Assessing fitness to drive
The driving task depends various aspects of cognitive function as well as sensory perception and motor function.[1]
No individual test or test of a single domain can definitively determine driving safety.[2] Avoid over-reliance on sMMSE scores. Instead, use a combination of aspects on history, examination and cognitive screening tools to determine if the patient is clearly safe, clearly unsafe or needs more testing.[3]
Also consider the presence of disability or medical conditions other than cognition (e.g. blackouts, seizures) that may affect fitness to drive according to Austroads’ national medical standards for licensing as well as reversible conditions or medications.
Test scores can be confounded by other factors such as communication or language difficulty and anxiety.
Suggested questions to ask the patient and family
Red flags [4][5]
- Accidents, new bumps/scratches, near misses
- Disorientated/lost on familiar routes
- Difficulty reading maps and following detours
- Difficulty making quick decisions at intersections or busy roads
- Not seeing vehicles, pedestrians or cyclists sharing the roadway
- Difficulty controlling the car
- staying in lane
- obeying signals and lights
- giving way
- using controls and pedals
Other questions
- Patient or others concerned with his/her driving
- Forgetting purpose of trip
- Self-regulating driving e.g. avoiding night driving, busy roads or long distances
Tools
- The 10 Minute Office-Based Dementia and Driving Checklist, available in the Dementia and Driving Toolkit for Health Professionals published by the Champlain Dementia Network and the Regional Geriatric Program of Eastern Ontario, Canada.[6]
- The Assessment of Driving Related Skills (ADReS) is jointly produced by the US National Highway and Traffic Safety Administration and American Medical Association.[7]
Austroads Ltd. Assessing Fitness to Drive for commercial and private vehicle drivers. Sydney, Australia: Austroads Ltd; 2017.
Bennett JM, Chekaluk E, Batchelor J. Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review. Journal of the American Geriatrics Society. 2016;64(9):1904-17.
Molnar FJ, Byszewski AM, Rapoport M, Dalziel WB. Practical Experience-Based Approaches to Assessing Fitness to Drive in Dementia. Geriatrics and Aging. 2009;12(2):83-92.
Dementia: VicRoads [updated 18 January 2017]
The Driving and Dementia Toolkit for Health Professionals. 3rd edition ed: Champlain Dementia Network and Regional Geriatric Program of Eastern Ontario; 2009.
Carr D, Schwartzberg J, Manning L, Sempek J. Physician's Guide to Assessing and Counseling Older Drivers. Washington, DC: National Highway and Traffic Safety Administration; 2010.