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Ap capstone training 2019 for money capstone partners lp for money texas parks and wildlife regional fishing reports growing older involves many changes and adjustments a transition that's getting more attention today is retirement from driving if you live long enough it's not a matter of if you will need to hang up the keys but simply when this is especially true for conditions that impact on memory and thinking such as Alzheimer's disease and other forms of progressive dementia most community-dwelling older adults are capable and safe drivers they understand that aging can bring changes in sensory motor and cognitive functions and so they adjust their driving patterns in response at any given time a portion of older drivers may be up to ten percent will experience changes in health and function that can impact negatively on driving a primary goal of driver fitness evaluation is preventive early recognition and thoughtful intervention are important if you treat older patients driving safety will be a clinical issue in your practice at some point if not already in Missouri like most states physicians are considered by statute as the go-to experts for driver fitness determination the physician statement in Missouri also known as form 1528 is designed to guide you through a thoughtful and thorough process towards a recommendation on driver capability when it comes to driving behaviors what predicts a future crash is having a previous motor vehicle crash so I do think primary care clinicians would do well to ask about previous crashes and or near misses we also know that moving violations or predictor of a crash and with older adults that could be too fast or too slow we would go through questions related to medical conditions and vision cognition and motor or muscle ability and then specifically on our examination we look at visual acuity we look at visual fields range of motion of joints cervical range of motion of the neck muscle strength and then from a cognitive perspective we would also do some cognitive testing let's review form 1528 briefly and discuss some rules of thumb for completion you'll notice that the first section is for the patient the patient's authorization signature allows you to communicate medical information to state officials a section on driving and transportation follows pay special attention to this ask questions of your patient and family members if present to better understand their driving in mobility situation is your patient still driving regularly at night and at highway speeds has a safety incident occurred recently if so find out how serious it was does your patient have non driving transportation alternatives the rest of the form is yours to complete you start on page 1 by describing your relationship to the patient and your impression of his or her disease awareness and compliance with medical recommendations these questions are intended to link your general knowledge of the patient with the driving task you are asked to note common vision conditions and provide acuity and filled with numbers at the bottom of page one this section can also be completed by a vision specialist you are asked about cardiovascular disease and its functional impact be sure to check yes for all conditions that apply and no for those that don't if the patient has no cardiovascular concerns and is functionally normal be sure to circle an aah a functional capacity of one on the chart that's provided medication review is next checkboxes are available for various medication types at the top of page two with blank space to write in specific drugs consider the patient's medications and how they may alone or through interaction impact on driving ability consider impacts on attention and alertness especially if you think a relationship may exist answer accordingly to the right the next sections lists conditions and symptoms which may impact on driving ability from the perspectives of cognition consciousness movement and psychiatric health you'll notice the heading combined impairment for driving for each of these categories you can rate the patient as unempowered for driving all the way up to severely impaired consider all that you have checked above relative to what you know about safe driving is it likely that your patient is impaired to some extent place an X in the box that best fits your clinical judgment at the bottom of page two is where you record your final judgment on driving safety and make other recommendations to state driver licensing officials you have three choices likely capable unclear if capable not capable the unclear category allows you to make secondary recommendations including further evaluation for vision or another area of concern when you choose the unclear rating for a patient be sure to select both the written knowledge and driving skills test options on form 1528 this combination is especially important for individuals with mild cognitive impairment and early dementia passing both indicates present capability for driving there is also a box in which you can recommend one of a number of common driving restrictions daylight driving only is the most common restriction used for senior drivers in Missouri today other restrictions such as use of a special hand or foot device are often suggested by occupational therapists and other rehabilitation specialists the evidentiary basis for driving restrictions and at risk older drivers is weak and so I cannot offer you any firm recommendations here except to use your common sense common sense also plays a role in your final recommendation on driving capability consider all you have learned about the patient and recorded on Form 1528 so far how many indicators of a driving safety concern did you document if none then checking likely capable would make sense if one or more consider how serious these concerns are in terms of your patients functional status consider too if these concerns are likely to worsen in the coming months as your final rating should take this fact into account for certain progressive conditions such as Alzheimer's disease the window for continued safe driving may be small your recommendation is not just for right now but also for the immediate future too if you identified one or more serious concerns a rating of not capable would be appropriate you can always choose unclear but do so when you really are unsure driver licensing officials will take it from there and confirm whatever your recommendation may be so physicians can make recommendations but they are not the licensing authority and there is an appeal process to go through so physicians should realize they should give their honest opinion be willing to put their nickel down realize that if someone loses a license it is a licensed authorities made that ultimate decision and we also recognize in our field there can be differences of opinion for driving safety when you have completed form 1528 to your satisfaction share the main findings with your patient and family if possible submission of the form is your responsibility either by fax or paper mail keep a copy of the patients record also completing form 1528 fulfills your responsibility to the state with respect to driver licensing to learn more about driver fitness evaluation and how to counsel your patients on driving retirement visit the american geriatrics society website dementia and driving guidelines are also available through the American Academy of Neurology you you capstone wireless motion sensor light for money Cold Spring Harbor Laboratory, North Shore, Long Island.