I just wanted some advice about what to do about an elderly driver who I am concerned about & whether she should continue to drive. This patient (>80 yo) is new to my practice, but recently got into an accident- no one was hurt, but she drove into something. When I suggested to her that maybe she should stop driving she was incredibly offended. Because I do not know her well enough-- my next step was to talk to her family, etc. I just get the feeling that she is not fully all there, but I have no solid proof just a gut feeling. She is very educated and intelligent & I feel like she is able to cover up some deficits because of it. I checked the DMV site in the city I live in and it says that you can fill out a report so that the driver can be evaluated, but it says that you have to be specific about their driving, etc.-- this is info that I do not have since I have not actually seen her drive. This is totally new to me since most of my elderly patients have voluntarily stopped their driving or their families have intervened. Since I am in a new city-- I am also not aware of how often the DMV here requires elderly drivers to get driving tests, etc. Any advice would be greatly appreciated. Thanks in advance.
DMV cannot stop someone from driving...they will drive without a license if they feel entitled to do so. Some families have been known to disable the car. Then they will say that it "can't be fixed." It is a little white lie, but it may be necessary to avoid future accidents. If the elder is savvy enough to try to get it fixed independently, it may take a full-on conspiracy with the local car repair shop.
If you are in a state where you are obligated to report, report her. If not, call the family and get a feel for her situation. This is what was going on with my mother a few years ago. She too was intelligent and covered her deficits well, but should not have been driving. There are many geriatric assessment centers where they will do a full assessment of the patient's capabilities. They should be able to tell whether she is capable of driving if the family can get her in there. Then they are the bad guys and not you or the family.
It's hard when you don't have an established relationship with someone. There was a great article and flowchart in American Family Physician within the last few months that dealt with addressing driving safety in the elderly (and a couple other things) that I found helpful. If her family is local, getting them to come in with her to discuss it would be ideal, because often the family is not aware of the true extent. Also perhaps you could talk her into neuropsych testing, with the idea that they will prove to both of you whether she can safely operate a vehicle. Good luck. Aging issues are difficult, a good sense of humor usually helps.
ResidentMom<br /><br />"If you bungle raising your children, I don't think whatever else you do well matters very much." --Jackie O.
My guess is that even if you do not have specific information (e.g. dates, locations) of your patient's misadventures in driving, if you file with the DMV and state your concern, they will do an appropriate investigation.
It can be uncomfortable to "blow the whistle" on someone you feel is an unsafe driver, but it must be done. Notifying the DMV does not guarantee that a driver will lose his/her license, but it does allow the state to look into a possible public safety risk.
When I file a report on patient I tell them clearly I am doing it, and why. I have done it maybe four times, and each time the news was not as poorly received as I thought it would be by the patient.
There have been many episodes with elderly drivers where terrible accidents with multiple deaths have occurred, where afterwards it turned out that family members and acquaintances knew and sometimes even joked about the person's diminished driving skills.
I reported my own father to our state's DMV, that is how strongly I feel about keeping people safe from potentially dangerous drivers.