Clinician's Guide to Assessing and Counseling Older Drivers, 3Rd Edition an Update of the Physician's Guide to Assessing and Counseling Older Drivers
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Clinician’s Guide to Assessing and Counseling Older Drivers 3rd Edition Disclaimer The project is supported by cooperative agreement number DTNH22-14-H-00454 from the National Highway Traffic Safety Administration of the U.S. Department of Transportation. The opinions, findings, and conclusions expressed in this publication are those of the authors and not necessarily those of NHTSA or DOT. The United States Government assumes no liability for its content or use thereof. If trade or manufacturers’ names or products are mentioned, it is because they are considered essential to the object of the publication and should not be construed as an endorsement. The United States Government does not endorse products or manufacturers. Suggested APA Format Citation: American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Washington, DC: National Highway Traffic Safety Administration. The American Geriatrics Society retains the copyright. Clinician's Guide to Assessing and Counseling Older Drivers, 3rd Edition An Update of the Physician's Guide to Assessing and Counseling Older Drivers Table of Contents Ch. # Title Page - Front Matter and Introduction i 1 The Older Adult Driver: An Overview 1 2 Is the Older Adult at Increased Risk of Unsafe Driving? 16 3 Screening and Assessment of Functional Abilities for Driving 29 4 Clinical Interventions 52 5 The Driver Rehabilitation Specialist 66 6 Advising the Older Adult About Transitioning from Driving 79 7 Ethical and Legal Issues 95 8 State Licensing and Reporting Laws 114 9 Medical Conditions, Functional Deficits, and Medications That May Affect 126 Driving Safety 10 Meeting Future Transportation Needs of Older Adults 190 App A CPT Codes 206 App B Patient and Caregiver Educational Material 210 - Am I a Safe Driver? 212 - Getting by Without Driving 214 - How to Assist the Older Driver 218 - NHTSA’s How to Understand and Influence Older Drivers 222 - Ten Tips to Aging Well 239 - Tips for Safe Driving 240 App C Clinical Team Resources 244 - Clinical Assessment of Driving Related Skills (CADReS) Score Sheet 245 - Evidence Table for Assessments (selected in Ch. 3) 248 - Medical Review Board Sample Letter 252 - Modified Driving Habits Questionnaire 253 - Montreal Cognitive Assessment (MoCA) and Form 258 - Motor Vehicle Adaptive Equipment Descriptions and NHTSA’s 263 Adapting Motor Vehicles for Older Drivers brochure - Sample Driving Cessation Plan 288 - Snellen Chart 290 - Snellgrove Maze Test and Form 292 - Three Levels of Spectrum of Driver Services 295 - Trails A Test 297 - Trails B Test 298 Clinician’s Guide to Assessing and Counseling Older Drivers, 3rd Edition An Update of the Physician's Guide to Assessing and Counseling Older Drivers COPYRIGHT Except where authorized, no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the American Geriatrics Society, 40 Fulton Street, 18th Floor, New York, NY 10038. Please note that the authors of this guide strongly discourage changes to the content, as it has undergone rigorous, comprehensive review by medical specialists and other experts in the field of older driver safety. The publication is produced under a cooperative agreement with the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). NHTSA is authorized to distribute the publication to the general public. Although the Clinician’s Guide to Assessing and Counseling Older Drivers, 3rd Edition, is distributed by various companies in the health care field, it is independently prepared. All decisions regarding its content are solely the responsibility of the authors. Their decisions are not subject to any form of approval by other interests or organizations. The information in this guide is provided to assist health care providers in evaluating the ability of their older patients to operate motor vehicles safely as part of their everyday, personal activities. Evaluating the ability of patients to operate commercial vehicles or to function as professional drivers involves more stringent criteria and is beyond the scope of this publication. This guide is not intended as a standard of medical care, nor should it be used as a substitute for health care provider’s clinical judgment. Rather, this guide reflects the scientific literature and views of experts as of July 2015, and is provided for informational and educational purposes only. None of this guide’s material should be construed as legal advice nor used to resolve legal problems. If legal advice is required, we urge you to consult an attorney who is licensed to practice in your