The patient should be advised to retire from driving. The American Medical Association recommends that physicians assess older patients for physical or mental impairments that might adversely affect driving abilities. Assessing the older driver is complex and relies heavily on physician clinical judgment in addition to evaluation of underlying conditions that pose a risk to safe driving. Risk factors that increase the likelihood of an adverse driving event include cognitive dysfunction, caregiver report of unsafe skills, history of citations or accidents, driving fewer than 60 miles per week, alcohol or medications that affect the central nervous system, emotional aggression or impulsivity, impaired mobility (including neck range of motion, range of motion of the extremities, and coordination), visual impairment, and medical disorders that predispose to loss of consciousness. The more risk factors the patient has, the higher the risk of an adverse driving event. This patient has four of these risk factors (cognitive dysfunction, driving fewer than 60 miles per week, caregiver concern, and impaired vision), none of which may be easily reversed. Therefore, given her level of risk, she should be advised to discontinue driving.

Patient self-rating of driving skill has been shown to be unhelpful in assessing driving risk. Caregiver report of driving ability is more reliable. Although this patient is confident in her driving abilities, her daughters' report of “near misses” should be taken into account along with the patient's risk factors for an adverse driving event.

This patient is being seen by an ophthalmologist for her vision loss, which has been stable and meets the minimum limits for the ability to drive. Although her ophthalmologist is able to render an opinion on the status and prognosis of her vision loss, the assessment of the ability to drive safely is complex and multifactorial, of which visual function is only one element. Therefore, the ability of a patient to drive safely should be made by the clinician who has knowledge of these different factors and is able to evaluate them in the overall context of the patient.

Although neuropsychiatric testing may provide greater detail regarding this patient's mild cognitive dysfunction, it is unlikely to change the recommendation to retire from driving considering the multitude of risk factors in addition to her cognitive dysfunction.