An overview of the older driver.

Although MVC rates are not substantially higher among older drivers after adjusting for mileage and may even be lower, the crash risk of the elderly driver remains a matter of increasing public concern. In part this is due to media attention over isolated cases of fatal MVCs involving older drivers, occasionally with a demented driver. This media attention has led to growing apprehension over the issue of elderly drivers. Physicians are likely to be involved increasingly in the evaluation of older drivers, whether they want to or not. The physician's quandary is the competing interests of the patient's well-being (i.e., continued independence), and the public's welfare (i.e., protection from impaired drivers). Unfortunately, there are no certain guidelines to protect the physician from liability for either of these conflicting duties. At issue is the foreseeability of harm from an elderly driver, either to self or to others. What degree of impairment is necessary before a physician is bound to report a patient to authorities? Although there are no clear answers, the best advice is to follow clinical judgment. One suggestion is to consider the diagnosis as suitable evidence. Thus, if the patient has a dementing illness of sufficient severity to warrant documentation in the medical record as a diagnosis, then perhaps the physician should consider advising the patient not to drive; reporting the patient to the appropriate authorities would be left to the physician's discretion after consultation with the patient's family. This might have the added benefit of obliging physicians to think twice before mislabeling patients with benign forgetfullness as demented, an all-too-frequent phenomenon. In this weighty ethical decision, it is critical for physicians to consider the consequences of removal of driving privileges from their elderly patients as well as their duty to protect the public health. Neither should be taken lightly. Above all else, physicians should not forsake their responsibility for advising either patients or the public regarding the driving privilege. To do so would simply relinquish the decision-making to those without clinical training or evaluative skills relevant to driving tasks. The physician's role in the evaluation of the elderly driver should be regarded as a pivotal challenge in the complicated management of the health of the elderly population.