Are they road-safe? New clinical tool grades older drivers’ risk of a crash

Physicians have a new clinical tool to determine if an older driver should stay on the road, or not. Researchers from the CanDrive research program developed a four-question tool that can be administered in the clinic in about five minutes. While drivers with certain medical conditions are at obvious risk of collision, for the majority of older drivers it’s more difficult to determine their fitness to drive. The idea behind the tool is to start a conversation with older adults about driving ability when new or worsening medical conditions prompt concerns. “I think we’d all agree that we’d prefer that everyone would be able to drive if that’s what they want to do, because it allows for autonomy. There are huge advantages to driving.” said Dr. Shawn Marshall, lead author and professor in the faculty of medicine at the University of Ottawa. “We don’t want to disadvantage older drivers. We know how important it is for people to drive, but we do want an objective, realistic conversation about risk,” he said. The CanDrive study included 928 drivers over the age of 70 with an average age of 76.2 at recruitment in 2009 and 2010. All participants agreed to undergo medical tests and have a recording device installed in their car. By the fifth year of the study, there were 583 participants, with an average age of 79.8 years. The participants were from Ontario, Quebec, Manitoba and British Columbia, and drove an average of 11,017 km in the first year of study. During the study, there were 231 police-reported collisions, which translated into 5.2% collisions per person-years of driving contributed. Of these, 48% were the participant’s fault. The researchers looked at the contribution of various variables to the accidents, rating drivers as low to high risk of causing a collision. The four predictors of being high risk of a collision are: A poor score in recalling five words after a delay (a test of memory) Not being able to provide a category after hearing two word pairs (test of executive function) Use a walking aid such as a cane or walker (indicates potential frailty) Not being able to recognize or explain meaning behind an uncommon road sign (evaluates deductive reasoning and interpret visual cues) Physicians can explain the risk to patients as comparable to other drivers their age, Dr. Marshall explained. For example, drivers who are low risk of a collision are comparable in risk to most other drivers their age. “The vast majority of older drivers are safe; 75% fell in the lowest risk category, and 85% in the low to moderate risk categories,” Dr. Marshall said. Read: Safe to drive after syncope? New Canadian research sheds light There are some drawbacks to the tool. For example, a patient’s hearing and knowledge of English has to be taken into account when assessing the results. A person may be strong but still need a walking aid. “In primary healthcare, in most things that we do, we rarely rely on a singular thing to make a decision,” Dr. Marshall said. In most cases, physicians would already have a relationship with the patient and have a good idea of their health. “It allows an objective opinion,” he said. “It’s an opening to have a conversation about driving status, it could say if they’re high risk or low risk if a concern has been raised.” If a patient scores as high risk, Dr. Marshall suggests that physicians discuss the risk with the patient and family, conduct further evaluation, think about interventions, and, if needed, consider reporting the patient to the ministry of transportation. “If this was heart disease and you applied a tool and found out you were in the highest risk category, you’d probably want to know if you were in the highest risk category and you’d probably want to do something about it,” he said. The risk stratification tool will be available as a pen-and-paper tool and in a physician’s EMR. First, the group is conducting a pilot study to understand the best ways of incorporating it into a physician’s practice so that it’s a useful tool. “It’s not that easy to change a physician’s practice,” Dr. Marshall said. The group will be assessing ease of access, the time it takes to administer the tool and if patients understand the outcomes. A future study may also test the validity of the risk stratification tool, although components have already been validated. For example, the word-finding questions are part of the Montreal Cognitive Assessment tool to detect dementia or cognitive decline. The paper was published in Journals of Gerontology, series A. Read: Obstructive sleep apnea behind drivers falling asleep at the wheel

Are they road-safe? New clinical tool grades older drivers’ risk of a crash

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