Clinical and assessment tools to determine driving risk and progress to driving cessation in older adults

Abstract

It is often difficult for the clinician to know how to proceed when confronted with a patient known to be both driving and diagnosed with early dementia. Ethically it can be a dilemma: trying to balance the impact of cessation of driving on the older person’s life with the risk to personal and public safety related to the known hazards of such progressive cognitive impairment. Furthermore, accurate prediction of accident risk in older adults is difficult. Risk assessments with this population have predominantly utilized cognitive, demographic and health measures to calculate levels of risk. In a small pilot project 50 older drivers (20 male, 30 female) aged 55-92 years who possessed current drivers licenses were given a short battery of common measures such as the Mini-Mental State Exam, as well as measures of personality such as risk-taking. Statistical regression analyses suggested no advantage in accident risk prediction for personality measures; however, measures of current cognitive performance, current mood state and selected demographic variables possessed significant predictive value. Implications of these findings are discussed in terms of combining test data with clinical observations and in terms of recommendations of driving risk to patients and their families. This process implies knowledge of the role and influence of police, physicians, specialized testing, the driving authority, and relevant legislation. The authors suggest a practical stepwise approach beginning with simple discussion, through to potential confrontation, notification of risk and involvement of legal authorities