Although healthcare providers could have a significant impact in older driver safety, discussions about driving are not routine in the clinical setting until there are serious safety concerns. Regulations on physician assessment or reporting of fitness-to-drive vary by state and many physicians express fear of liability from such actions. In the absence of a “gold standard” brief assessment for older driver ability, guidance from providers may be crucial in helping older adults decide when to stop driving.
In a new study, 15 providers (physicians, nurses, medical assistants, social workers, and administrative staff) were interviewed on stakeholder-perceived system-level factors affecting driving discussions with older patients in primary care settings.
Four major themes emerged regarding system-level factors:
- Complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency)
- Inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists)
- Gaps in education of providers and patients about discussing driving
- Suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record)
An additional fifth theme was that participants characterized their experiences in terms of current and ideal states. Providers acknowledged that they had a role in discussion driving with older patients, although some admitted to dreading this role. Others questioned the appropriateness of older drivers and family members in looking to providers for support and thought that the department of motor vehicles (DMV) should instead be the primary stakeholders. Time constraints were also a significant theme in discussions of inadequate resources. The defined process and implementation of routine screening of all patients for depression in the study clinics was frequently referenced as a contrast to driving discussions.
Even with these system-level barriers, the participants agreed that an initial question about current driving status may be a suitable start for discussions, as many providers admitted uncertainty as to whether some older patients were still driving. A screening question on driving status in electronic medical records (EMRs) could also facilitate conversations on this sensitive topic.