Assessing fitness to drive in older people: the need for an evidence‐based toolkit in general practice

Wallis, Katharine; Matthews, James; Spurling, Geoffrey

doi:10.5694/mja2.50588

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Often the onus is on general practitioners (GPs) to assess when patients should stop driving. 4 However, this is not a simple assessment. Although there are guidelines provided in Austroads' Assessing fitness to drive, 5 the nature of dementia and age-related decline means assessment needs to be individualised, and there is a lack of consistency among existing findings regarding cognitive testing and driving.…”

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confidence: 99%

Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions

McKernan¹,

Chia²,

Traynor³

et al. 2022

Aust J Gen Pract

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Background and objectiveGeneral practitioners (GPs) in New South Wales are required to perform annual medical assessments of driving fitness in patients aged 75 years or older. The objective of this study was to understand GPs' attitudes towards driving assessments and to highlight guideline limitations and possible solutions. MethodsSemi-structured interviews with a sample of 10 GPs were audio-recorded, transcribed and thematically analysed. ResultsThe key themes that emerged were challenges GPs face with the current driving fitness assessment, techniques used to overcome these challenges, and the process of negotiating with patients. DiscussionThe findings highlighted the need for further support of GPs and for more statistical evidence of driving risks. Key areas of uncertainty were applying licence restrictions, calculating the sum of effects of comorbidities and assessment of new patients. This study might prompt consideration of a range of supports to assist GP decision making, as well as contribute to a decision aid for older drivers. AUSTRALIA'S POPULATION IS AGEING.Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions Research

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mentioning

confidence: 99%

Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions

McKernan¹,

Chia²,

Traynor³

et al. 2022

Aust J Gen Pract

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“…Another potential limitation of the study is that it was performed in Queensland, and the findings might not be generalisable to other Australian states and territories. However, although there is some variation in the medical assessment of older drivers across Australia, 13 there is no reason to suspect that the three toolkit tests would be any more or less useful for informing GP clinical judgement in different jurisdictions. Another limitation of the study is that we used a predictive equation based on Belgian data.…”

Section: There Is Some Confusion About … What Is the Measurement How ...mentioning

confidence: 99%

“…11,12 To be feasible in Australian general practice, given the fast pace of practice with time pressures and multiple competing demands, any screening toolkit needs to be relatively quick and straightforward to administer, readily accessible and to require no expensive equipment or prolonged training. 13 The 3-Domains screening toolkit for older driver medical assessment has been developed with these factors in mind. The 3-Domains toolkit uses three tests that are relatively easy to administer and require no expensive equipment or special training to assess across the three functional domains essential for driving, namely Snellen chart visual acuity (sensory), functional reach 14 (motor) and the road signs recognition test, a component of the Stroke Drivers Screening Assessment 15 (cognitive).…”

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confidence: 99%

3-Domains screening toolkit for medical assessment of older drivers: Feasibility study in Australian general practice

Spurling¹,

Wallis²,

Scott³

et al. 2023

Aust J Gen Pract

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Background and objectiveSome general practitioners (GPs) find the older driver medical assessment challenging, citing clinical uncertainty and concerns about communicating the need for further testing or driving cessation while maintaining a trusting therapeutic relationship. A screening toolkit could help support GP decision making and communication about fitness to drive. The aim of this study was to investigate the feasibility, acceptability and utility of the 3-Domains screening toolkit for the medical assessment of older drivers in Australian general practice. MethodsA prospective mixed-methods study was conducted in nine general practices in south-east Queensland. Participants were older drivers (age ≥75 years) attending annual driving licence medical assessment, GPs and practice nurses. The 3-Domains toolkit comprises three screening tests (Snellen chart visual acuity, functional reach, road signs recognition). We evaluated the feasibility, acceptability and utility of the toolkit. ResultsPractices used the toolkit in 43 older driver medical assessments (age 75-93 years; combined predictive score 13-96%). Twenty-two semistructured interviews were conducted. Older drivers felt reassured by the thorough assessment. GPs said the toolkit fitted into practice workflows, informed clinical judgement and supported conversations about fitness to drive while preserving therapeutic relationships. DiscussionThe 3-Domains screening toolkit is feasible, acceptable and useful for the medical assessment of older drivers in Australian general practice.THE MEDICAL ASSESSMENT of older drivers is an important role for general practice, but some general practitioners (GPs) find the role challenging, citing clinical uncertainty and concerns about communicating the need for further testing or driving cessation while maintaining a trusting therapeutic relationship. [1][2][3][4][5] Austroads has recently released Assessing Fitness to Drive (2022), with updated standards and an implementation strategy that includes increasing awareness and education to 'build confidence in addressing fitness to drive and embed early conversations into routine management of health conditions'. 6 A screening toolkit that was feasible in general practice could help support GP decision making and communication about fitness to drive in older age. Although several screening toolkits have been developed previously, their uptake in practice has been limited. [7][8][9][10] Screening for visual acuity has long been required for older driver medical assessment in Australia, but no formal assessment of motor or cognitive function is required or regularly used in practice, despite a plethora of screening tests being available. 11,12 To be feasible in Australian general practice, given the fast pace of practice with time pressures and multiple competing demands, any screening toolkit needs to be relatively quick and straightforward to administer, readily accessible and to require no expensive equipment or prolonged training. 13 The 3-Domains screening toolkit f...

