BACKGROUND: Discussions about driving cessation are difficult. "Advance driving directives" (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help make driving decisions for them in the future. It is not known if older drivers support the concept of ADDs. DESIGN AND METHODS: Cross-sectional study of a convenience sample of English-speaking drivers (55+ years) at 2 independent living facilities and 2 community centers who completed anonymous surveys. RESULTS: Of 168 participants, 80% were female; the median age was 76.5 years (range = 56-93 years). Most (74%) drove daily or almost daily, and 7% reported a crash in the past year. Few had spoken with someone about driving safety (5%) or their wishes when driving skills decline (21%). Of the few who had discussed this topic, 83% had spoken with a family member; only 17% had spoken with a health care provider. However, participants were open to driving discussions, and 54% said they would be willing to complete an ADD if recommended. Of these, 79% said it was "likely" or "very likely" they would comply with the directive in the future. Most (73%) supported mandatory, age-based retesting; the median recommended testing age suggested was 80 years. More participants thought the driver (71%), a family member (61%), or a physician (59%) should determine license revocation for an unsafe driver, rather than the department of motor vehicles (32%). CONCLUSIONS: Many older drivers may be open to discussing their driving plans with physicians and family members. ADDs may facilitate these discussions in the present and help define driving-related wishes in the future.
BACKGROUND: Discussions about driving cessation are difficult. "Advance driving directives" (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help make driving decisions for them in the future. It is not known if older drivers support the concept of ADDs. DESIGN AND METHODS: Cross-sectional study of a convenience sample of English-speaking drivers (55+ years) at 2 independent living facilities and 2 community centers who completed anonymous surveys. RESULTS: Of 168 participants, 80% were female; the median age was 76.5 years (range = 56-93 years). Most (74%) drove daily or almost daily, and 7% reported a crash in the past year. Few had spoken with someone about driving safety (5%) or their wishes when driving skills decline (21%). Of the few who had discussed this topic, 83% had spoken with a family member; only 17% had spoken with a health care provider. However, participants were open to driving discussions, and 54% said they would be willing to complete an ADD if recommended. Of these, 79% said it was "likely" or "very likely" they would comply with the directive in the future. Most (73%) supported mandatory, age-based retesting; the median recommended testing age suggested was 80 years. More participants thought the driver (71%), a family member (61%), or a physician (59%) should determine license revocation for an unsafe driver, rather than the department of motor vehicles (32%). CONCLUSIONS: Many older drivers may be open to discussing their driving plans with physicians and family members. ADDs may facilitate these discussions in the present and help define driving-related wishes in the future.
Authors: Marian E Betz; Deborah Azrael; Rachel L Johnson; Christopher E Knoepke; Megan L Ranney; Garen J Wintemute; Daniel Matlock; Krithika Suresh; Matthew Miller Journal: JAMA Netw Open Date: 2020-07-01