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Clinicians shouldn’t wait to discuss seniors' driving

Tuesday June 4, 2013
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Clinicians often wait too long before talking to elderly patients about giving up driving, even though many may be open to those discussions earlier, according to a study.

"These conversations often don’t happen until clinicians see a 'red flag,’ which could mean an accident or some physical problem that makes driving more difficult for the elderly," the study’s lead author, Marian Betz, MD, MPH, of the University of Colorado School of Medicine, said in a news release.

Betz said previous studies have shown people tend to outlive their ability to drive safely by more than six years.

The small study, published in May on the website of the Journal of General Internal Medicine, involved focus groups and interviews with 33 drivers over age 65 and eight healthcare providers including physicians, nurses and physician assistants. The research took place at three clinics at the CU School of Medicine, and drivers were recruited from a local senior center and senior living community.

The researchers found that while clinicians often were the first to raise the subject of whether elderly drivers should hand over their keys, they tended to wait for 'red flags’ before bringing up the subject. They also reported that those conversations usually were "unpleasant."

"Driving is linked to independence," Betz said, "and asking for someone’s keys is very emotional." Betz said healthcare providers should start conversations with elderly drivers earlier, perhaps at age 65 when Medicare benefits begin. That way, drivers can be thinking about the issue years before having to make the decision.

"A primary theme that emerged from this study was the overall importance of improved communication about driving safety," according to the study. "Both clinicians and drivers supported the idea of regular questioning about driving as a way to make it an easier topic, as patients might be more receptive if they heard it once before."

The researchers recommended a practice known as anticipatory guidance to gently prepare elderly drivers, by monitoring physical and mental changes, for the day when they no longer can operate a vehicle safely. Physicians could include driving status in their patient questionnaires and talk about it during regular office visits, they said.

"It’s not just about taking the keys, it’s about making plans," said Betz, an ED physician. "Drivers in our studies reported needing help in preparing for that transition, including learning about transportation alternatives."

With 10,000 baby-boomers turning 65 each day, the subject has taken on a new urgency. "It is now a public health issue," Betz said.

Read the study abstract: http://link.springer.com/article/10.1007/s11606-013-2498-x.


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