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“…The possible roles of Family Physicians (FPs) in this regard could be divided into two main activities: i) informing and advising older people and their relatives about the health risks related to driving or walking, the specific circumstances in which this risk is higher and how to manage them; and ii) detecting older drivers at high-risk and applying selective prevention strategies to them, ranging from specific counseling to issuing legal reports leading to the withdrawal of driving licenses. [18][19][20][21] Several guidelines have been developed in some countries aimed to instruct FPs on efficient PCIOA activities. 1,[22][23][24] Unfortunately, this theoretical approach contrasts sharply with the activities related to the PCIOA that FPs are currently carrying out, which show enormous heterogeneity across different countries and even within countries.…”

Section: Introductionmentioning

confidence: 99%

Attitudes, Beliefs, and Current Practices Carried Out by Family Physicians in Spain Regarding the Prevention of Road Injuries in Older Adults: A Nationwide Cross-Sectional Study

Jiménez-Mejías¹,

Ruiz-Rodríguez²,

Martín-delosReyes³

et al. 2023

CIA

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The activities related to the prevention of crash injuries in older adults (PCIOA) performed by Family Physicians (FPs) have been scarcely studied. Our aim was to estimate the frequency of PCIOA activities performed by FPs in Spain and its association with attitudes and beliefs regarding this health problem. Methods: We conducted a cross-sectional study in a nationwide sample of 1888 FPs working in Primary Health Care Services, recruited from October 2016 to October 2018. Participants completed a validated, self-administered questionnaire. Study variables included three scores related to current practices (General Practices, General Advice and Health Advice), several scores related to attitudes (General, Drawbacks and Legal), demographic and workplace characteristics. To obtain the adjusted coefficients and their 95% confidence intervals, we applied mixed effects multi-level linear regression models and the likelihood-ratio test to compare multilevel and one-level models. Results: The frequency of PCIOA activities reported by FPs in Spain was low. The General Practices Score was 0.22/1, the General Advice Score was 1.82/4, the Health Advice Score was 2.61/4, and the General Attitudes Score was 3.08/4. The importance given to road crashes in the elderly obtained 7.16/10, the role that FPs should play in the PCIOA obtained 6.73/10, and the current perceived role obtained 3.95/10. The General Attitudes Score and the importance that FPs give themselves in the PCIOA were associated with the three Current Practices Scores. Conclusion:The frequency of activities related to the PCIOA that FPs usually carry out in Spain is far below desirable standards. The average level of attitudes and beliefs about the PCIOA of the FPs working in Spain seems adequate. The variables of the most pronounced FPs associated with the prevention of traffic accidents in older drivers were age over 50 years, female sex and foreign nationality.

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Assessing fitness to drive in older people: the need for an evidence‐based toolkit in general practice

Cited by 5 publications

References 15 publications

Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions

Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions

3-Domains screening toolkit for medical assessment of older drivers: Feasibility study in Australian general practice

Attitudes, Beliefs, and Current Practices Carried Out by Family Physicians in Spain Regarding the Prevention of Road Injuries in Older Adults: A Nationwide Cross-Sectional Study

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