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Driving is an essential and highly valued instrumental activity of daily living that becomes increasingly difficult to safely maintain with age-related medical conditions. Health-care providers are uniquely positioned to (1) identify and modify risk factors associated with on-road safety, (2) offer rehabilitation strategies to improve safety and extend driving life, and (3) combine clinical information with resources related to driving to support safe continued community for older patients. Clinicians face myriad challenges in assessing patients' medical fitness to drive, including multiple comorbidities, polypharmacy, and reluctance to address driving issues due to the potential impact on the relationship with the patient, as well as legal/ethical concerns. However, assessment and intervention are important to prevent injury and the potential loss of driving privileges, the latter which may have a negative impact on quality of life. This chapter describes the functional abilities necessary to be a safe driver at any age; acute and chronic medical risk factors for driving impairment; clinical tools to stratify risk of medical impairment to drive; opportunities to intervene or refer patients flagged for impairments; resources to support patients transitioning from driver to nondriver; and ethical and legal concerns for clinicians advising patients on driving.
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