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Posted: January 03, 2007
Physicians Recruited to Keep Demented Drivers Off the Road
Doctors are being enlisted nationwide to help get dangerous, aging drivers off the road, especially those suffering from dementia or other cognitive impairments.
With the surge of baby boomers now entering their 60s, more drivers on the road who may be impaired by thinking impairments linked to aging. Researchers at the Alzheimer's Disease Research Center (ADRC) of Washington University School of Medicine in St. Louis and other key centers nationally have developed a three-hour workshop to train health care providers to identify potentially unsafe drivers with dementia and to encourage appropriate retirement from driving.
In a recent issue of the journal Gerontologist, Meuser and colleagues reported on the effects of their workshop after presentations to health professionals in seven Missouri locations, including a number of rural cities with large elderly populations. The presentations were organized with assistance from local chapters of the Alzheimer's Association and other groups.
"We found a significant change in the willingness of participants to ask their patients questions about driving and to document findings and concerns in the medical record," Meuser says. "There was a real sense among participants that, yes, there is something I can do."
Debate is ongoing about when in the progression of dementia a patient driving becomes an almost certain danger. Most states don’t have specific prohibitions in this regard, but all states allow health professionals and others to report individuals perceived as medically unfit to drive due to dementia or other conditions. In 2001, the American Academy of Neurology recommended that persons diagnosed with mild dementia stop driving for reasons of personal and public safety.
Physicians at Washington University use the Clinical Dementia Rating (CDR) interview to determine the level of dementia-related impairment. According to Meuser, a CDR rating of 1, representing mild to moderate deficits in memory and other cognitive and functional areas, is a reasonable stage at which retirement from driving may be initiated.
"Primary care physicians and other health professionals often have limited experience in diagnosing dementia and assessing driving safety, but a small amount of additional training can make a big difference," Meuser notes.
At the workshop, Meuser introduces Alzheimer's disease and its various stages. In another section, workshop developer Dr. David B. Carr, associate professor of medicine and of neurology, explains an American Medical Association recommendation that physicians stratify according to risk their patients, grouping them on the basis of their clinical observations into safe, unsafe and unsure. This offers physicians unfamiliar with the specialized process of CDR testing a framework to help identify patients who may need to be prohibited from driving.
"The reporting process is anonymous," Meuser says. "And the federal Health Insurance Portability and Accountability Act (HIPAA), which places strict regulations on patient privacy, should not apply to this, because HIPAA allows for state reporting to protect public safety and health."
In Missouri, as in other states, when a report has been filed, drivers are notified by the Department of Revenue that they have several options for proving they can still drive safely, starting with a statement from their physicians. Drivers may also have to retake the standard on-road driving safety test administered by the State Highway Patrol.
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© 2007 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.
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