Driving Decisions: Distinguishing Evaluations, Providers and Outcomes

Abstract

Driving is a highly valued instrumental activity of daily living on which many older adults depend for access to their community. The demand to address driving is changing as older adults experience increasing longevity while facing medical conditions that often affect their fitness to drive. As one of the most complex of daily tasks, driving is a multifaceted issue that involves the older driver, family members, state licensing and health care practitioners. This commentary discusses potential options and strategies for making evidence-based fitness to drive decisions by differentiating between driving skills and driving capacities, and how these differences are manifested on the road. Typical service options are described using an algorithm format that suggests decision points with options and referrals for service based on the individual’s experiences and/or needs.

Fitness to drive practices among non‐driver trained occupational therapists in an Australian community‐based rehabilitation setting

“…This is concerning as Laycock (2010) has highlighted that although medical practitioners have a role in the return to driving process, their skills involve assessing whether a person meets the national medical standards to hold a licence (Austroads, 2019), not determining the functional impact of these medical conditions on driving ability (Brooks et al, 2011;Laycock, 2010). It has been shown that GPs are often not good predictors of driving performance (Dickerson et al, 2018) nor are they consistently addressing and/or documenting driving discussions (Frith et al, 2017). If neither medical personnel nor occupational therapists are consistently addressing driving suitability, this leaves clients to make their own decisions which may include either prematurely returning to driving when unsafe or prematurely ceasing driving when they could continue, both of which cause negative consequences .…”

“…Non-OTDAs also have a large role in promoting alternative community mobility when driving is no longer safe (Dickerson et al, 2018). Non-OTDAs' role in identifying driving potential as part of routine care is pivotal to maximising road safety, as OTDAs can only comprehensively assess those clients who have been referred.…”

Self-awareness predicts fitness to drive among adults referred to occupational therapy evaluation

“…Changes in functional and/or health status may affect various skills associated with driving (e.g., cognitive, motor, and visual). Such changes may be due to a new medical diagnosis such as dementia or acquired brain injury (ABI) ( 6 – 8 ), mental health diagnoses such as schizophrenia ( 9 ), or various chronic diseases. The aging process may also affect driving ability, with changes in visual functioning and processing ( 10 , 11 ) or declining cognitive function ( 12 ).…”

“…In fact, chronic medical conditions and age (>75 years) are associated with decreased driving safety and increased risk of traffic accidents and road deaths ( 13 , 14 ). Thus, changes in health and age may indicate the necessity to re-evaluate one's ability to drive ( 6 , 7 ).…”

“…As part of the clearance process to be considered fit to drive, drivers are required to undergo a thorough evaluation of off- and on-road driving abilities ( 3 , 7 , 16 ). The off-road section of the evaluation (in-clinic) assesses vision, cognitive, and motor skills ( 6 , 7 ). The on-road test assesses actual driving skills and is conducted by driving instructors (DIs) and OTs specialized in driving rehabilitation ( 6 , 7 , 17 ).…”