According to the Centers for Disease Control and Prevention (CDC, 2020), in 2018, there were over 45 million licensed drivers aged 65 or older in the United States, a 60% increase since 2000. In 2018, almost 7,700 older adults were killed in traffic crashes, and over 250,000 were treated in emergency departments for injuries related to traffic crashes. Adults over age 75 are at even higher risk of death due to their vulnerability in a crash. The driving ability of older adults is affected by age-related declines in vision and cognitive functioning.

Home health clinicians have a responsibility to ensure the safety of their patients, including making sure they are as safe as possible if still driving. You may need to provide information on driving safety to patients and/or their caregivers. For instance, older adult drivers should have their route planned prior to getting in the vehicle; use the safest route possible with well-lit streets, and try to frequent places that have easy parking. Older drivers should leave a large following distance between their car and the one in front of them, and avoid distractions such as loud radios, using the phone for talking or texting, and eating while driving (CDC, 2020). Older driver deaths and injuries can be prevented by seat belt use, avoiding driving in poor weather or at night, and not consuming alcohol prior to driving. Additionally, encourage older adult drivers to have their eyes checked at least yearly or as recommended by their eye doctor. A regular activity program is recommended to increase strength and flexibility, and medications should be reviewed to reduce any potential side effects and interactions that can impair driving (CDC).

Home health clinicians can help patients and loved ones determine if it is time for an older adult to stop driving. Warning signs that suggest someone should not be driving include vision changes affecting their ability to safely see while driving, getting lost in familiar areas, ignoring traffic signs and signals, becoming easily agitated or angered when driving, falling asleep or inability to concentrate when driving, reacting too slowly to dangerous situations, forgetting or ignoring driving basics (such as when to yield the right of way), and having trouble judging distances (American Geriatrics Society [AGS], 2019). Encourage caregivers to have their loved ones assessed by their primary care physician; get a driving evaluation (some occupational therapists are trained in driving rehabilitation and can be utilized for this service); consider cognitive testing, and check state rules to see if there is required testing for older adults (AGS).

Options for alternative driving services include volunteer programs (such as a faith or community-based organizations); paratransit services (such as minibuses and small vans that are run by public transportation, aging organizations, and private agencies); public transportation; or ride share companies and taxis. Clearly, safe driving in older adults is an important concern. You can help patients and caregivers be safe drivers or assist with finding alternative services.

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