Assessment of Older People's Health and Social Care Needs and ...

een found in the brains of drivers who crash'" but subsequent assessment of the families did notreveal significant premorbid deterioration in the subjects' general function"'. The most carefullycontrolled study of crashes and dementia showed no increase in crash rates for drivers withdementia". Likely causes for this counter-intuitive finding include a lower annual mileage andrestriction of driving by the patient, family and physiciansThe effect of drugs on driving has also assumed greater importance'". This is a complex area, withmany difficult methodological considerations, not least of which is the question of whether it is thedisease or the medication that impairs the driver. From the existing literature, several key pointsemerge when considering the prescription of psychoactive medications. Does the patient really needthe medication? If benzodiazepines are required, long-acting agents should be avoided"; ifunavoidable, they would tip the scales towards driving cessation during the course of theprescription. The choice of an antidepressant in an older driver should be directed away fromtricyclic". Neuroleptic medication (and the underlying illness) would be a negative influence ondriving ability. Physicians need to be Vigilant about over- the -counter medications (particularly thosecontaining antihistamines) and newer drugs with uncommon but important side effects which mayaffect driving, such as changes in neurological status due to ciprofloxacin"._f------------------------The schedule for the assessment of the older driver is akin to that of geriatric assessment of olderpeople, a process which is marked by the following qualities: medical and functional assessment,detection and prioritisation of diseases, interdisciplinary assessment and remediation (Table 3).Functional assessments, such as a comprehensive test of visual processing, a falls history and areview of current medications may be of greater relevance than specific medical conditions in theidentification of older at-risk drivers", Early specialist referral may prove beneficial for the primarycare physician who does not have access to an interdisciplinary team.73 O'Neill,D. 'Physicians, elderly drivers, and dementia'. Lancet 1992;339 (8784):41-374 O'NeiJl, D., editor. 'Follow-up of Alzheimer's disease and apolipoprotein E E4 allele in older drivers who died in automobileaccidents'. The Older Driver, Health and Mobility; 1999; Dublin. ARHC Press.75 Trobe, l.D., Wailer, P.F., Cook-Flannagan, CA., Teshima, S.M., Bieliauskas, L.A.. 'Crashes and violations among drivers withAlzheimer disease'. Arch Neuro/1996;53 (5):411-6.76 O'NeiJl, D. 'Benzodiazepines and driver safety' Lancet 1998;352 (9137):1324-5.77 Hemmelgarn, B., Suissa, 5., Huang, A., Boivin, l.F., Pinard, G. 'Benzodiazepine use and the risk of motor vehicle crash in theelderly' Jama 1997; 278 (1):27-31.78 Ray, W.A., Thapa, P.B., Shorr, R.I. 'Medications and the oider driver'. Clin Geriatr Med 1993;9 (2):413-3879 Gray, K.J., Alien, K.D., Ridgway, E.J. 'Impairment of driving by ciprofioxacin'. Br Med J 1994; 309: 542.80 Sims, R.V., Owsley, C, Allman,R.M., Ball, K., Smoot, T.M. 'A preliminary assessment of the medical and functional factorsassociated with vehicle crashes by older. JAm Geriatr Soc 1998; 46 (5):556-61.Conference Proceedings