Studies Support Screening Hospital Patients for Driving Disorders

NEW ORLEANS – Although the American Medical Association recently updated recommendations for office-based screening of older adults for driving impairment, little guidance is available on screening hospitalized patients before discharge, Dr. Linda Hill said at the annual meeting of the Gerontological Society of America.

So Dr. Hill and her associates performed two studies. In one, they screened 755 patients, who were older than 60 years and in hospital and affiliated outpatient settings, for driving disorders. About one in six (17%) failed the screening, meaning that they did not pass one or more tests for visual acuity, visual fields, clock drawing, range of motion, timed gait, strength, or the Trail Making Test.

"We’ve been working on trying to educate health professionals. There has been less uptake than would be ideal, since the AMA said this should be done routinely," said Dr. Hill of the department of family and preventive medicine at the University of California, San Diego.

Their second study indicated that few physicians implement screening of older, office-based patients for age-related driving disorders (ARDDs), as outlined in the AMA 2003 and 2010 Physicians Guide to Assessing and Counseling Older Drivers. However, a training program improved practitioner awareness and willingness to screen in this study of 492 providers, 81% of whom were physicians. Confidence about performing ARDD screening rose from 19% before training to 73% afterward. Intent to screen surpassed 90% after the activity.

"We think the doctors could take a much more proactive role." Dr. Hill said. For example, "hospitalists are seeing the highest-risk elderly population and should be aware if their patients are high-risk drivers."

Dr. Hill acknowledged that physicians have a lot of competing priorities for their time, and added, "Our other message is that it does not have to be the doctor doing the screening, just the interpretation."

Also, if screening uncovers some impairment, a physician can refer the patient. "There is a whole group of occupational therapists who do driving assessments," Dr. Hill said.

In the first study, the mean age of the 755 adults was 72 years, and 56% were men. They were screened from January 2008 to October 2009 using the AMA guidelines, followed by a satisfaction survey and 1-month follow-up.

Older age, male sex, self-restrictions on driving, and inpatient status predicted failing at least one of the ARDD tests adapted to the inpatient setting. A total of 74% passed screening, 17% failed (11% of these cases were reported to the department of motor vehicles), and 9% had incomplete testing.

In all, 537 older patients (71%) completed the satisfaction survey. The majority (71%) indicated that the screening was useful; 75% would recommend the screening, and 78% were not surprised by their results.

At 1 month post screening, 49% of the patients who failed and 14% of those who passed said they were not driving. Another 37% of those who failed and 24% of those who passed had restricted their driving.

The primary care physician ordered additional testing to assess driving ability in 16% of participants who failed screening and 6% of those who passed, Dr. Hill said.

The studies showed that screening for driving impairment is feasible in both inpatient and outpatient settings, Dr. Hill said.

The research was funded by the California Office of Traffic Safety through the National Highway Traffic Safety Administration. Dr. Hill said she had no relevant financial disclosures.

NEW ORLEANS – Although the American Medical Association recently updated recommendations for office-based screening of older adults for driving impairment, little guidance is available on screening hospitalized patients before discharge, Dr. Linda Hill said at the annual meeting of the Gerontological Society of America.

So Dr. Hill and her associates performed two studies. In one, they screened 755 patients, who were older than 60 years and in hospital and affiliated outpatient settings, for driving disorders. About one in six (17%) failed the screening, meaning that they did not pass one or more tests for visual acuity, visual fields, clock drawing, range of motion, timed gait, strength, or the Trail Making Test.

"We’ve been working on trying to educate health professionals. There has been less uptake than would be ideal, since the AMA said this should be done routinely," said Dr. Hill of the department of family and preventive medicine at the University of California, San Diego.

Their second study indicated that few physicians implement screening of older, office-based patients for age-related driving disorders (ARDDs), as outlined in the AMA 2003 and 2010 Physicians Guide to Assessing and Counseling Older Drivers. However, a training program improved practitioner awareness and willingness to screen in this study of 492 providers, 81% of whom were physicians. Confidence about performing ARDD screening rose from 19% before training to 73% afterward. Intent to screen surpassed 90% after the activity.

"We think the doctors could take a much more proactive role." Dr. Hill said. For example, "hospitalists are seeing the highest-risk elderly population and should be aware if their patients are high-risk drivers."

