Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia

Abstract

IMPORTANCE There is an urgent need to develop evidence-based assessments to identify older individuals who may be unsafe drivers. OBJECTIVE To validate 8 off-road brief screening tests to predict on-road driving ability and to identify which combination of these provides the best prediction of older adults who will not pass an on-road driving test. DESIGN, SETTING, AND PARTICIPANTS This prognostic study was conducted between October 31, 2013, and May 10, 2017, using the criterion standard for screening tests, an on-road driving test, with analysis conducted from August 1, 2019, to April 2, 2020. A volunteer sample of older drivers was recruited from community advertisements, rehabilitation and driver assessment clinics, and an optometry clinic in Canberra and Brisbane, Australia. EXPOSURES Off-road driver screening measures, including the Useful Field of View, DriveSafe/ DriveAware, Multi-D battery, Trails B, maze test, Hazard Perception Test, DriveSafe Intersection test, and 14-item Road Law test. MAIN OUTCOMES AND MEASURES Classification as unsafe on a standardized 50-minute on-road driving assessment administered by a driving instructor and an occupational therapist masked to the participant's clinical diagnosis and off-road test performance. RESULTS A total of 560 drivers aged 63 to 94 years (mean [SD] age, 74.7 [6.2] years]; 350 [62.5%] men) were assessed. Logistic regression and receiver operating characteristic analyses indicated the area under the curve was largest for a multivariate model comprising the Multi-D, Useful Field of View, and Hazard Perception Test, with an area under the curve of 0.89 (95% CI, 0.85-0.94), sensitivity of 80.4%, and specificity of 84.1% for predicting unsafe drivers. The Multi-D battery was the most accurate individual assessment and had an area under the curve of 0.85 (95% CI, 0.79-0.90), sensitivity of 77.1%, and specificity of 82.1%. The multivariate model had sensitivity of 83.3% and specificity of 91.8% in the cognitively impaired group and sensitivity of 87.5% and specificity of 70.8% in the visually impaired group. CONCLUSIONS AND RELEVANCE These findings suggest that off-road screening tests can reliably identify older drivers with a strong probability of failing an on-road driving test. Implementation of these measures could enable better targeting of resources for managing older driver licensing and support injury prevention strategies in this group.

Strong evidence for age as the single most dominant predictor of medically supervised driving test—mini mental status test outcomes provide only weak but significant moderate additional predictive value

“…Congregated analyses of individual such reports allow putting our individual results in a bigger context [ 22 , 23 , 29 ], although data sets diverge vastly either in size, outcome measure, combination of test, or prevalence of unsafe driving. This prompts justified efforts to compare a wide range of tests in forward-studies under the same conditions [ 33 ].…”

“…As compared to other approaches trying to provide comprehensive and cost-effective tools to potentially complements or – wherever necessary– replace on-road performance tests, our analysis and resulting data are clearly neither intended nor by any means strong enough to replace MSDT. Large scale validation studies do show that such tools can reliably identify those elderly drivers with a high likelihood of failing on road tests, be it due to dementia [ 43 ], or due to (mild) cognitive or visual impairment [ 33 ]. In addition, off-road screening tools for safe driving in the elderly could be shown to benefit both time- and cost-wise from including also from simple non-cognitive information, such as number of medication taken per day, cervical spine mobility, impaired visual acuity or field of view and avoidance behavior, while maintaining high validity to results from on-road testing [ 26 , 27 , 44 ].…”

The Pilot Study of the Hazard Perception Test for Evaluation of the Driver’s Skill Using Virtual Reality

“…Previous hazard perception tests used one-screen or three-screen monitors, limiting users' visual field [6,8,9,[11][12][13][33][34][35][36]. In terms of situation awareness theory [15,16], the hazard perception test needs to be conducted in the actual driving situation due to its requirement of reproducing the visual field of actual driving.…”

“…The evaluation of hazard perception is an important area to be completed in clinical practice. Among the various driving tests in rehabilitation, the hazard perception test, the useful field of view test, and the Multi-D battery are recommended driver's tests in Australia in terms of their high reliability and high level of evidence [11]. A previous study that included subjects with hemianopia showed that a significant number of subjects could not identify hazards on their blind side [12].…”

Error in Methods

“…In the Original Investigation titled “Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia,” 1 published June 17, 2020, there was an error in the Methods in the description of the maze test used. The correct maze test is Occupational Therapy—Driver Off Road Assessment maze test.…”