High risk on the highway. How to identify and treat the impaired older driver.

Among older adults who drive, the rate of those involved in fatal crashes rises after age 70. Problem driving in older adults involves visual, cognitive, and motor skills, which may decline with aging and chronic disease. Physicians and other health care providers may not be prepared to evaluate and advise the older patient on the emotion-loaded topic of driving ability. Although it is difficult to identify prospectively a high-risk driver, a targeted history and physical exam are useful clinical tools. Two models are proposed to guide the health care provider and patient through the process of limiting or ending the impaired older driver's time behind the wheel.