1. Elder Drivers

2. Goals and Objectives  Review Pennsylvania driving regulations  Review Pennsylvania reporting regulations  Discuss pertinent geriatric physiology, pathophysiology, and syndromes  Learn to manage loss of licensure  Rehabilitation  Gray areas

3. PA Driving Regulations

4. Driver Licensing Agency  Pennsylvania Department of Transportation  Driver and Vehicle Services  1101 South Front Street  Harrisburg, PA 17104-2516  www.dot.state.pa.us www.dot.state.pa.us  800-832-4600 (within state)  717-391-6190 (out of state)

5. Licensing Requirements:Visual Acuity  Each eye with/without correction20/40  Both eyes with/without correction20/40  If one eye blind-other with/without correction 20/40  Absolute visual acuity minimum20/40 in better eye for unrestricted license; up to 20/100 binocular vision for a restricted license  Bioptic telescopes Not permitted for meeting acuity standards Permitted for driving Must have acuity of 20/100 or better with carrier lens only http://www.biopticdriving.org/

6. Licensing Requirements:Visual Fields  Minimum Field Requirement120 o both eyes  Testing device not regulated

7. Licensing Requirements: Bioptics  Bioptic telescopes Not permitted for meeting acuity standards Permitted for driving Must have acuity of 20/100 or better with carrier lens only http://www.biopticdriving.org/

8. Licensing Requirements: Color Vision  No requirement

9. Licensing Requirement: Hearing  Amplified or Unamplified for Forced whisper at not less than five feet or Worse than 40 db loss in better ear at 500 Hz, 1000 Hz and 2000 Hz  Positive office screen Do you have trouble hearing with background noise?  USTFP Clinical Guideline: obsolete 2006 Hand held audiometer  Less sensitive and specific, but is often more convincing to ptnt

10. Road Test  Standardized  Similar to 1 st time permit application drivers

11. Restricted Licences  Vision Daytime driving only Area Dual mirrors Class

12. License Renewal Procedures  Standard Time 4 yr Options/Conditions internet, email, in person Vision test required? No Road test required? No  Age-based renewal Over 65+ every 2 yr Over 45+ random 1650/mo submit PE/vision

13. PA Reporting Procedures: Medical  “All physicians and other persons authorized to diagnose or treat disorders and disabilities defined by the Medical Advisory Board shall report to PENNDOT in writing the full name, DOB, and address of every person 15 years of age and older, diagnosed as having any specified disorder or disability with 10 days.” Physicians must report neuromuscular conditions (eg. Parkinsons), neurospsychiatric conditions (eg. Alzheimer’s dementia), cardiovascular, cerebrovascular, convulsive, and other conditions that may impair driving ability.

14. PA Reporting Procedures: Immunity  “No civil or criminal action may be brought against any person or agency for providing the information required under this system.”  Legal protection is available  Anonymity Reporting is not anonymous, but the identity or the reporter will be protected.

15. PA Reporting Procedures  DMV follow-up PENNDOT sends the appropriate correspondence to the driver asking him/her to submit the necessary froms and examinations reports  Other reporting Will accept information from courts, others DMV’s, police, emergency personnel, family members, neighbors, and caregivers. Reports must be signed in order to confirm reporter facts.

16. Medical-Legal Concerns

17. EBM

18. Predictors

19. Physiologic Concerns  Frailty  Decreased Cardiac Reserve  Slower reflexes  Decreased oculomotor function Useful field of view Trail-making B Decreased neck rotation  Decreased light sensitivity  Decline in musculoskeletal function

20. Diseases

21. Drugs  Sedative/Hypnotics  Antihistamines  Antidepressants  Antipsychotics  Antiepileptics  Cardiac  Rheumatologic

22. Screening  Foot abnormalities  Gait abnormalities  Folstein less than 21(21-23 intermediate)  Intersecting pentagons  Citation within a year of visit

23. Screening: Marottoli 1994  Intersecting Pentagons  Blocks walked daily  3 or more foot abnormalities  Mini-mental 25 or less  Crash Risk by Factors None6% 112% 226% 347%

24. Driver’s Evaluation

25. Vehicle Adaptations  Many  Most Common Spinner Knob Foot Pedal Modification  Automatic Transmission

26. Rehabilitation  PT  OT  Driver’s Rehab  American Automobile Association  AARP  Association for Driver Rehabilitation Specialists

27. Re-testing  After resolution of medical problems  After vehicle modifications

28. Conflict Resolution  Giving bad news  Referral  Second opinion  Legal issues  Resource brokering

29. Alternative Transportation  Public  Private Family Friends Hired  Medical

30. Follow-up  Structured follow-up for care coordination

31. Psychiatric Follow Up Care  Grief  Depression  Anxiety

32. Summary  Treatment of hearing, vision, and orthopedic problems preserves driving ability  Physicians and nurse practitioners must report medically incapable drivers  There are community and private services available to assist with driving and alternate transportation

33. Bibliography