Clinical Geriatrics

Motor vehicle crashes are the leading cause of injury to adults 65-75 years of age, and the second leading cause of injury to those 75 years of age and older.1 Physicians and other health care professionals can play a critical role in preventing motor vehicle injury claims and in helping older patients maintain their mobility through the use of preventive clinical practices. In addition, clinicians can assess health changes of older patients and provide effective medical treatment to address any functional limitations that arise and may inhibit mobility. Finally, if remediation is not possible, clinicians can help patients maintain mobility through proper counseling. This article details ways in which physicians can maximize the mobility of their older patients by assessing their patients’ functional abilities and help older patients transition from the personal automobile into other means of transportation.

CASE PRESENTATION
Mrs. C is a 75-year-old, active mother of four and grandmother of 12. She lives alone in a retirement community located just outside of a large metropolitan area. At a recent visit to her primary care physician, to which she was accompanied by her eldest daughter, she mentioned that she received a ticket for failing to yield while making a left-hand turn out of her retirement community. Mrs. C complained that the officer was rude and threatened to report her to the Division of Motor Vehicles. Mrs. C’s daughter then stated that she and her siblings had some concerns about their mother’s driving. As a family, they believed that consultation with a physician was necessary.

Mrs. C’s health history is significant for osteoarthritis and osteoporosis, although otherwise she is in good health. She complained of occasional forgetfulness, but this has not caused any significant impairment in her daily activities; she has not had any formal neuropsychological testing.

On further discussion, Mrs. C mentioned that she has run over the curb pulling into her driveway a few times, and her daughter has noticed some small unexplained dents in her mother’s car. However, Mrs. C was adamant that she is a safe and cautious driver, pointing out that this was her first ticket and she has never been involved in an accident. Is Mrs. C a risk on the road?

The issue of older driver safety is a concern for both the individual and the public. Often, patients and family members look to physicians for guidance, leaving physicians wondering what their obligations are regarding the driving safety of their older patients.

EPIDEMIOLOGY
Although younger drivers experience the highest crash rate per vehicle mile traveled, crash rates rise appreciably for adults over the age of 70.2 In 1995, the crash rate for teenagers was 2434 crashes per 100 million vehicle miles traveled (VMT). The next highest crash rate was for adults over the age of 80, with 1466 crashes per 100 million VMT. In comparison, the crash rate for an adult 16-64 years of age was 522 crashes per 100 million VMT.2

Typically, crashes involving younger drivers are due to inexperience and risky driving behavior, such as speeding and alcohol use. In contrast, older persons are generally safe and cautious drivers. They are more vigilant with seatbelt use and are less likely to speed, tailgate, or use alcohol while operating a motor vehicle.3 So, why is there an increase in crash risk for this population?

Health changes that are more prevalent with age, particularly those that affect vision, cognition, or motor function, can affect a person’s ability to drive. Most older adults have at least one chronic medical condition, and many have multiple conditions. These health implications can impair important physical functions that are necessary for driving.