Journal of General Internal Medicine

, Volume 28, Issue 12, pp 1573–1580 | Cite as

“I Wish We Could Normalize Driving Health:” A Qualitative Study of Clinician Discussions with Older Drivers

  • Marian E. Betz
  • Jacqueline Jones
  • Emma Petroff
  • Robert Schwartz
Original Research



Driving for older adults is a matter of balancing independence, safety and mobility, and prematurely relinquishing the car keys can impact morbidity and mortality. Discussions about “when to hang up the keys” are difficult for clinicians, drivers, and family members, and therefore are often avoided or delayed. “Advance Driving Directives” (ADDs) may facilitate conversations between health care providers and older drivers focused on prevention and advance planning for driving cessation.


To examine clinician and older driver perspectives on ADDs and driving discussions.


Qualitative descriptive study using iterative focus groups and interviews with clinicians and drivers.


(1) Eight practicing internal medicine physicians, physician assistants or nurse practitioners working at three university-affiliated clinics; and (2) 33 community-dwelling current drivers aged 65 years or older.


Theme analysis of semi-structured focus groups and interviews with clinicians and older drivers was used to explore clinician and driver perspectives on “ADDs” and driving conversations. General inductive qualitative techniques were used to identify barriers and facilitators to conversations between older drivers and their healthcare providers about driving and health.


Five dominant themes emerged: (1) clinicians usually initiate conversations, but typically not until there are “red flags;” (2) drivers are open to conversations, especially if focused on prevention rather than interventions; (3) family input influences clinicians and drivers; (4) clinical setting factors like short appointments affect conversations; and (5) both clinicians and drivers thought ADDs could be useful in some situations and recommended making general questions about driving a part of routine care.


Clinicians and older drivers often wait to discuss driving until there are specific “red flags”, but both groups support a new framework in which physicians routinely and regularly bring up driving with patients earlier in order to facilitate planning for the future.


older driver physician anticipatory guidance Advance Driving Directive qualitative research 



Author Contributions

MEB participated in study concept and design, moderation of focus groups and interviews, transcript analysis and interpretation, and preparation of manuscript, and she takes responsibility for the manuscript as a whole. EP participated in study concept and design, moderation of focus groups and interviews, transcription of digital recordings, transcript analysis and interpretation, and preparation of manuscript. RS participated in study concept and preparation of manuscript. JJ participated in study concept and design, moderation of focus groups, transcript interpretation, and preparation of manuscript.

Prior Presentations

Accepted for poster presentation at the 2013 American Geriatrics Society Annual Meeting (Grapevine, Texas).


This work was supported by the John A. Hartford University of Colorado Denver Center of Excellence. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the John A. Hartford University of Colorado Denver Center of Excellence. No sponsor had any direct involvement in study design, methods, subject recruitment, data collection, analysis, or manuscript preparation.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

Supplementary material

11606_2013_2498_MOESM1_ESM.docx (24 kb)
ESM 1 (DOCX 23 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Marian E. Betz
    • 1
  • Jacqueline Jones
    • 2
  • Emma Petroff
    • 1
  • Robert Schwartz
    • 3
  1. 1.Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraUSA
  2. 2.College of NursingUniversity of Colorado Anschutz Medical CampusAuroraUSA
  3. 3.Division of Geriatric Medicine, Department of MedicineUniversity of Colorado School of MedicineAuroraUSA

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