Elderly patients presenting to the emergency department: Do physicians identify unsafe drivers?

Study objectives: The 1995 US Department of Transportation Nationwide Personal Transportation Survey reports that the crash involvement rate per 1 million miles traveled triples from age 65 up to age 85. The fatality rate per 1 million vehicle miles increases by 500% for the same populations. The Pennsylvania Vehicle Code requires physicians to report patients with a "condition that could impair their ability to drive" to the Pennsylvania Department of Transportation (PENNDOT). Thirteen diagnoses of disorder or disability are listed on the Department of Transportation Initial Reporting Form. We conduct a survey of elderly patients presenting to the emergency department (ED) to determine driving status, ED diagnosis compared with PENNDOT's reportable diagnoses, and driving recommendations by discharge physician. Methods: A 1-month convenience sample of patients aged 65 years or older was asked to participate in a study of their driving practices. The survey was conducted in a community teaching hospital ED with an annual census of 60,000. Verbal informed consent was obtained. Participants were asked whether they had a valid driver's license. Drivers were asked about their driving habits, whether their ability to drive had ever been questioned, and whether they felt safe to drive. Each driver's ED diagnosis, medication list, and potential reportable diagnoses were recorded. Physician driving recommendation at discharge was noted. One author (RSB) reviewed all medical records to determine potential reportable diagnoses. Institutional review board/Health Insurance Portability and Accountability Act–approval was obtained. Descriptive statistics were used. Results: Of 112 patients asked to participate, 31 (28%) were excluded because of the following: 24 declined consent; 4 younger than 65 years; 2 incomplete data; 1 surveyed twice on the same visit. Of the remaining 81 patients, 24 (30%) did not have a valid license or had voluntarily stopped driving. Thirty-nine (48%) patients were judged not to have a reportable diagnosis. Of the 18 patients judged to have a reportable medical condition, only 3 were instructed not to drive at discharge. There was no documentation on any record that a PENNDOT form was completed. Family had previously discussed driving ability with 9 patients. All 9 reported continued driving at the ED visit. Two other patients had voluntarily stopped driving after being told by their family physician to stop. Conclusion: Elderly patients often present to the ED with conditions that could impair their ability to drive. A sample of patients in our ED demonstrates a lack of discharge instructions about driving and underreporting of potentially hazardous conditions to PENNDOT. Of the 11 patients told by family or physician to stop driving, only the 2 patients instructed by the family physician discontinued driving. Emergency physicians should be educated about reporting requirements in their locale. Elderly ED patients should have a driving history obtained. Patients with conditions that could impair their ability to drive should be given driving-specific discharge instructions. Reporting to the appropriate agency should be completed if required by the practitioner's state.