Assessing Driving in Older Adults: Perspectives of Vision Care Providers
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2011-11-01
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Abstract:Purpose: Despite the relationship between vision, aging and driving, there is a dearth of research investigating the perspectives of vision care providers (VCPs) regarding their role in their older patients’ decisions about driving. This study investigated VCPs’ attitudes about, barriers to, actions taken regarding, and information used when assessing the driving capabilities of their older adult patients. Additionally, this study describes the referral patterns of VCPs when driving concerns are identified as well as additional assessment resources desired by VCPs. Methods: We surveyed a stratified random sample of 500 VCPs (response rate 80.1%, n=404), identified using membership lists of the Michigan Society of Eye Physicians and Surgeons and the Michigan Optometric Association, about their attitudes and behaviors surrounding driving evaluation. Linear regression analyses were performed to identify associations with responses. Results: Over 80% of VCPs feel confident in their ability to determine whether vision is adequate for safe driving. VCPs cite liability risk – both for reporting (24%) and not reporting (44%) -- as a barrier to reporting unsafe drivers. Two-thirds report routinely inquiring about driving and 86% consider counseling patients about driving their responsibility. Approximately 60% are concerned that reporting patients negatively impacted the doctor-patient relationship and 43% think reporting is a breach of doctor-patient confidentiality. Significant differences were found between VCP characteristics, particularly, provider type, regarding attitudes and behaviors around driving evaluation. Based on responses of “often” or “always”, the vision tests that VCPs reported to be most frequently used in assessing driving capabilities included visual acuity (99%), peripheral vision (82%), and visual field (66%). VCPs less frequently considered other medical conditions (49%) and medications that might affect driving (33%). Inquiries by VCPs about night driving, reading signs, and glare were very common (≥87%), whereas questioning about other driving challenges (merging, making left turns, and backing up) and the patient’s recent driving record were infrequent (<10%). VCP characteristics that increased the likelihood of seeking driving information included female gender, younger age, and general practice (vs. specialization). Regarding referral, 36% of VCPs report sometimes/often/always relating concerns about patients’ driving to the primary care physician. Additional resources endorsed by VCPs as helpful/very helpful included driving assessment guidelines (81%), clinical screening instruments (70%), and a patient self-evaluation tool (60%). Conclusions: While VCPs view advising patients regarding safe driving as an important responsibility, addressing barriers, finding ways to increase communication between VCPs and other members of the healthcare team, and providing useful resources deserves further attention.
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