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Geriatric: Driving Risk

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Geriatric: Driving Risk

Post  Admin on Thu Feb 26, 2015 9:42 pm

75 year old male with history of dementia is referred to you for evaluation of his driving risk.
Presence of which of the following has highest strength of evidence to recommend stop driving?
(a) Clinical Dementia Rating (CDR) score of 1
(b) Caregiver rating of unsafe driving
(c) MMSE of 20
(d) History of crashes or citations


Ans: A.

For patients with dementia, consider the following characteristics useful for identifying patients at increased risk for unsafe driving (Strength of evidence: A, B &C- Level A being highest and Level C is lowest strength of evidence)

• The CDR scale (Level A)
• A caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
• A history of traffic citations (Level C)
• A history of crashes (Level C)
• Reduced driving mileage (Level C)
• Self-reported situational avoidance (Level C)
• MMSE scores of < 24 (Level C)
• Aggressive or impulsive personality characteristics (Level C).

Patients with mild dementia (CDR of 1) are at a substantially higher risk for unsafe driving and thus should strongly consider discontinuing driving. The ORDT (On Road Driving Test) pass rate is 41-76% for CDR score of 1.

Source: Practice Parameter update: Evaluation and management of driving risk in dementia. Neurology 2010;74:1316–1324.

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