Blog | Wednesday, December 4, 2013

QD: News Every Day--Routinely addressing driving with older patients may make talks easier

Older patients might be more willing to talk about their ability to drive than their doctors realize, a study found.

Instead of waiting for red flags to pop up, physicians could routinely bring up driving as a topic, in the context of planning for the future, to make the subject easier to address, the study found.

Researchers created a qualitative descriptive study based on focus groups and individual interviews with clinicians and drivers. Researchers reviewed conversations among patients and 8 internists, physician assistants or nurse practitioners at 3 university-affiliated clinics with 33 community-dwelling current drivers aged 65 years or older.

Results appeared in the Journal of General Internal Medicine.

The 5 dominant themes found during the conversations were:
• Clinicians usually start conversations only after red flags emerge;
• Drivers are open to conversations that are focused on prevention rather than intervention;
• Family input influences clinicians and drivers;
• Factors such as short appointments affect conversations; and
• Both clinicians and drivers thought advance driving directives making general questions about driving a part of routine care could help.

Author Robert S. Schwartz, MD, FACP, and co-authors noted that both clinicians and drivers supported the idea of regular questioning about driving, such as part of annual Medicare wellness exams, to make the inquiries would feel less threatening, as well as linking the questions to patient education about maintaining independence without driving.

“While primary care providers traditionally have prided themselves on developing close relationships with established patients, our findings suggest gaps in these relationships, at least concerning driving and mobility. These gaps may stem from time constraints, practices where patients see multiple providers, or provider hesitation about talking about driving,” the authors wrote. “On the issue of driving, these relationship gaps could be especially problematic, given the way health and mobility affect each other and the way older patients’ family members often ask providers for help. Thus to optimize older patients’ well-being, providers must work with drivers and their family members to balance competing priorities in mobility, independence, and safety.”

Learn more tips about handling difficult conversations in general, and driving specifically, in this article from the June 2012 issue of ACP Internist.