Discussions About Driving Between Older Adults and Primary Care Providers

Abstract

Background/Objectives Driving confers both risks and benefits to older adults, and physicians have been tasked with counseling them. We sought to estimate how many older patients discuss driving with a primary care provider during a calendar year, and to describe discussion triggers. Design Observational retrospective medical record review. Setting Three primary care clinics (geriatrics, hospital-based general internal medicine [GIM], and community-based GIM) affiliated with a tertiary care hospital. Participants Random sample of 240 older (≥65 years) patients with ≥1 visit in 2014 (January 1 to December 31). Measurements Standardized chart abstraction of patient demographics, medical diagnoses, and presence and context of discussions about driving. Provider factors (obtained from clinic administrators) included gender and average amount worked per week. Results Geriatric clinic patients were oldest, had more medical diagnoses, and had a median of 4 visits in 2014 (versus 3 visits in GIM clinics). Documented discussions about driving occurred with a greater proportion of patients in the geriatric (n=22; 28%, 95% CI 18-39%) and GIM hospital (n=15; 19%, 95%CI 11-29%) clinics than the GIM community clinic (n=6, 7.5%, 95%CI 2.8-16%). Medical diagnoses that might affect driving were prevalent but not associated with increased frequency of documented discussions. In multivariable analysis, patients were more likely to have ≥1 documented driving discussion in 2014 if they went to the geriatric clinic or had a primary care provider aged ≤45 years or who worked <6 half-day clinics per week. Conclusion Over one year, a minority of older patients had a documented discussion about driving with a primary care provider, with differences by clinic and provider characteristics. Strategies to support routine and preparatory conversations about driving should incorporate these findings.

Physician and Family Discussions about Driving Safety: Findings from the LongROAD Study

“…1,9 A retrospective medical record review documented that physicians discussed driving with only 8% to 22% of patients within a 12-month period. 10 The LongROAD study, a multi-site longitudinal cohort study of older drivers, offers opportunities to examine the prevalence of driving discussions with family and providers in a larger sample than prior work. Understanding the frequency of such discussions and the demographic and driving characteristics associated with them may enhance communication strategy development and refinement.…”

Older adults and planning for firearm safety: A qualitative study of healthcare providers

“…Focusing interventions solely on routine primary care visits is likely to miss a large portion of older adults in need of firearm safety counseling, as time‐limited visits may need to prioritize complex medical problems over safety concerns. Similarly, focusing on establishing firearm safety templates within the context of AWV may be insufficient given the low uptake 18,19 . Interventions to address firearm safety will need to be tailored to settings where older adult firearm owners are most likely to seek care, particularly in the context of medical/mental health comorbidities.…”

Prevention of road crashes in older adults: perspectives on facilitators, barriers and the role of the family doctor

“…Another potential obstacle is that published studies on this topic are not widely disseminated among family doctors [ 27 ]. Furthermore, the scarce time that doctors can devote to each patient (the average duration of family doctor consultations in public health services is about 3 to 5 min), and the high volume of patients with a variety of medical problems, create stress for family doctors, which eventually curtails potential opportunities for preventive counselling [ 28 ].…”

“…In light of our findings, we suggest some strategies for preventing road accidents in older drivers: (1) developing action protocols for the prevention of traffic accidents in primary care, in order to increase health care users’ trust in their family physicians [ 28 ]; (2) considering the implementation of mandatory medical examination and certification for license renewal in older drivers [ 27 ]; and (3) providing information on transportation alternatives [ 33 ]. These interdisciplinary measures would address a multifaceted problem, since the prevention of traffic accidents affects not only medical care, but also physical therapy, psychology, nursing, public health, social work, and urban planning.…”