Screening seniors for age related driving disorders

Background: Vision problems, cognitive impairment, and general frailty increase with age, leading to age-related driving disorders (ARDDS). The AMA-recommended screening tools for ARDDS are not widely used, especially in hospitalized populations.

Purpose: This study reports on the barriers to screening for age related driving disorders in outpatient and hospital settings.

Methods: From 2004-2006, through funding from the CA State Office of Traffic Safety (OTS), we developed an online module for physicians on ARDDS. We conducted a series of seminars to ambulatory care physicians. Verbal feedback was obtained regarding concerns and plans to implement ARDDS. In October 2007, OTS funding was provided to implement ARDDS in hospitals. Barriers to in-patient based screening was ascertained based on interviews with hospital based surgeons, internists, IT personnel, and staff.

Results: Barriers to implementation of office-based ARDDS includes time, staff training; the greatest concern expressed by the physicians was that screening and restricting driving (when appropriately) could alienate patients. In-patient screening barriers include competing procedures, pain level, consciousness level, and medications that could interfere with testing. Advantages to in-hospital testing are the access to patients, and lack of concerns by the hospitalists that they will alienate patients with such testing.

Conclusion: Out-patient ARDDS testing is not well accepted, but could reach a large group of seniors. There are less barriers to in-patient testing, which is useful in detecting acute ARDDS issues, especially those related to the admission diagnosis. Both settings are needed to address the expected increase in ARDDS with our aging population.