Knowledge Of AMA Guidelines And Willingness To Discuss Driving Cessation

The Driver With Dementia: A Survey of Physician Attitudes, Knowledge, and Practice

Recognized as a cause for concern, close to 40% of those with dementia continue to drive. Although crashes are infrequent, reported problems include a decreased understanding of traffic signs, becoming lost in unfamiliar areas, making incorrect turns, improper signaling, and lane deviation. Unfortunately, legal requirements to address cognitively impaired drivers by state Departments of Motor Vehicles are not uniform and fitness to drive continues to be one of the most difficult issues to address when it comes to those with dementia. Nevertheless, most drivers, their families, and motor vehicle professionals expect physicians to provide support and assistance with these decisions. In fact, families report that collaboration with physicians relieves much of the burden that comes from discussing driving cessation on their own. The target article therefore sought to assess what factors influence a physician’s likelihood to address this topic with their patients.

A 65-item questionnaire that measured viewpoints about and experiences with drivers’ with dementia was mailed to 239 physicians from North Carolina and South Carolina. Family practitioners represented the largest specialty group of those completing the questionnaire. The strongest predictors of the decision to address driving with a patient included the physician’s perceived responsibility to discuss the topic of driving and their years in practice. Particularly, physician’s who saw discussing driving cessation as their responsibility were 4.9 times more likely to address the issue with their patients than physician’s who did not have a perceived responsibility. Moreover, the likelihood of addressing driving increased by 5% for each additional year the physician had been practicing.

While knowledge regarding legal requirement to report to the DMV was somewhat associated with addressing the topic of driving cessation, knowledge of the AMA Physician's Guide to Assessing and Counseling Older Drivers was significantly more associated with addressing the topic. In fact, a total of 77.8% of the 140 physicians’ who had made a referral for driving evaluation in the past 6 months were aware of the AMA Guidelines. It is possible that a greater knowledge about driving-related issues may serve to enhance a physician’s confidence, competence, and comfort in addressing this challenging topic with the patient and their family members. In line with this, over 75% of physician’s who did not address driving were not familiar with the AMA Guidelines, indicating a need to increase awareness of this important resource. Other ways to increase this awareness include through continuing medical education (CME) courses such as the Driving and Dementia CME course.