Gimme the Keys, Grandpa! - The Older Driver

    Its a well known fact that old people drive like crap. I know you probably think its because they are too busy checking Facebook and texting and tweeting, but you would be wrong. Old people have things like arthritis, dementia, hearing and vision problems. Actually, most older drivers do drive fine and most older drivers are able and responsible enough on their own to stop driving. The purpose of this article is to figure out how to tweeze out all the crabby old bastards who refuse to accept the fact that its time to get a bus pass.
     Fist thing that you want to do is to find out their driving history. Have they gotten into more accidents recently, more tickets, or more "close calls"? What do passengers say about how the older person drivers? Do they feel safe? It also a good idea to review the medications that the driver is on. Changing medications with ones that have fewer unwanted side affects may be beneficial.
    It is also important to consider chronic diseases, especially diabetes. It has been shown that hypoglycemic episodes and improper insulin doses are often seen in automobile injuries[2]. Other diseases, such as epilepsy, heart disease, musculo-skeletal, Parkinson's etc. can contribute to problems driving.
   It is important to check the hearing, vision, cognition (with a Mini Mental Status Exam or Clinical Dementia Rating,CDR), alcoholism (CAGE questions) attention (reciting numbers backwards), and visual spatial skills (clock-drawing test and the Trails B test[3]).   Patients with a Clinical Dementia Rating (CDR) of 1 or more should not drive [3,5]. Referral to an occupational therapist who specializes in driving may be a consideration. A road test to assess the patients competence may also be valuable. Depending on the state, this can be a slippery slope, so it is helpful if the family supports your decision and is willing to help in this transition. Offering to give rides and helping with public transportation can really make a big difference in the quality of an old bastards life. 

1. Marottoli, RA,The Physician's Role in the Assessment of Older Drivers,  Am Fam Physician. 2000 Jan 1;61(1):39-42.

2. Carr, DB. The Older Adult Driver, Am Fam Physician. 2000 Jan 1;61(1):141-146.

3. Carr DB, Duchek, JM, Meuser, TM, Morris Oldr Adult Driver with Cognitive Impairment.Am Fam Physician. 2006 Mar 15;73(6):1029-1034. 

4. Finestone, AJ, Rauch CJ. The older driver: When is it time to take away the keys?,Consultant. 2012. 52;11:753-760.

5. http://alzheimer.wustl.edu/cdrtraining