State. No responsibility is assumed by the authors or the American Geriatrics Society for any injury or damage to persons or property, as a matter of product liability, negligence, warranty, or otherwise, arising out of the use or application of any methods, products, instructions, or ideas contained herein. No guarantee, endorsement, or warranty of any kind, express or implied (including specifically no warrant of merchantability or of fitness for a particular purpose) is given by the Society in connection with any information contained herein. Independent verification of any diagnosis, treatment, or drug use or dosage should be obtained. No test or i procedure should be performed unless, in the judgment of an independent, qualified health care provider, it is justified in the light of the risk involved. ACKNOWLEDGEMENTS This edition of the Clinician's Guide to Assessing and Counseling Older Drivers is the product of a cooperative agreement between the American Geriatrics Society (AGS) and the National Highway Traffic Safety Administration (NHTSA), and is an update to the Physician’s Guide to Assessing and Counseling Older Drivers that was originally developed by the American Medical Association (AMA) under a prior cooperative agreement with NHTSA. EDITORIAL BOARD EDITORIAL BOARD CHAIR Alice Pomidor, MD, MPH, AGSF Professor, Department of Geriatrics Florida State University College of Medicine Tallahassee, FL EDITORIAL BOARD MEMBERS Anne E. Dickerson, PhD, OTR/L, FAOTA Department of Occupational Therapy East Carolina University Greenville, NC Shelly Gray, PharmD, MS Professor and Vice Chair for Curriculum and Instruction, Department of Pharmacy Director, Geriatric Program and Plein Certificate School of Pharmacy Seattle, WA Richard Marottoli, MD Medical Director of the Dorothy Adler Geriatric Assessment Center Yale University New Haven, CT Irene Moore, MSSW, LISW-S, AGSF Professor, Department of Family and Community Medicine University of Cincinnati Geriatric Medicine Program Cincinnati, OH ii Barbara Resnick, PhD, RN, CRNP, FAAN, FAANP Professor University of Maryland Baltimore, MD Elin Schold-Davis, OTR/L, CDRS Project Coordinator AOTA Older Driver Initiative Bethesda, MD SUBJECT EXPERT ADVISORY PANEL David B. Carr, MD Alan A. and Edith L. Wolff Professor of Geriatric Medicine, and Professor of Neurology Washington University School of Medicine St. Louis, MO Carl A. Soderstrom, MD Adjunct Professor of Surgery at the University of Maryland School of Medicine Senior Volunteer Staff Member of the school’s National Study Center for Trauma and EMS Chief of the Medical Advisory Board (MAB) of the Maryland Motor Vehicle Administration Baltimore, MD ORIGINAL CONTENT AUTHORS, CONSULTANTS, AND ADVISORY PANEL FIRST EDITION: PRIMARY AUTHORS Claire C. Wang, MD, American Medical Association Catherine J. Kosinski, MSW, American Medical Association Joanne G. Schwartzberg, MD, American Medical Association Anne Shanklin, MA, American Medical Association SECOND EDITION: PRINCIPAL FACULTY AUTHORS Editor: David B. Carr, MD, Associate Professor of Medicine and Neurology Washington University at St. Louis, Clinical Director Planning Committee: David B. Carr, MD, Associate Professor of Medicine and Neurology Washington University at St. Louis, Clinical Director Joanne G. Schwartzberg, MD, Director, Aging and Community Health, American Medical Association Lela Manning, MPH, MBA, Project Coordinator, American Medical Association iii SECOND EDITION: CONTENT CONSULTANTS Lori C. Cohen, AARP Senior Project Manager, Driver Safety Jami Croston, OTD, Washington University at St. Louis T. Bella Dinh-Zarr, PhD, MPH, Road Safety Director, FIA Foundation North American Director, MAKE ROADS SAFE–The Campaign for Global Road Safety John W. Eberhard, PhD, Consultant, Aging and Senior Transportation Issues Camille Fitzpatrick, MSN, NP, University of California Irvine Clinical Professor Family Medicine Mitchell A. Garber, MD, MPH, MSME, National Transportation Safety Board Medical Officer Anne Hegberg, MS, OTR/L, Marionjoy Rehabilitation Hospital Certified Driver Rehabilitation Specialist Patti Y. Horsley, MPH, Center for Injury Prevention Policy and Practice SDSU EPIC Branch California Department of Public Health Linda Hunt, OTR/L, PhD, Pacific University School of Occupational Therapy Associate Professor Jack Joyce, Maryland Motor Vehicle Administration Driver Safety Research Office Senior Research Associate Karin Kleinhans OTR/L, Sierra Nevada Memorial Hospital Center for Injury Prevention Policy & Practice Occupational Therapy Association of California Kathryn MacLean, MSW, St. Louis University Mangadhara R. Madineedi, MD, MSA, Harvard Medical School Instructor in Medicine VA Boston Healthcare