Doctors who urge some elderly patients to stop driving may help to keep them safer, a new study suggests. The study was done in Canada. Doctors there must report to licensing officials if a patient has a condition that might impair driving. These conditions include epilepsy, sleep disorders, alcoholism and dementia. In 2006, Ontario started giving doctors a small fee to encourage reporting. Researchers used the fee structure to track more than 100,000 patients. Most were older than 60. Researchers added up the car crashes for drivers from this group in the year before the warnings began. They included only crashes serious enough for the driver to go to an emergency room. Then they kept track of the group for 3½ years. Crashes per year dropped 45%. The study could not tell if the patients stopped driving or were more careful. There was another result, as well. About 1 in 5 drivers changed doctors. The New England Journal of Medicine published the study. The Associated Press wrote about it September 27.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Perhaps something like this has happened to you, or to a family member or friend. You come to an intersection. You look both ways, then start through. And suddenly a car zooms across your path, horn blaring.

You're sure that car wasn't there a second ago. This can happen at any age. But failure to yield the right-of-way is the biggest source of accidents for older drivers.

If you're over age 60 and have had a scare behind the wheel, you may wonder whether age is beginning to affect your driving. Unsafe driving doesn't have to occur as people get older. In fact, older drivers have some excellent driving habits.

Older folks tend to drive slower and more cautiously. Either consciously or unconsciously, they realize that their reaction times are not as quick as 30 years ago. They are also more likely to wear a seat belt. And they rarely use cell phones while driving.

The risk of unsafe driving is not age itself. It's the fact that more medical problems happen to us with age. And some of these medical problems clearly impair driving skills.

The special article in today's New England Journal of Medicine highlights how a simple warning from a doctor can decrease the risk of a road crash in an impaired driver. But here's the important unanswered question: Which patients should be cautioned? And what does "caution" mean? Don't drive at all? Drive only to church and the grocery store?

There are no federal guidelines regarding who can drive. This has always been left up to each state. And rules about reporting impaired drivers differ from state to state.

What Changes Can I Make Now?

No matter what your situation and no matter what your age, there are things you can do to decrease your risk of a car crash.

Be honest about how well you can see. If your vision is even a little blurry, get it checked. If you need glasses or contacts, always wear them when driving.

Don't accept dozing off at the wheel as just being tired. If you are often drowsy and fall asleep easily during the day, you may have sleep apnea. Loud snoring is another clue. Talk with your doctor. Meanwhile, avoid long periods of driving after dark or after a big meal. Whenever you feel drowsy, find a safe spot to pull off the road and take a nap. Even 15 to 20 minutes can make a big difference in your alertness.

Consider changing the time of day you take any medicines that make you sleepy. If you know you will need to drive at certain times, adjust your medicine schedule so that any drowsiness wears off before you drive.

Be honest with your doctor. Your doctor wants to help keep you safe and not hurt others. In most situations, your doctor will not stop you from driving. In fact, there's no way to enforce a doctor's advice not to drive. In most states, it is not even reportable to any state agency. So share with your doctor any concerns you have about near misses on the road. Usually that will lead to some advice that can help you to be a safer driver. If you are a family member worried about the driving skills of a mother or father, go with your parent to his or her next doctor visit to discuss driving.

Eliminate blind spots. These are the areas of the road you can't see in your rear-view mirror or side mirrors. Here's how to fix them. With your car parked, sit upright and glance toward the driver's window. Push the driver's side mirror in or out so the mirror just barely reflects the side of your car. Now glance to the right and adjust the right side mirror so you can barely see the right side of the car in the mirror. Adjust the rear-view mirror so that it covers your view out the back window. Whenever you change lanes, check the mirrors and also glance back quickly to be sure no car is hiding in a blind spot.

What Can I Expect Looking to the Future?

Don't expect more regulations about who can and can't drive. And there shouldn't be any. We don't need to make a complicated issue more complicated.

You should not drive until you have been evaluated by a doctor if you:

• Have blackout spells that can't be explained or predicted
• Have an uncontrolled seizure disorder
• Frequently doze off at the wheel

With medical evaluation and treatment, you will likely be able to drive again.

There are many other conditions for which driving might need to be restricted. Often, the restriction is temporary.