General IM Q11

An 82-year-old man is evaluated during a routine evaluation. He is accompanied to the visit by his son. The patient lives alone, and his son expresses reservations about his father continuing to drive. The patient no longer drives after dark or on the interstate highway. He limits his driving to within a 10-mile radius of his home and mainly drives for local errands and to church on Sundays. He has had no traffic accidents, but he had two recent incidents in which he misjudged the angle of his car in the grocery store parking lot and ran into the shopping cart stand. Medical history is significant for coronary artery disease, hypertension, and mild cognitive impairment. Medications are atorvastatin, aspirin, hydrochlorothiazide, lisinopril, and metoprolol.

On physical examination, blood pressure is 132/82 mm Hg, and pulse rate is 64/min; other vital signs are normal. The patient appears frail with a pleasant demeanor. He wears eyeglasses and hearing aids, and he has impaired hearing as measured by the whispered voice test. On musculoskeletal examination, limited mobility of the cervical spine is noted. He scores 26/30 on the Mini–Mental State Examination. The remainder of the examination is unremarkable.

Which of the following is the most appropriate management regarding this patient's driving?

A Advise the patient to retire from driving

B Obtain neuropsychological testing

C Obtain occupational therapy driving evaluation

D Reassure the patient he is competent to drive with self-imposed limitations

Choose an Answer Above

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