Loss of driving privileges is--after nursing home placement--probably the most feared of events for an elderly person. Supportive psychotherapy combined with a cognitive-behavioral focus on emphasizing "bad" consequences of continued driving can be helpful. Caution should be paid to the possible onset of a mood or adjustment disorder in the context of loss of driving privileges and, should it occur, may require psychopharmacologic intervention.
What alternatives to driving can be offered to the older citizen? Many suggest that the current transportation system is inadequate. While public transportation may be convenient for some, it may fail to provide the resources necessary to aid the elderly person. Furthermore, mass transit in large cities often introduces an element of danger to the elderly person. Not only does the criminal element pose a threat, but also the pace at which the transportation system operates may be too rapid. If society intends to reduce driving privileges for older people, then society must provide an efficient, cost-effective and safe alternative.
Mr. Rinkert is forensic psychology intern in the Forensic Psychiatry Clinic at the Superior Court of San Diego.
Dr. Naimark is associate clinical professor of psychiatry at the University of California, San Diego, and adjunct professor of law at the University of San Diego.
References
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Cable G, Reisner M, Gerges S, Thirumavalavan V (2000), Knowledge, attitudes, and practices of geriatricians regarding patients with dementia who are potentially dangerous automobile drivers: a national survey. J Am Geriatr Soc 48(1):14017 [see comment].
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Fitten LJ (2003), Driver screening for older adults. Arch Intern Med 163(18):2129-2131 [see comment].
