Clinician Effectiveness in Assessing Fitness to Drive of Medically At-Risk Older Adults

Objectives of this study were to model the relative contributions of clinical ratings of driver capability for a state licensing authority and driver data and clinical judgments, and also to compare on-road test results with ratings. Logistic and retrospective regression were used. Participants were from the Missouri Driver License Bureau, aged 60 and older (N = 652; 52% male), evaluated by a physician of their choosing and a portion subsequently road tested (n = 286). Measurements were based on clinical data from an evidence-based physician statement (Form 1528). A three-level rating (likely capable, unclear, not capable) was collapsed into two outcomes (0 likely capable; 1 unclear, not capable) as the dependent variable. Age, sex, driving exposure, recent crash or police action, number of medical conditions, medication side effects, driver insight, and disease functional severity rating for driving were the independent variables (predictors). The results showed that three variables in the model (Nagelkerke coefficient of determination = 0.64; P < .001) were significant in the expected direction, as follows: (1) disease functional severity for driving (odds ratio (OR = 6.65); (2) insight (OR = 2.35); and (3) age (OR = 1.06). Proportionately fewer drivers rated unclear or not capable (62%) passed the road test than those rated likely capable (73%). In conclusion, clinician ratings of driving capability were influenced by judgments of disease severity, decrements in driver insight, and older age. The complexities in translation of clinical judgments to on-road performance are highlighted by the imperfection of correspondence of physician ratings to on-road test outcomes. With regards to driver licensing, both means of assessment have important and additive roles.


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  • Accession Number: 01607004
  • Record Type: Publication
  • Files: TRIS
  • Created Date: Jun 17 2016 1:36PM