MMS Physician Focus: January 2011
By Janet Jankowiak, M.D.
When reports surface on the dangers of impaired driving,
headlines usually include alcohol, age, and the multi-purpose
category of "distracted driving." Those rightfully belong at
the top of the list.
Alcohol abuse is the greatest risk factor for motor-vehicle
collisions, deaths, and injury. For the five years 2005-2009,
one-third of the motor-vehicle related fatalities in the U.S. every
year were alcohol related, according to the National Highway
Transportation Safety Administration. The same holds true for
Massachusetts, which has averaged 400 alcohol-related fatalities
over the same period.
Age has also taken center stage with driving ability, as the
older driver has become a growing national public health concern.
Federal data show that drivers 75 year and older have higher rates
of fatal motor vehicle crashes than any other group, except teens.
Every elderly person, either by physical or mental impairment, will
reach a point where it will be unsafe to drive, though the rate of
decline will vary from person to person.
"Distracted driving" - especially talking and "texting" with
cell phones - has also captured the spotlight, after several tragic
accidents. Such events have led the state legislature to enact a
new law, banning texting as well as the use of cell phones and
other electronic devices by those under 18. Although the law
targets young drivers, multitasking while driving is risky at any
age. The same law also requires drivers over 75 years of age
to renew their licenses in person at a Registry office. Many other
states are doing the same.
While alcohol, age, and distracted driving catch the attention,
it's important to remember that sleep deprivation and many medical
conditions also have the potential to cause impaired driving.
- A driver's visual acuity must be at a level where he or she has
time to detect and react to pedestrians, obstacles, signs, and
other vehicles in daylight and darkness. State motor vehicle
departments have set minimum standards on vision requirements,
including color and peripheral vision standards.
- Prescription drugs and other medications can affect sensory,
mental or physical functions, particularly for those who may be
taking several medicines at the same time. Sedatives,
antidepressants, muscle relaxants, codeine, and pain control
medicines are just some medications that can impair driving. People
taking prescription drugs or over-the-counter medicines should read
the instructions carefully and question their physician and
pharmacist about possible side effects, how a medicine might
interact with others they may be taking, and how driving ability
might be affected. Drinking alcohol when taking certain drugs can
add to the side effects of the medication.
- Diseases of the nervous system can impair muscle control,
alertness, and consciousness. Patients with such conditions as
dementia, seizures, severe pain, head injuries, Parkinson's
disease, multiple sclerosis, or stroke should be evaluated
carefully by their physicians. This is especially important if the
condition is progressive.
- Patients with sleep disorders, such as obstructive sleep apnea
or narcolepsy, as well as diabetes, cardiovascular disease,
respiratory disease, psychiatric disorders, and musculoskeletal
disabilities should also be cautious. These conditions may
impact cognitive, visual, and muscular abilities needed for safe
operation of motor vehicles.
The Massachusetts Registry of Motor Vehicles has established
policies on such medical conditions as visual or cognitive
impairment, seizures and loss of consciousness, arthritis and
musculo-skeletal disease, cardiovascular and respiratory disease.
Its Medical Affairs Branch may issue restrictions - or deny a
license - related to these and other medical conditions. Licensees
with a medical condition that makes them ineligible to drive have
the responsibility to report their medical condition to the
Registry's Medical Affairs Branch.
Motor vehicle operators should know that the new law adopted by
the legislature in 2010 allows physicians and other health care
providers to report in good faith any patient whom they have
reasonable cause to believe is not physically or mentally capable
of safely operating a motor vehicle., However, such reports cannot
be based solely upon age or a diagnosis, and must be made on
observations of the "actual effect" of the condition on a person's
ability to drive - a provision to prevent routine filings and
discrimination in denial of licenses. The Registry will then
determine whether that person is competent to drive.
As safe operation of motor vehicles is a shared responsibility
and a critical public health and safety concern, individuals with
medical conditions should become familiar with applicable laws and
regulations. For information on state laws, visit www.mass.gov/rmv. The
Massachusetts Medical Society's Medical Perspectives on
Impaired Driving, while developed for physicians, can be
useful for others in describing medical conditions and how they
affect driving. Download a free copy at www.massmed.org/impaireddriving
Janet L. Jankowiak, M.D., is a geriatric neurologist and was a
member of the Massachusetts Medical Society's Working Group on
Impaired Drivers. Physician Focus is a public service of the
Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult with their physician
for treatment and check with local and state officials for the
latest laws regarding medical aspects of driving. Send