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Medically At-Risk Drivers Evidence-Based Decisions

This publication provides guidance for health professionals assessing the fitness to drive of medically at-risk drivers, including those with chronic conditions and cognitive impairments. It discusses the limitations of diagnosis-based decisions and introduces evidence-based driving evaluations.

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Medically At-Risk Drivers Evidence-Based Decisions

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  1. Medically At-Risk DriversEvidence-Based Decisions

  2. Change of Focus: Older Drivers vs. Medically At-Risk Drivers In 2008 WA introduced new laws requiring the Mandatory Reporting of Medical Conditions. All drivers with a long term medical condition that has the potential to impair driving ability must notify the licensing department.

  3. Rate of MVAs per Kilometre Driven Crash Involvement Rate Driver Age Group Sources: COTA National Seniors, ACT (2004) Cerrelli , E. (1989) Older Drivers: The Age Factor in Traffic Safety.

  4. Age - Illness Association • Australians Aged 65+ • 80 % have at least 1 chronic • condition • 50% have at least 2 chronic • conditions • Co-morbidities & poly- • pharmacy are the norm Sources: ABS (2008); Freedman, Martin & Schoeni (2002)

  5. At Fault Crash Risk By Diagnosis Increased At Fault Crash Risk Source: Diller, E et al. (1998)

  6. Prevalence of Cognitive Impairment 1 in 4 people over 65 years have cognitive impairment Source: *(CSHA, 1991)

  7. Diagnosis Inadequate For Fitness To Drive Decisions eg. In the early stages of dementia: 2/3 will be unsafe to drive but 1/3 remain safe to drive Revoking licence based on diagnosis alone is discriminatory to those who are still safe But... how do you best determine at what point someone becomes unsafe?

  8. This publication is intended for use by any health professional involved in assessing fitness to drive, including: Medical Practitioners (GPs & Specialists) Occupational Therapists Physiotherapists Psychologists Optometrists

  9. Categories of Medical Conditions EPISODIC (eg. MI, Epilepsy, Hypoglycaemia) PERSISTENT (eg. Head injury, dementia) No question about driving ability when an event occurs Assessment question is “likelihood of the event” No question about likelihood of event - it is ongoing Assessment question is “competence of the driver” Assessment Issue: Judgement about the risk level Assessment Issue: Measurable outcome impairment Science unlikely Consensus guidelines = Suggested best practice Evidence based driving evaluations = best practice

  10. DriveABLE™ S.I.M.A.R.D. Screen for Identifying Medically At -Risk Drivers D.C.A.T. DriveABLE Cognitive Assessment Tool D.O.R.E. DriveABLE On-Road Evaluation

  11. Motor Speed and Control • Assesses the time between the appearance of a visual stimulus in an unpredictable location & driver’s response. • Shifting of attention, response speed, and accurate movements are involved in task performance. • Measures: • Reaction time • Motor speed • Movement Accuracy

  12. Span of Attentional Field Driving requires an ability to attend to the road ahead while simultaneously responding to events occurring in the periphery. Measures: Ability to maintain focus on centrally presented items; While simultaneous identifying peripheral visual stimulus

  13. Spatial Judgement & Decision Making • Turns, merges, & crossing traffic are associated with high crash rates • Difficult for cognitively impaired drivers due to impaired judgement & decision making • Complex task requiring speed, gap & acceleration judgments • Measures: • Spatial judgement • Response time • Collision rate

  14. Speed of Attentional Shifting • Assesses how quickly the driver can shift focus of • attention from one stimulus to another. • Measures: • Time to respond when attention is • Correctly focused • Inappropriately focused • Left unfocused • Disengagement of attention

  15. Executive Function Higher cognitive function related to our ability to organise, plan, prioritise, manage & make decisions. Evaluates how well driver can hold information in working memory while responding to other stimuli.

  16. Identification of Driving Situations Series of short videos of real driving scenes The driver makes decisions about each driving scenario Provides information about the driver’s interpretation of road situations Measure: Ability to identify hazardous situations & take appropriate action

  17. DriveABLE On Road Evaluation Specifically designed to identify the errors known to be related to competence decline Protects those drivers who remain competent from being unfairly penalised

  18. 43% Needed road test to resolve competence 5% Error Rate 51% Pass/Fail Identified Validation Field Testing Accuracy of predicting Road Test Results 95% Accuracy *Florida

  19. www.DriveABLE.com.au

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