Determining fitness to drive for older and cognitively impaired drivers. DriveSafe DriveAware: a touch screen test for medical practice

Every year thousands of Australians are diagnosed with a medical condition that may impact ability to manage the cognitive aspects of driving, such as stroke, brain injury or dementia. Licensing authorities manage large numbers of drivers with potential cognitive impairment who wish to retain their ability to drive. Appropriately identifying ‘at risk’ drivers is a growing challenge. Responsibility for determining fitness to drive ultimately falls to the primary healthcare physician. General practitioners report concern about their role in assessing patient fitness to drive, including the impact of withdrawing driving on the patient’s quality of life and the patient-doctor relationship. General practitioners frequently report a lack of objective, valid, and reliable tools for predicting driving ability to assist them in this role (Sims, Rouse-Watson, Schattner, Beveridge & Jones, 2012). A standardised off and on-road driving assessment conducted a driver-trained occupational therapist is considered the gold standard for determining fitness to drive (Kay, Bundy, Clemson, & Jolly, 2008). This method of testing, however, is time consuming and costly, and access can be limited due to a shortage of specialist therapists. For more than 25 years, researchers have examined a variety of clinical tests to identify an off-road assessment that can accurately predict driving performance without taking drivers on the road. The computer version of DriveSafe DriveAware (DSDA) is one test that has shown sufficient sensitivity and specificity to predict on-road performance accurately (Kay, Bundy, Clemson, Cheal, & Glendenning, 2012). This test has been used by occupational therapists as part of a clinical assessment of fitness to drive for more than 20 years. Computer administration of DSDA is limited to driver-trained occupational therapists because verbal responses need to be interpreted by trained professionals. The touch-screen version of the DSDA was therefore developed as a user-friendly test that would allow administration by general practitioners and other health professionals in clinical practice, without specialised training. A prospective study was conducted to determine if touch-screen DSDA is a valid tool to use in determining if older and cognitively impaired patients are able to manage the cognitive aspects of driving, or if they required referral to a specialist driving services for further assessment.