Excerpt: 'The Driving Dilemma'

Recognizing the growing importance of evaluating driving ability among older adults, the American Medical Association created an assessment guideline for physicians called the Assessment of Driving-Related Skills (ADReS). This is a set of brief tests, conducted in a doctor's offi ce, which measures the three key functions for safe driving (vision, cognition, and motor function). Some physicians may use other systems or they may have developed their own strategies for assessing function. If your physician is not familiar with the ADReS, it can be freely accessed via the internet from the professional resources section (Public Health: Geriatric Health) of the AMA Web site (www.ama-assn.org or via the National Highway Transportation Safety Administration at www.nhtsa.dot.gov/ people/injury/olddrive/OlderDriversBook). Here's a brief overview of the ADReS evaluation and what you or a loved one can expect.


Aspects of vision that are important for safe driving can be assessed by most primary care physicians. Far visual acuity is assessed using the standard Snellen E Chart. With the chart hung at the proper distance the patient reads the smallest line of text possible. The visual acuity score is based on the lowest full-row read. One's fi eld of view is measured by what is called confrontational testing. The examiner sits or stands 3 feet in front of the patient, at the patient's eye level. The patient is asked to close his or her right eye, while the examiner closes his or her left eye. Each fi xes on the other's nose. The examiner then holds up a random number of fi ngers in each of four quadrants and asks the patient to state the number of fi ngers. The process is repeated for each eye.


General cognitive function is measured with the Trail- Making Test (Part B), in which the person is asked to draw a line between small circles on a page in a specifi ed order. Research indicates that poor performance on the test is associated with poor driving performance. Another simple evaluation of memory, visual perception, and executive skills is the Clock Drawing Test. In this test the examiner gives the patient a piece of paper and a pencil and asks him/her to draw a clock, including the face and numbers, and to indicate the time as specifi ed.


The Rapid Pace Walk is used to measure lower limb strength, endurance, range of motion, and balance. A 10-foot path is marked and the patient is asked to walk the path, turn around, and walk back to the starting point as quickly as possible. The Manual Test of Range of Motion and Manual Test of Motor Strength are simple subjective tests of resistance to an examiner's pressing or of measurements of the range of motion of the head or extremities.


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