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

----------Screening for medical illness relevant to driving is difficult due to the complex nature of the drivingtask and underlying societal prejudices. Some European countries have attempted screening bydemanding a doctor's certificate at regular intervals after a certain age. A comparison of accidentrates between Sweden (where there is no medical control) and Finland (requiring regular medicalrecertification after age 70) showed no reduction in motor crash fatalities and an increase inpedestrian and cycle fatalities among the over 70s in Finland. This may be as a result of stoppingolder people driving unnecessarily and forcing them into the much higher risk group of pedestriansand cyclists". A more enlightened approach is under assessment in the State of Maryland, where thescreening process is directed towards a rehabilitation outcome. Those who screen as 'at risk' on asimple test battery at the time of licence renewal are offered an assessment by the GeriatricEvaluation System of Maryland State. Preliminary results are awaited with anticipation lGIIID---------Access to the full interdisciplinary team, a good working relationship with a specialist driVingassessment centre, and the availability of car adaptation services are important factors in offering anappropriate service. If a patient with dementia is judged to be capable of driVing, the driver andcarer should be advised against driving alone, to return for review in three to six months, or soonershould the co-pilot notice any deterioration in driving skills. This form of restriction makes sense fortwo reasons. Drivers with medical conditions and restricted driving licences have been shown to havefewer crashes than those similarly affected but with no restrictions 9S , and drivers with dementia whodrive accompanied are also more crash-free'·.When Driving is No Longer PossibleWhen driving cessation is indicated, it is important to explore alternatives with the patient. Asympathetic social work intervention may be helpful, and can work though the various optionsavailable to the patient. Public transport, even if free, is often irrelevant to older, compromisedadults. Family members may be able to prOVide some driving input. The ideal situation is to provide asystem of paratransit: affordable, tailored individual transportation. Various models have beendeveloped (an excellent example is the service in Portland, Maine), but the funding remainsproblematic".Refusal to stop driving occurs in a minority of cases. In the Republic of Ireland, only a District Court(and not, as is often supposed, the Driver licencing Section of the newly founded Department ofTransport) can remove a licence. Approaches to the Garda Siochana may be needed in such cases. As94 Hakamies-Blomqvist, L., Johansson, K., Lundberg, C. 'Medical screening of older drivers as a traffic safety measure - acomparative Finnish-Swedish Evaluation stUdy'. J Amer Geriatr Soc 1996; 44: 650-3.95 Transportation Research Board. Evaluating drivers iicensed with medical conditions in Utah. 1992-1996. 1999;Washi,lgton DC.96 Bedard, M., Moiloy, M., Lever, J. 'Should demented patients drive alone?' Journal of American Geriatric Society 1996;44 (September, 1996):59.97 Freund, K. 'The politics of older driver legislatio'n. Gerontologist 1991; 31 (special issue I1): 162.Conference Proceedings