Safe Driving Program for Elders and Those with Parkinson's

A new program aims to help people of all ages who have experienced neurological, psychological and/or physical impairments and their doctors make the proper decisions regarding driving. The DriveWise program, created by the department of neurology at Harvard Medical School and Beth Israel Deaconess Medical Center, in Boston, Massachusetts, includes a safety video and tools for doctors to help assess their patients' driving ability. For more info, see www.bidmc.org.

Program Includes Road Test

Many clinicians have difficulty determining whether their patients are fit to drive. They often do not have the tools or the time to assess driving skills and, in any case, there is a lack of consensus on how exactly to do this. At the same time, research shows that Parkinson's patients have motor deficits such as axial rigidity and postural instability, as well as vision problems and/or cognitive problems that may affect their driving function.

DriveWise was developed to address the needs of PD patients and others with medical conditions that might compromise their driving skills. The program includes counseling, office-based testing, and a road test. Decisions about driving are made on the basis of a functional skill analysis rather than on the basis of age or diagnosis.

Each patient meets with a clinical social worker for a discussion of their driving history and their concerns about possible driving cessation. They undergo a brief cognitive assessment focused on visual scanning and attention. They also undergo a thorough analysis of vision, brake reaction time, and traffic sign recognition. They then undergo a 45-minute standardized road test during which they were rated on a number of driving parameters, including speed, lane position, turning, and compliance with traffic signs.

The patients could get a Pass with a 6-month follow-up test (62% passed), a Fail with counseling about alternative transportation (17%), or a Remediation, which indicated some bad habits or minor errors that might be corrected with driving lessons (21%). In the remediation group, 60% gave up driving on their own, but the rest returned for reevaluation and passed the road test.

Problems With Rapid Processing

The PD patients tended to have problems with rapid processing of visual information. While doctors are being encouraged to play an active role in determining the driving competence of their patients with neurological disease, this can be difficult for a busy doctor who lacks the proper resources, according to the poster. "Physicians are particularly challenged by patients with PD whose driving abilities fluctuate. They are reluctant to end driving privileges prematurely, but they also fear deadly consequences of allowing driving to continue too long," the authors write.

It also developed a project to teach health providers how to include a driving history in the medical exam and a driving screening tool focused on domains relevant to driving safely (crashes, concerns, clinical status, and cognition). This tool allows clinicians in a primary care setting to identify potentially unsafe drivers who need further assessment with a road test.

Additional info:  For additional information, or to schedule an evaluation, contact 617-667-4074.

-Adapted from: “AD/PD 2009: Safe Driving Program Aimed at Patients With Parkinson’s” Poster, 9th International Conference on Alzheimer's and Parkinson's Diseases: Abstract 115. Presented March 12, March 13, 2009. Pauline Anderson reported for Medscape Medical News 2009 at http://www.medscape.com/viewarticle/589668 retrieved 3/23/09; and program information from http://www.bidmc.org/News/InMedicine/2005/March/DriveWiseHelpsEldersFamilyEvaluateDrivingSkills.aspx retrieved 3/23/09. Links no longer available, 7/19

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