A right of passage or a risk of passing?
Jacqueline Vance, RNC, CDONA/LTC
When I die, I want to go like my grandmother, peacefully in her sleep … not like the three passengers screaming in the back seat of her Buick! (OK, old joke). But what isn't a joke is elders with cognitive impairment and safe driving.
Ah, driving — a rite of passage! Who doesn't remember the day they got their driver's license, giving them a new independence dreamed of for years! At some point for some of our elders, however, driving may pose a risk of “passing.”
Why should you care? Well gone are the days when our residents are here to stay and we don't have to worry about them getting behind a wheel again. With the paradigm shift of increasing short-stay residents, safety upon discharge is in our wheel house (pardon the pun).
Let's be honest, this is a subject we aren't usually comfortable with. Being behind a wheel offers an older adult independence and taking that independence away is not an easy decision. So how do we make it? What evidence exists that might tip us off that our short-term residents might be a danger to themselves or others behind a wheel?
Well, believe it or not, a simple Clock-Drawing Test is one familiar to us and a good clue as to how safe it is for an older adult to drive. According to a study by Freund* and colleagues, the scientific evidence evaluating the Clock-Drawing Test for assessing driving ability has been shown to be of moderate to strong quality and demonstrates that drawing a clock is considered to be a task that requires a higher level of cognitive function.
The Clock-Drawing Test can indicate deficits related to visual perception and can identify issues with short-term memory and planning.
While the Clock-Drawing Test is no longer part of the MDS, it is a fairly simple standard tool. If you suspect cognitive impairment that may impede driving, it couldn't hurt to perform the test and then give the results over to the practitioner. Be proactive, don't avoid the issue. While you won't be the ones making “the” decision, you will be advocating safety for your residents (and those around them).
And if that isn't enough to motivate you, just remember, most of our residents live in our community. So that person in front of you in the fast lane going 20 miles under the speed limit, driving in the middle of both lanes, with the right turn single on for the last 12 miles might be the person you discharged last week!
Just keeping it real,
* Freund, B., Gravenstein, S., Ferris, R., Burke, B.L., and Shaheen, E. (2005). Drawing clocks and driving cars: Use of brief tests of cognition to screen driving competency in older adults. Journal of General Internal Medicine, 20(3): 240-244.
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.