Marian E Betz1, Jacqueline Jones2, Emma Genco3, David B Carr4, Carolyn DiGuiseppi5, Jason S Haukoos6, Steven R Lowenstein7, Robert Schwartz8. 1. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora. Department of Epidemiology, Colorado School of Public Health, Aurora. marian.betz@ucdenver.edu. 2. College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora. 3. VISN 19 Mental Illness Research, Education and Clinical Care Center, Veterans Affairs Eastern Colorado Healthcare System, Denver. 4. Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology , Washington University School of Medicine, St Louis, Missouri. 5. Department of Epidemiology, Colorado School of Public Health, Aurora. 6. Denver Health Medical Center, Denver. 7. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora. 8. Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Abstract
PURPOSE OF THE STUDY: Widespread screening of older drivers, with in-depth evaluation only of those who screen positive ("tiered assessment"), might efficiently balance driver safety and mobility. To inform program development, we sought to examine the perspectives of older drivers and clinicians on the concept of tiered assessment in primary care settings. DESIGN AND METHODS: Iterative focus groups and interviews with 33 community-dwelling current drivers aged ≥65 years and 8 primary care providers. We used inductive and deductive theme analysis to explore driver and clinician perspectives and to identify barriers and facilitators to establishing a tiered older driver assessment program in primary care settings. RESULTS: Four dominant themes emerged. Two themes addressed the overall concept: (a) support for the concept of tiered older driver assessment and (b) concerns about the consequences of older driver assessment and how these could affect program viability. Two themes addressed screening: (c) tension inherent in using a generalized approach to the highly individualized issue of driving and (d) logistical considerations for screening in primary care settings. IMPLICATIONS: Standardized older driver screening and referral might improve clinician-driver communication, but screening should occur in a context that includes personalized mobility counseling.
PURPOSE OF THE STUDY: Widespread screening of older drivers, with in-depth evaluation only of those who screen positive ("tiered assessment"), might efficiently balance driver safety and mobility. To inform program development, we sought to examine the perspectives of older drivers and clinicians on the concept of tiered assessment in primary care settings. DESIGN AND METHODS: Iterative focus groups and interviews with 33 community-dwelling current drivers aged ≥65 years and 8 primary care providers. We used inductive and deductive theme analysis to explore driver and clinician perspectives and to identify barriers and facilitators to establishing a tiered older driver assessment program in primary care settings. RESULTS: Four dominant themes emerged. Two themes addressed the overall concept: (a) support for the concept of tiered older driver assessment and (b) concerns about the consequences of older driver assessment and how these could affect program viability. Two themes addressed screening: (c) tension inherent in using a generalized approach to the highly individualized issue of driving and (d) logistical considerations for screening in primary care settings. IMPLICATIONS: Standardized older driver screening and referral might improve clinician-driver communication, but screening should occur in a context that includes personalized mobility counseling.
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