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    Trading the Car Keys for a Bus Pass

    Older Drivers

    Role of the Family Physician

    According to Richard A. Marottoli, MD, MPH, an associate professor of medicine and geriatrics at the Yale University School of Medicine, and chairman of the National Research Council's Safe Mobility for Older Persons Committee, the vast majority of drivers who quit do so on their own hook. "They experience uneasiness in certain situations and become progressively more uncomfortable," he says.

    In some cases, however, alarmed adult children or spouses consult their family physician about the driver's condition. According to Carr, the doctor should first take a detailed driving history both from the patient and someone who has ridden with the person. Medications need to be reviewed. Of course, if the patient has a history of an impairing illness such as stroke, sleep apnea, alcohol abuse, illicit drug use, epilepsy, psychiatric disorders, Alzheimer's, and others, this must be taken into consideration. The physician will then check functioning, including complex reaction time, visual acuity, divided attention (think cell phones), hearing, and the width of the useful visual field.

    Some physicians, warns Carr, do not want to get this involved. They may just refer the driver to a physical therapist specializing in retraining drivers. In other cases, courses and tips are available from both AARP (http://www.aarp.org/55alive/home.html) and the American Association of Automobiles (www.seniordrivers.org) . The 55Alive program from AARP has been taken by 6 million people thus far, but Carr says this is mostly for the self-aware driver who wants a refresher course, rather than the true road menace.

    In the latter case, Carr clearly communicates his doubts about the patient's physical fitness to drive. "I say, 'You need to stop driving.' I also put it in writing (for a contract you can have the person sign to that effect, go to www.thehartford.com/alzheimers/agreement.html)." It'simportant, too, he says, that a family member be present for this discussion.

    If the individual does not quit driving, Carr writes to the authorities and asks that the person's license be revoked. Even this can become a problem, however, in that sometimes people whose judgment is impaired will drive without a license or even buy another car if theirs is confiscated. In some cases, a family member may even need to file down the ignition key or remove the battery.

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