Too many American authors to count have written about our country's love affair with “the open road.” Arguably one of the best was Nobel Prize winner John Steinbeck. His Travels With Charley: In Search of America (Steinbeck, 1962) is a classic road trip memoir—and, perhaps surprisingly, a classic case-in-point for geriatrics expertise.
Steinbeck was approximately 60 when he embarked on the memoir's namesake road trip with his dog, Charley (Newman, 2018). A lifelong smoker, Steinbeck was already living with several chronic conditions, including heart disease (Newman, 2018). By our standards, he would have been a prime candidate for geriatrics expertise. So, too, perhaps would his road trip!
Like Steinbeck, many of us—particularly older adults—see driving as more than just a national pastime and a means of transportation. Driving reflects our independence, mobility, and freedom. But as our health changes with age, we know our reliance solely on independent driving must follow suit (Pomidor, 2019). The real questions for many older adults—and many geriatrics health professionals, to be candid—are “When?” and “What next?”
A newly updated guide from the American Geriatrics Society (AGS) developed through a Cooperative Agreement with the National Highway Traffic Safety Administration (NHTSA) aims to make those questions easier to address by again putting health care professionals on the road to success in assessing and counseling older drivers. The Clinician's Guide to Assessing and Counseling Older Drivers (Pomidor, 2019) translates the latest literature, research findings, and public health initiatives into practical, person-centered advice for keeping older adults safe when navigating the open road.
Reviewed and edited by an inter-professional board of nurses, physicians, social workers, occupational therapists, and pharmacists, the updated guide walks through key issues, opportunities, and challenges faced by older drivers, their health care professionals, and their caregivers. Key areas of emphasis include:
- Determining when an older person may be at increased risk for unsafe driving. The AGS–NHTSA guide highlights certain “red lights” that clinicians should look for, such as impaired vision or hearing (Pomidor, 2019).
- Recognizing medical conditions, functional deficits, and medications that may affect driver safety. Increased longevity and the number of health conditions that can come with longer life means that many older individuals may outlive their ability to drive safely (Pomidor, 2019). Recognizing why—and how to determine when a discussion about driving safety may be necessary—is an important priority reflected in the updated guide's insights.
- Understanding how to screen and assess functional abilities for driving. Motor skills, sensory perception, vision, and cognition are all important to driving (Pomidor, 2019). But they may not be equally important for each older adult. One area of function may warrant greater attention than another on a case-by-case basis (Pomidor, 2019).
- Advising older adults about transitioning from driving. Proactively screening frail older adults for driving safety means knowing when to make strategic recommendations and how to plan for driving retirement (Pomidor, 2019).
- Considering ethical and legal issues affecting older drivers. Laws, regulations, and policies on driving vary not only by state but also by local jurisdiction (Pomidor, 2019). Geriatrics health professionals need more than an awareness of these laws; they need to understand how they impact care, care decisions, and overall well-being.
- Meeting the future transportation needs of older adults. For older adults who can no longer drive on their own, coordination among clinicians, licensing agencies, and relevant state/community entities can help forge connections to resources once independent driving is no longer an option (Pomidor, 2019). These alternatives are often a lifeline to staying active, mobile, and engaged.
The full guide and collateral tools are available for free on GeriatricsCareOnline.org, the online home for AGS resources. Public education materials also are available from the AGS Health in Aging Foundation at HealthinAging.org. Although these materials may not make a road trip as poetic as Steinbeck's, they certainly can ensure that safe driving—and the transition to safe alternatives—can remain an important priority on the road to health and independence as we age.
Sunny Linnebur, PharmD, FCCP,
FASCP, BCPS, BCGP
President, American Geriatrics Society