What tests are required to determine if an elderly individual is fit to drive?

Assessment of Elderly Individuals' Fitness to Drive

A comprehensive driving evaluation for elderly individuals should include assessment of sensory function (vision, visual fields, visual attention), motor function (strength, coordination, reaction time), and cognitive function (perception, problem-solving, decision-making speed, and judgment), ideally conducted by a driver rehabilitation specialist. 1

Key Components of Driving Fitness Assessment

1. Sensory Assessment

• Vision Testing:
  • Visual acuity examination
  • Visual field testing
  • Contrast sensitivity evaluation
  • Visual attention assessment
  • Reading comprehension 2

2. Motor Assessment

• Physical Function Testing:
  • Strength evaluation
  • Coordination testing
  • Reaction time measurement
  • Neck mobility assessment 1
  • Physical flexibility evaluation 3

3. Cognitive Assessment

• Cognitive Function Testing:
  • Mini-Mental State Examination (MMSE) - though should not be used as the sole predictor 4
  • Trail Making Test, Part B (with attention to cues needed) 5
  • Tests of perception, problem-solving, judgment
  • Decision-making speed evaluation 2
  • Knowledge of road signs 3

Evaluation Process

Initial Screening

1. Conduct office-based screening of the 5 key domains: cognition, vision, physical function, medical comorbidities, and medications 6
2. Stratify drivers into low, intermediate, and high risk categories based on screening results

Comprehensive Assessment

For those with identified concerns:

• Refer to an occupational therapist, ideally one specialized in driving evaluation
• Consider simulator-based assessment which can significantly increase predictive accuracy of fitness to drive 3
• For patients with relevant residual deficits, a full comprehensive driving evaluation including a government-sanctioned on-road assessment is recommended 2

Special Considerations

For Patients with Cognitive Impairment

• Approximately 70% of drivers with very mild and mild cognitive impairment fail on-road driving tests 2
• MMSE alone has insufficient predictive value - patients scoring above 25 may still fail on-road assessments 4
• Patients with multi-infarct cognitive impairment show poorer on-road driving skills than healthy older people 2

For Patients with Stroke History

• Patients should stop driving for at least one month after stroke 2
• After TIAs, driving should not resume until a comprehensive neurological assessment shows no residual functional loss 2

For Patients with Multiple Conditions

• Older adults with a combination of conditions (cognitive impairment, visual impairment, limited mobility) should be referred for formal evaluation 1
• Consider the impact of medications, especially psychotropic drugs, which can affect driving performance 2

Recommendations After Assessment

1. For those deemed fit to drive: Regular reassessment as appropriate
2. For those with remediable deficits: Refer to training programs, such as simulator-based training 2
3. For those deemed unfit to drive: Discuss transportation alternatives to maintain mobility and independence

Important Considerations

• Family reports of driving concerns should be taken seriously as significant indicators of risk 1
• Document discussions about driving safety in the medical record 1
• Acknowledge the potential psychological impact of driving cessation, which can lead to depression and social isolation 1
• Consider the impact of multimorbidity on driving ability, as the accumulation of medical conditions is often associated with frailty 2

This structured assessment approach helps identify at-risk elderly drivers while allowing those who can drive safely to maintain their independence and quality of life.