1 / 22

The Elderly Driver: Functional Assessment

The Elderly Driver: Functional Assessment. Richard Marottoli, MD, MPH, VA CT and Yale University Shirley Neitch, MD, FACP, Hanshaw Geriatric Center, Marshall University, WV

indra
Download Presentation

The Elderly Driver: Functional Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Elderly Driver:Functional Assessment Richard Marottoli, MD, MPH, VA CT and Yale University Shirley Neitch, MD, FACP, Hanshaw Geriatric Center, Marshall University, WV Adapted from a satellite conference produced by Department of Veterans Affairs Employee Education Service and Office of Geriatrics and Extended Care, and Consortia of Geriatric Education Centers.

  2. Mr. Jones is an 83 year old widower sent for follow-up after hospital discharge • PMH: HTN, hyperlipidemia, hip fracture, OA, cataracts • Function • Lives in own home • Independent in l/B ADL, uses cane • Daughter visits twice/week • Straightens house • Brings food to reheat

  3. Driving • 3-4 x/wk • Mostly familiar places • Minor crash 3 yrs ago • Rear-ended at stop sign • No navigation problems

  4. Hospitalized 2 Weeks Ago • Found on bathroom floor by daughter • Awake but confused • Unsure what happened, how • ER: temp, +UA, renal insufficiency admitted for observation b/o ? LOC, hit head

  5. Hospital Course: • Confusion resolved w/ IV fluids, antibiotics • Head CT: Infarct of ? age • Function: Needed assist w/transfers, walker for ambulation • Disposition: STR; f/u appt. w/you regarding driving, living situation • Home after 1 week at STR, returned to baseline mobility

  6. Types of Assessments • Driving skills and behaviors can be assessed in different settings and at different levels of complexity: • DMVs • Rehabilitation Facilities • Local or Regional Assessment Clinics • Primary Care Provider Offices

  7. Types of Assessments • “ADReS” Assessment of Driving-Related Skills • available in Physician’s Guide to Assessing and Counseling Older Drivers developed by the American Medical Association in cooperation with the National Highway Traffic Safety Administration, September 2003, Chapter 3. • Seven component testing protocol • Much of the testing can be done by office staff • Time required generally 10 min. or less

  8. Visual Fields Visual Acuity Rapid Pace Walk Range of Motion Motor Strength Trail-Making Test, Part B Clock Drawing Test ADReS • Seven Components:

  9. ADReS

  10. ADReS

  11. ADReS

  12. ADReS

  13. ADReS

  14. ADReS

  15. ADReS

  16. Visit Information(2 Weeks Post Discharge) • Hx: No new complaints, feels fine • Meds: Beta blocker, thiazide, statin • Exam: BP, HR WNL Cataracts; OA changes hands/knees; good strength; independent transfers, stable slow gait with cane

  17. ADReS Findings • Visual Fields: Intact • Visual acuity: 20/40 ou • Rapid pace walk: 8 sec (w/cane) • ROM: Neck rotation, finger curl limited • Strength: 4+ - 5/5 • Trails B: 135 sec • Clock: # spacing slightly off

  18. Questions • What do you advise Mr. Jones regarding his driving? His living situation? • Are there other history, exam, or laboratory data that would be helpful at this point?

  19. Follow Up Visit • 9 Months later (1 no show in interim) • Accompanied by daughter who reports • More confused - oversees meds • House less clean, hygiene worse • Still drving - lost going to her house; no known crashes, but ? new scrapes/ scratches on car

  20. Follow Up Visit • Mr. J: • No functional changes • Increase in urinary frequency, occasional incontinence • PE: • BP, HR higher compared with prior visits, otherwise unchanged except unkempt appearance, stains on clothes

  21. ADReS changes • Rapid pace walk: 8.5 sec (8) • Trails B: 165 sec (135) • Clock: # spacing off, # on margin of clock, hand placement incorrect • Fields, Acuity, ROM, strength unchanged

  22. Questions • What do you advise Mr. Jones regarding his driving? His living situation? • Are there other history, exam, or laboratory data that would be helpful at this point?

More Related