Functional Assessment Of Older Drivers

The functional assessment includes an assessment of the visual, physical and cognitive abilities of a patient. When performance is adequate in these areas is necessary for safe driving. Most of the functional assessment can be made by family doctors, but if necessary, specialists must (eg. As eye doctors, neuropsychologists, “subspecialists,” occupational and physical therapists, rehabilitation specialists) should be consulted. Identified deficits may require interventions (interventions for older drivers), including additional training, tools, reporting to the State Department of Motor Vehicles, traffic restrictions and cessation with driving or a combination thereof. Some complicated cases may be referred to state medical councils. A useful resource is the American Geriatrics Society’s Physician’s Guide to Assessing and Counseling Older Drivers. The visual function visual function is essential for safe driving. Age-related and pathological changes in vision are common and can contribute to impaired driving ability. Changes with aging are Reduced retinal illuminance (amount of light falling on the retina), visual acuity and peripheral vision presbyopia (decreased ability to accommodation), the depth perception impaired Decreased ability to adapt to changed light and increased sensitivity to glare, which drive the at night impaired Common eye diseases in old age are age-related macular degeneration cataract glaucoma Diabetic retinopathy. In many states, the central visual acuity and peripheral vision are routinely tested by the licensing agency when a license is renewed. Most states require for unrestricted driving a visual acuity of 20/40 in at least one eye (glasses or contact lenses are allowed). In some states, doctors may even extend to medical reasons the request. In addition, some states have approved the use of Bioptics (a lens system with a telescope on a pair of glasses) for people with severely impaired vision. The limits for horizontal peripheral vision, which is necessary for safe driving, vary greatly between states of no preset up to about 140 °. Tests of the field used (spatial location, from the visual stimuli can be detected in quiescent view) offer integrated measures of visual performance (eg. As visual processing speed, visual-spatial attention, visual memory) and can be used to predict a higher car accident risk. The Indzidenz auto accidents such. For example, if the used field of view is 6 times higher reduced by> 40%. However, field tests are not available in all practices. Older drivers need for a comprehensive examination often a referral to an ophthalmologist. Physical functioning Various physical function parameters can be assessed in the authority. Motor speed, balance and coordination can be assessed with the high speed walking test. The patient is asked to enter a 3 m long way to go to turn around and quickly return to the starting point. If the patient usually goes with a walker or cane, it should also be used during the test. A time of> 9 s may indicate an increased risk of a car accident. Physicians should try the cause of the camera malfunction (eg. As Parkinson’s disease, arthritis) to get to the bottom to create a treatment plan. The range of motion should be tested in the neck area and in all joints of the upper and lower extremities. Decreased cervical mobility affects the ability to turn his head and look after intercourse (v. A. In the blind spot). The lateral rotation should be 30 ° to either side in older adults ?; is the rotation low, they can be referred to a physical therapist to improve the mobility; or a specialist in driving rehabilitation can install a wide-angle rearview mirror. Reduced mobility of the limb interferes with the ability to control the vehicle. The strength in the upper and lower extremity should be judged qualitatively (in view of the requirements when driving a vehicle). The grip strength can be determined with a dynamometer. A grip strength <16 kg for men and <14 kg in women reflects possibly a decreased ability to the steering wheel to operate. Proprioception of the lower extremities and peripheral sensory function should be tested. Decreased sensor may affect the ability to modulate the pressure on the pedals. Physical and occupational therapists who specialize in "Driving Rehabilitation" can offer comprehensive tests of motor function capability in terms of driving ability. heard sometimes, for assessing the driving rehabilitation specialist that extends to the patient together in a vehicle to evaluate its actual driving ability. which is used while the vehicle should be equipped with features that allow a secure control of the specialist (z. B. brake on the passenger side). Specialist in driving rehabilitation can be found by contacting local rehabilitation facilities or www.driver-ed.org. In most states, the cost of a review of the driving rehabilitation are not covered by insurance (Medicare or private), it can be a private performance. Cognitive function The incidence of cognitive impairment increases ? 65 years in individuals. People with cognitive impairment often do not know their limits and have a higher risk of car accident; the risk increases with the severity of the impairment. Although no test has shown that he can predict the driving safety complete and accurate, some tests are able to some extent to make a predictability for impairing driving behavior in older adults. Watches test: These tests include the following This short test tests visual perception, visuospatial abilities and executive functions. Trail Making Test (Part B): This test assesses the attention and visual perception. Part B rated changing attention and executive function. Part B is to be found on the National Highway Traffic Safety Administration web site. Driver with a different score in Test B (z. B.> 180 s) may be candidates for further special tests by a specialist in driving rehabilitation. Mini-Mental State Test: The test of mental status (examination of mental status) checks for cognitive impairment. However, this test has not been validated for use in the testing of driving licenses and road safety experts disagree whether it is suitable for this purpose. Maze test: In various maze tests (. Eg the maze test Snell Grove) persons must navigate through a printed on paper maze. These tests help in the assessment of visual recognition and executive functions. Drivers with mild cognitive impairment should be considered for a referral for a more detailed neuropsychological assessment into consideration. Clinical Calculator: Watches-drawing test (screening for cognitive impairment) Clinical Calculator: screening for cognitive impairment with 6 questions

Health Life Media Team

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