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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.
Cra
sh I
nvo
lvem
ent
Rat
e
Driver Age Group
Rate of MVAs per Kilometre Driven
Sources: COTA National Seniors, ACT (2004) Cerrelli , E. (1989) Older Drivers: The Age Factor in Traffic Safety.
Australians Aged 65+
• 80 % have at least 1 chronic
condition
• 50% have at least 2 chronic
conditions
• Co-morbidities & poly- pharmacy are the norm
Age - Illness Association
Sources: ABS (2008); Freedman, Martin & Schoeni (2002)
Incr
ease
d A
t F
ault
Cra
sh R
isk
At Fault Crash Risk By Diagnosis
Source: Diller, E et al. (1998)
Prevalence of Cognitive Impairment
Source: *(CSHA, 1991)
1 in 4 people over 65 years have cognitive impairment
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?
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
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”
Assessment Issue:Judgement about the risk level
Science unlikelyConsensus guidelines =Suggested best practice
No question about likelihood of event - it is ongoing
Assessment question is “competence of the driver”
Assessment Issue:Measurable outcome impairment
Evidence based driving evaluations = best practice
Categories of Medical Conditions
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
DriveABLE™
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
Motor Speed and Control
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
Span of Attentional Field
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
Spatial Judgement & Decision Making
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
Speed of Attentional Shifting
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.
Executive Function
Series of short videos of real driving scenes
The driver makes decisions about each driving scenario
Provides information about the driver’s interpretation ofroad situations
Measure:
Ability to identify hazardous situations & take appropriate action
Identification of Driving Situations
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
DriveABLE Driven by Research
Assessment Date: May 27, 2004 Assessment Language: English Name: The Driver Date of birth: June 22, 1927 Address: 123 My Road Age: 73 Anytown, Anywhere Health Care #: 1234567 Driver's License #: 99999 Phone: 555-5555 Referred by: Physician, MD Phone: 555-5555 Fax: 555-5555 ________________________________________________________________________________________
Cognitive Assessment Report Performance Outcome:
Age-normed performance was commensurate with a decline in driving ability.
Summary of Findings: In-Office Competence Assessment:
Mr. Driver was given sufficient individualized practice on each task to enable a valid assessment and appeared cooperative and effortful during testing.
Assessment Outcome Measures (in Standard Scores)
Well Below Below Average Above Motor Speed/Control 0.0 Span of Attentional Field *-5.2 Spatial Judgment and Decision Making *-1.6 Speed of Attentional Shifting *-3.4 Executive Function *-2.7 Identification of Driving Situations *-10.7
Overall Performance: 99% predicted probability of road test failure. Mr. Driver’s overall performance outcome indicates cognitive abilities have declined and driving performance may be compromised.
DriveABLE Assessment Centres Inc. Suite 304, 10050 – 112 Street * Edmonton, Alberta * T5K 2J1
Phone: (780) 433-1494 * Fax: (780) 433-1531
Validation Field TestingAccuracy of predicting Road Test Results
Road Test ResultsIn Office Pass Fail
Predict Pass
30% 3%
In-determinant 25% 18%
PredictFail
2% 21%
51%Pass/Fail Identified
*Florida
5% Error Rate
43%Needed road
test to resolve competence 95% Accuracy