Planning essential to help patients hang up the keys: Research

It is a sensitive conversation often met with anger, denial, or sadness, but new Australian findings are shedding light on how doctors can best talk to their patients about driving retirement.
 
According to University of the Sunshine Coast researchers, active planning from GPs is key to helping elderly drivers step away from the wheel for the final time.
 
It found these early conversations with patients, in which GPs plant the seed, are vital to a smooth transition away from driving, as well as a sense of individual acceptance from the patient.
 
Importantly, it revealed feedback from others does not play a large role in influencing driving retirement.
 
To form the findings, researchers combined a review of 12 studies which included 600 older and retired drivers from four countries, as well as in-depth interviews with a dozen Sunshine Coast residents.
 
Lead author Kyle Schofield said the investigation found factors such as declining physical health, vehicle cost, and worry about harming others are often the driving force behind surrendering a licence.
 
‘Our local participants reported that they did not receive feedback on their driving, therefore feedback from family, peers and doctors did not play a large role in their decision-making,’ he said.

‘This identifies a great opportunity to encourage and improve conversations about this critical life event in our community.
 
‘Ensuring that older people have the social support, environmental infrastructure and policies to achieve this without driving is extremely important.’
 
They also discovered access to neighbourhood facilities, continuous footpaths and pedestrian crossings, and alternative transport are significant influences in patients agreeing to driving retirement.
 
Professor Dimity Pond, a GP with an interest in aged care, told newsGP she often starts broaching the subject with patients as early as their mid-70s.
 
‘I do a little spiel about how everyone’s reaction time slows, and how driving is a combination of putting your foot on the pedal, and keeping your eyes on the road, and having your neck turned back to see the traffic coming,’ she explained.
 
‘Sometimes patients accept it and sometimes they don’t, sometimes they’re very angry.
 
‘But then, all of a sudden the next year when they come, they say they’ve been thinking about it, and so we can do a lot if we just give people time to adjust to the thought of getting older and how they might limit themselves.’
 
Currently, 91% of those within the 65–69 age group are drivers, which drops to 71% of people aged over 80 years old.
 
Nationally, those aged over 65 years old account for 21% of total road deaths, despite making up just 17% of the total population.
 
Professor Pond said she’s treated several patients who have had near misses on the road – an upsetting experience for all parties involved.
 
‘Sometimes I do one of our brief cognitive tests, sometimes I send them off for a health assessment by the nurse, or I can do a physical test to see whether they can turn their head or stamp their feet on the ground,’ she said.
 
‘However, one problem is that if you don’t know the patient well, it can be hard to tell, especially when we don’t know their history.
 
‘It would also be great to have subsidised occupational therapy driving assessments, because they can cost upwards of $700 and they’re not really available in rural areas.’
 
The study’s co-author Associate Professor Florin Oprescu said older driver safety is of increasing interest for policy makers, especially as Australia’s ageing population continues to grow.
 
‘Previous evidence suggests that only a small percentage of drivers plan for driving retirement and that there is limited understanding of the factors influencing this behaviour,’ he said.
 
‘This research shows how we can normalise the conversation around planning for driving retirement and support respectful conversations between older drivers, family, clinicians and peers.’
 
According to the national Assessing Fitness to Drive medical standards, ‘talking with an older person about their driving can be difficult’ especially if it is delayed.
 
Austroad’s advice to GPs is to actively observe and screen older patients, intervene early, consider the impacts of their medical conditions, and help them transition to other means of transport.
 
It also encourages GPs to watch for changes in a patient’s vision, cognition and motor and sensory functions, as well as their acuity, visual fields, and contrast sensitivity.
 
Professor Pond said the research highlights the importance of continuity of care as a means of quickly spotting changes in patients.
 
‘It’s much easier for us to work with people that we’ve known for a long time and to assist them and to warn them to get them ready to stop driving,’ she said.
 
‘Because who wants a faceless bureaucrat doctor saying you can’t drive, it’s much easier coming from someone you know and trust.’
 
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