Over the last fifty years specialist healthcare for older people has promoted the concept that functional loss in older people is primarily a health issue. For a major loss of function, such as incontinence or immobility, we now recognize the need for detection, investigation and treatment. Not only do we appreciate the benefits of an interdisciplinary assessment, but we are also accustomed to estimating risk and competence when making decisions about discharging frail older people back to their home environment. One common higher order function is the ability to drive, and geriatricians and psychiatrists of old age (and their teams) have many of the basic skills necessary for enhancing safe mobility in older people: to these need to be added further training and availability of specialist on-road assessments.
The challenge to researchers and clinicians is to understand the interaction between age-related disease and transportation, particularly driving, and to formulate effective intervention strategies.
One of the most challenging tasks is to formulate a model of driving behaviour. Driving is an over-learned skill and psychometric approaches have proven unsuccessful in delineating performance. Behavioural, hierarchical and motivational models have more promise. Preliminary studies of the operationalization of this approach have been encouraging. Further support for this strategy comes from the positive attributes that old age brings to the equation: there is considerable evidence for effective strategic adaptation by older people.
The schedule for the assessment of the older driver is akin to that of geriatric assessment of older people, a process which is marked by the following qualities: medical and functional assessment, detection and prioritization of diseases, interdisciplinary assessment and remediation. Functional assessments, such as a comprehensive test of visual processing, a falls history, and a review of current medications may be of greater relevance than specific medical conditions in the identification of older at-risk drivers. A cascade system for interdisciplinary assessment is probably the most cost-effective way to approach the patient.
This symposium will draw on the skills of geriatricians, a psychogeriatrician and occupational therapist/specialist driving assessors to outline advances in the area of driver assessment and remediation.
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