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Colter Mitchell: Biological consequences of poverty
Musch, David C., Nancy K. Janz, Rebecca Leinberger, Leslie M. Niziol, and Brenda W. Gillespie. 2013. "Discussing Driving Concerns With Older Patients II. Vision Care Providers' Approaches to Assessment." JAMA Ophthalmolgy, 131(2): 213-218.
Objectives: To characterize situations that prompt vision care providers (VCPs) to ask about their older patients' driving, the types of information they consider, and the factors that influence these inquiries.
Methods: A survey was conducted among a random sample of 500 VCPs who were active members of their Michigan professional organizations and had patients 65 years or older in their practice. Factors associated with the survey responses were identified using ordinal logistic regression analyses.
Results: Survey results were obtained from 404 respondents (80.8%). Common situations that prompted VCPs to ask patients about driving included poor visual function, inquiries from the patient or family, and requests from the state. Visual acuity and peripheral vision testing were frequently relied on (performed always or often by >80% of VCPs), but other ocular test results and nonocular information were infrequently obtained. Questioning about night driving, reading road signs, and experiencing glare were frequent, but inquiries about driving tasks (eg, making left turns) were infrequent. The likelihood of asking about specific driving tasks was significantly greater with more time in practice and with a higher percentage of older patients in their practice, and the likelihood was significantly less for ophthalmologist specialists vs optometrists.
Conclusions: Vision care providers are often placed in a primary role of advising older patients about their ability to drive safely or legally. The most frequent tests they use fail to capture the complexities of visual function that contribute to safe driving. The driving tasks about which they usually inquire include some, but not all, tasks commonly associated with crash risk. Educating VCPs on useful resources, tests, and questions is needed.