Functional assessment of older drivers*

* These screens may be useful for identifying key functional impairments in visual, cognitive, and motor domains touted to be necessary for safe driving. In addition, clinicians who adopt these screens may end up identifying medical conditions that are amenable for intervention and treatment that may reduce crash risk (eg, cataracts, obstructive sleep apnea, hypersomnolence from sedating drugs). These screens may also identify chronic and progressive illnesses (eg, Alzheimer disease) associated with driving impairment where improvement is unlikely. Instructions for administration for these tests can be found on appropriate websites and/or the American Geriatrics Society's Clinicians Guide to the Assessment and Counseling of Older Drivers.
¶ The cutoffs listed in the table are suggested by the evidence-based literature with the intent to identify medical conditions and do not necessarily indicate associations with driving outcomes such as crash risk and/or impaired road test performance. Studies that have adopted these screens differ in the type of setting where they were utilized (eg, licensing agency versus medical clinic) and the type of sample studied (eg, general older drivers versus medically impaired drivers), and they also may examine different driving outcomes (eg, motor vehicle crash versus driving simulator versus road test). Thus, the adaptation of these screens may be limited as a fitness-to-drive tool in your own clinical setting. In general, these screens should not be used as a final arbitrator for fitness to drive recommendations, but they may be a trigger for a more formal assessment such as a comprehensive driving evaluation (CDE). In addition, there are additional measures that have been associated with driving impairment, such as contrast sensitivity and Useful Field of View (UFOV), but these are not typically available in most clinician's offices.