Driving and the Older Adult

Driving is an essential and highly valued instrumental activity of daily living (IADL) that becomes increasingly difficult to safely maintain with age-related medical conditions. In 2017, nearly 44 million licensed drivers were over age 65 in the United States and approximately 250,000 were injured in motor vehicle accidents.[1] Health-care providers can play an important role in helping older adults make decisions about driving; they are uniquely positioned to (1) identify and modify risk factors associated with on-road safety, (2) offer rehabilitation strategies to improve safety and extend driving life, (3) report unsafe driving when appropriate, and (4) combine clinical information with resources related to driving to support safe continued community for older patients. Clinicians face myriad challenges in assessing older patients’ medical fitness to drive, including multiple comorbidities, acute and/or chronic medical conditions such as dementia, modifiable and/or irreversible conditions, and polypharmacy. Clinicians may also be reluctant or unsure of how to address driving issues because of the potential impact on the relationship with the patient and legal/ethical concerns. These choices can be especially difficult in states that mandate health-care providers report drivers who are medically unfit to drive, adding further stress and uncertainty for providers. However, assessment and intervention are important to prevent injury and the potential loss of driving privileges, the latter of which may have a negative impact on quality of life.