Dr. Hill acknowledged that physicians have a lot of competing priorities for their time, and added, "Our other message is that it does not have to be the doctor doing the screening, just the interpretation."

Also, if screening uncovers some impairment, a physician can refer the patient. "There is a whole group of occupational therapists who do driving assessments," Dr. Hill said.

In the first study, the mean age of the 755 adults was 72 years, and 56% were men. They were screened from January 2008 to October 2009 using the AMA guidelines, followed by a satisfaction survey and 1-month follow-up.

Older age, male sex, self-restrictions on driving, and inpatient status predicted failing at least one of the ARDD tests adapted to the inpatient setting. A total of 74% passed screening, 17% failed (11% of these cases were reported to the department of motor vehicles), and 9% had incomplete testing.

In all, 537 older patients (71%) completed the satisfaction survey. The majority (71%) indicated that the screening was useful; 75% would recommend the screening, and 78% were not surprised by their results.

At 1 month post screening, 49% of the patients who failed and 14% of those who passed said they were not driving. Another 37% of those who failed and 24% of those who passed had restricted their driving.

The primary care physician ordered additional testing to assess driving ability in 16% of participants who failed screening and 6% of those who passed, Dr. Hill said.

The studies showed that screening for driving impairment is feasible in both inpatient and outpatient settings, Dr. Hill said.

The research was funded by the California Office of Traffic Safety through the National Highway Traffic Safety Administration. Dr. Hill said she had no relevant financial disclosures.

NEW ORLEANS – Although the American Medical Association recently updated recommendations for office-based screening of older adults for driving impairment, little guidance is available on screening hospitalized patients before discharge, Dr. Linda Hill said at the annual meeting of the Gerontological Society of America.

So Dr. Hill and her associates performed two studies. In one, they screened 755 patients, who were older than 60 years and in hospital and affiliated outpatient settings, for driving disorders. About one in six (17%) failed the screening, meaning that they did not pass one or more tests for visual acuity, visual fields, clock drawing, range of motion, timed gait, strength, or the Trail Making Test.

"We’ve been working on trying to educate health professionals. There has been less uptake than would be ideal, since the AMA said this should be done routinely," said Dr. Hill of the department of family and preventive medicine at the University of California, San Diego.

Their second study indicated that few physicians implement screening of older, office-based patients for age-related driving disorders (ARDDs), as outlined in the AMA 2003 and 2010 Physicians Guide to Assessing and Counseling Older Drivers. However, a training program improved practitioner awareness and willingness to screen in this study of 492 providers, 81% of whom were physicians. Confidence about performing ARDD screening rose from 19% before training to 73% afterward. Intent to screen surpassed 90% after the activity.

"We think the doctors could take a much more proactive role." Dr. Hill said. For example, "hospitalists are seeing the highest-risk elderly population and should be aware if their patients are high-risk drivers."

Dr. Hill acknowledged that physicians have a lot of competing priorities for their time, and added, "Our other message is that it does not have to be the doctor doing the screening, just the interpretation."

Also, if screening uncovers some impairment, a physician can refer the patient. "There is a whole group of occupational therapists who do driving assessments," Dr. Hill said.

In the first study, the mean age of the 755 adults was 72 years, and 56% were men. They were screened from January 2008 to October 2009 using the AMA guidelines, followed by a satisfaction survey and 1-month follow-up.

Older age, male sex, self-restrictions on driving, and inpatient status predicted failing at least one of the ARDD tests adapted to the inpatient setting. A total of 74% passed screening, 17% failed (11% of these cases were reported to the department of motor vehicles), and 9% had incomplete testing.

In all, 537 older patients (71%) completed the satisfaction survey. The majority (71%) indicated that the screening was useful; 75% would recommend the screening, and 78% were not surprised by their results.

At 1 month post screening, 49% of the patients who failed and 14% of those who passed said they were not driving. Another 37% of those who failed and 24% of those who passed had restricted their driving.

The primary care physician ordered additional testing to assess driving ability in 16% of participants who failed screening and 6% of those who passed, Dr. Hill said.

The studies showed that screening for driving impairment is feasible in both inpatient and outpatient settings, Dr. Hill said.

The research was funded by the California Office of Traffic Safety through the National Highway Traffic Safety Administration. Dr. Hill said she had no relevant financial disclosures.