Researchers at the Alzheimer’s Disease Research Center (ADRC) at the School of Medicine and elsewhere have developed a three-hour workshop that trains health-care providers to identify potentially unsafe drivers with dementia and to encourage appropriate retirement from driving.
“We don’t want to give the message that older drivers are always unsafe, because that’s just not the case,” said Thomas M. Meuser, Ph.D., research associate professor of neurology. “But there are health-related changes associated with aging, including Alzheimer’s disease and other forms of dementia, that impair medical fitness to drive.”
In a recent issue of Gerontologist, Meuser and his 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 said. “There was a real sense among participants that yes, there is something that I can do.”
Debate is ongoing about when in the progression of dementia a patient becomes ineligible to drive. Most states, including Missouri, do not have specific prohibitions in this regard, but all states allow health professionals and others to report persons 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.
WUSTL physicians use the Clinical Dementia Rating (CDR) interview to determine the level of de-mentia-related impairment. The ratings are based on a scale of 0 to 3, with 0 being normal and 3 repre-senting severe dementia. Meuser said 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.
At the workshop, Meuser introduces Alzheimer’s disease and its various stages. In another section, workshop developer David B. Carr, M.D., associate professor of medicine and of neurology, explains an American Medical Association (AMA) recommendation that physicians group patients on the basis of their clinical observations into three risk categories: 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.
A 1998 Missouri law allows physicians, family members and others to anonymously notify the state’s Department of Revenue, which issues driver licenses, when concerned about an older motorist’s ability to drive safely. At the workshop, participants are shown sample reporting forms and procedures for filling them out.
When a report is filed, drivers are notified by the state that they have several options to prove they can drive safely, starting with a statement from their physicians. Drivers may have to retake the standard on-road driving test administered by the Missouri State Highway Patrol.
“Officials with the Department of Revenue, the State Highway Patrol and the Missouri Department of Transportation have been an absolute joy to work with,” Meuser said. “They are very concerned about older driver safety and have welcomed us as researchers with open arms.”
Pat Niewoehner, workshop co-author and a driver rehabilitation specialist with the St. Louis VA Medical Center, shows how occupational therapists/driver rehabilitation specialists can help in evaluating medical fitness to drive.
Another co-author, Marla Berg-Weger, Ph.D., professor of social work at Saint Louis University, shows physicians how they can cooperate with family members to eliminate patient access to driving and seek alternate forms of transportation that allow patients to continue to lead fulfilling lives.
The workshop was created with funding provided by the National Highway Traffic Safety Administration (NHTSA) and the National Institute of Aging through the ADRC and John C. Morris, M.D., the Harvey A. and Dorismae Hacker Friedman Professor of Neurology and ADRC director.
Additional educational efforts and research studies are or will soon be under way with support from NHTSA, the AAA Foundation for Traffic Safety, the AMA and the American Society on Aging.