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

Safe Mobility forlSOlder PeopleProfessor Desmond O'Neill, Department of Medical Gerontology, TrinityCentre for Health Sciences and Adelaide and Meath HospitalDriving: A New Geriatric Giant?'"Over the last fifty years geriatric medicine has promoted the concept that functional loss in olderpeople is primarily a health issue. For a major loss of function, such as incontinence or immobility, werecognise the need for detection, investigation and treatment. Thediagnostic/therapeutic/rehabilitation paradigm takes precedence over the prosthetic approach. Notonly do we appreciate the benefits of an interdisciplinary assessment, but we are also accustomed toestimating risk and competence when making decisions about discharging frail older people back totheir home environment.These skills will provide the foundation for tackling a different set of challenges over the next fiftyyears. The second generation of geriatric giants may be earlier (or preclinical) diagnosis of functionalloss, increasing understanding of the physiological mechanisms of geriatric syndromes (i.e.vasodepressor syncope) and attention to higher order functional impairment. One common higherorder function is the ability to drive, and geriatricians have many of the skills necessary forenhancing safe mobility in older people. A small but growing literature on the older driver supportsthe concept that age-related disease may interfere with the ease and safety of using many modes oftransportation. The data also suggest that there are many interventions that can ameliorate theimpact of disease on driving ability.Transportation is very important to older people. At the White House Conference on Ageing in 1971,transportation was ranked third in importance after income and health as priorities in later life ",Although environmental and other considerations may not favour increasing use of the motor car, weneed to recognise that for many older people driving has become the main form of transportation.Older people do not consider that public transport is adequate or efficient, and it poses problems ofsecurity and convenience" . In the us public transport accounts for less than 3 percent of trips byolder people" and its use by older people has been steadily declining in both Europe and the US.As a result, there has been an exponential increase in the number of older drivers in the developedworld. In the United Kingdom there has been an increase of 200 percent and 600 percent15 Due to a late change in the programme for the Conference, Professor Desmond O'Neill presented a paperon Comprehensive Geriatric Assessment on the day. The topic he had originally been scheduled to address,the assessment of competence to drive, is discussed here.16 Carp FM, Byerts T, Gertman J, Guillemard A, Lawton MP, Leeds M, et al. Transportation. Gerontologist 1980;12:11-16.17 Rabbitt P, Carmichael A, Jones S, Holland C. When and why older drivers give up driving. Basingstoke: AA Foundationfor Road Safety Research, 199618 Eberhard, J.,. 'Safe mobility for senior citizens'. IATSS 1996; 20 (1): 29-37.Conference Proceedings