increasingly will be faced with addressing this growing public health issue, weighing the safety of their patients and the safety of other drivers. It's not an easy position to be in. Patients may react negatively to questions about their ability to drive, and that can strain the physician-patient relationship.

Nevertheless, physicians need to look for warning signs of problems among patients and ask about them. Often enough those suspicions will be confirmed. Doctors also must know their ethical and legal obligations to report at-risk drivers. States vary in driver's license regulations and reporting laws, so physicians need to familiarize themselves with their own state's rules. Six states have mandatory reporting: California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania.

In 2003, the American Medical Association created a guide to empower physicians and help them evaluate their aging patients' ability to drive safely. In March, the AMA released the second edition of the "Physician's Guide to Assessing and Counseling Older Drivers." The Association worked with the NHTSA to develop the guide, which is available free online to physicians and the public. Later this year, the AMA Web site will offer a continuing medical education course featuring a case-based interactive program assessing a patient's fitness to drive.

The guide is a valuable resource that enables doctors to examine how illness, age and medications affect their patients' driving ability. It provides tools such as an office-based assessment of medical fitness and a list of illnesses and drugs that may impact driving.

The guide includes recommendations about screening for illnesses that may impair driving, treating causes of functional decline and counseling patients on driving restrictions and safe driving behaviors. There also is advice about looking for signs of social isolation and depression in those who stop driving.

Armed with the right information, physicians can provide preventive health care and appropriate treatment to keep the right drivers on the road. Car keys should not be taken away just because a patient becomes a senior citizen. Rather, physicians can play a vital role in determining patients' fitness to stay behind the wheel and know when it is time to tell patients to seek other forms of transportation. That way, physicians protect their patients and the public from an avoidable risk on the roads.