Helping eye care providers better assess driving in older adults

Kellogg researcher David C. Musch, Ph.D., M.P.H., recently led a multidisciplinary University of Michigan (U-M) study team, which was supported by a grant from M-CASTL, a unit of the U-M Transportation Research Institute, who surveyed how 500 vision care providers in Michigan assess the driving capabilities of their senior patients.

Dr. Musch and his team found that the majority of eye care providers feel it's their responsibility to ask senior patients about driving, and most do it routinely. They test visual acuity and peripheral vision but often fail to ask about other factors -- such as medical conditions or medications -- that might affect the ability to drive. Inquiries about glare, driving at night and reading signs were very common (87 percent) but questions about challenging driving situations -- merging or backing up -- or the patient's driving record were very infrequent (8 percent).

Many eye care providers (81 percent) stress that certain resources -- driving assessment guidelines, clinical screening instruments and a patient self-evaluation tool -- would help them in assessing the driving capabilities of their senior patients, and help to address higher accident rates for older drivers.

"We've identified a need and a desire on the part of vision care professionals to help," says Dr. Musch, who cites research indicating that when seniors lose the ability to drive, there are consequences. These individuals have higher rates of depression and social isolation, more limited access to health care services, and are more likely to need long-term care. "Our goal is to intervene and work with our patients in modifying their driving habits. This will allow them to drive appropriately and maintain their independence," he says.

While most eye care providers feel confident in their ability to determine whether vision is adequate for safe driving, few consider themselves the most-qualified professional to identify unsafe drivers. Only a small number of eye care providers (8 percent) communicate driving concerns with the patient's primary care physician or refer patients to driving rehabilitation specialists or driving school. And, when asked about reporting unsafe drivers, some common concerns were negative impact on the doctor-patient relationship, liability issues, doctor-patient confidentiality and patient's quality of life.

Still, eye care providers are among the most important professionals in seniors' health care, and they need to be on the lookout for seniors who may need special attention, says Dr. Musch. Identifying and providing effective resources to eye care providers to aid them in evaluating and assisting patients is the next step in the process, he adds.

Additional authors include Brenda Gillespie, Ph.D., Nancy K. Janz, Ph.D., Rebecca Leinberger, M.P.H., and Leslie M. Niziol, M.S.