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    1 Comment for this article
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    Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia (Anstey et al., 2020)
    Ediriweera Desapriya, PhD | University of British Columbia
    Motor vehicle injuries are a leading cause of injury-related deaths in senior drivers in US. Per mile driven, the fatality rate for drivers 85 years and older is nine times higher than the rate for drivers 25 to 69 years old, Physicians play an important role in the senior driver safety and mobility (1, 2).
    The American Medical Association encourages physicians to make driver safety a routine part of their elderly care and geriatric medical services. Driving legislation and recommendations from medical practitioners requires evidence based tools. Part of the reason doctors are reluctant to assess senior drivers is
    that the current in-office assessments tools available can result in some safe drivers failing the assessment and some unsafe drivers passing the assessment (3, 4).
    A new study using a convenience sample of older drivers shows that there is promising evidence to support the off-road screening tests to identify unsafe older drivers in primary care settings (5). The overall, advantage is that the use of an objective assessment battery could relieve physicians of the need to make subjective or clinical judgments about fitness to drive.
    Many jurisdictions in North America and the Europe, clinicians have legal obligation to report high risk frail older drivers to licensing authorities in timely appropriate manner (3). In addition, all jurisdictions, when physician fails to report in circumstances that a driver is unfit can face potential quasi-criminal liability, civil liability and/or College disciplinary proceedings. Available literature show that physician are often reluctant to assess and report unsafe older drivers to licensing authorities due to appended reasons: (a) an intent to preserve the patient’s quality of life (b) a lack of attention and time (c) a lack of tools to determine fitness (d) physician is challenged by the competing interests of being a patient advocate and also a protector of society (e) physician-patient relationship was negatively affected by reporting a patient unfit to drive.
    Accurate and evidence based screening tools such as described in the new study may influence clinicians to screen and identify more high risk drivers and remove them from the road timely appropriate manner. However, in order to increase screening for unsafe drivers’ clinician may need additional monetary compensation for the assessment, enhanced training on how to use these tools effectively and efficiently, simplify unsafe driver reporting requirement and the process and the availability of alternative older driver safe mobility options.
    REFERENCES:
    (1). AMERICAN MEDICAL ASSOCIATION (AMA) OLDER DRIVER SAFETY PROGRAM (2016)-http://www.programsforelderly.com/safety-ama-older-drivers.php
    (2). AMA Tool Helps Assess Older Drivers' Risks. (2012) The Medical Fitness to Drive course will be available for continuing educational credits for physicians and other health care professionals.https://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety.page?
    (3). Desapriya E, Harjee R, Brubacher J, et al. Vision screening of older drivers for preventing road traffic injuries and fatalities. Cochrane Database Syst Rev. 2014;(2):CD006252. Published 2014 Feb 21. doi:10.1002/14651858.CD006252.pub4
    (4). Desapriya E, Ranatunga Y, Pike I. We need evidence based tools to identify medically at risk drivers. BMJ. 2012;345:e7087. Published 2012 Oct 24. doi:10.1136/bmj.e7087
    (5). Anstey KJ, Eramudugolla R, Huque MH, et al. Validation of Brief Screening Tools to Identify Impaired D
    CONFLICT OF INTEREST: None Reported
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    Original Investigation
    Geriatrics
    June 17, 2020

    Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia

    Author Affiliations
    • 1School of Psychology, University of New South Wales, Sydney, Australia
    • 2Neuroscience Research Australia, Sydney, Australia
    • 3UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
    • 4Centre for Vision and Eye Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
    • 5School of Psychology, University of Queensland, Brisbane, Australia
    JAMA Netw Open. 2020;3(6):e208263. doi:10.1001/jamanetworkopen.2020.8263
    Key Points español 中文 (chinese)

    Question  Are brief off-road screening measures sufficiently sensitive and specific to identify older drivers who will not pass an on-road driving test in Australia?

    Findings  This prognostic study including 560 drivers aged 63 years and older found that off-road screening tests could identify older drivers who would not pass an on-road driving test with 77% sensitivity and 82% specificity. A combination of measures drawing from multiple skill domains provided the best prediction.

    Meaning  These findings suggest that brief off-road screening tests could be a cost-effective, objective tool to screen older drivers to determine who might be an unsafe driver and to indicate referral for an on-road driving test.

    Abstract

    Importance  There is an urgent need to develop evidence-based assessments to identify older individuals who may be unsafe drivers.

    Objective  To validate 8 off-road brief screening tests to predict on-road driving ability and to identify which combination of these provides the best prediction of older adults who will not pass an on-road driving test.

    Design, Setting, and Participants  This prognostic study was conducted between October 31, 2013, and May 10, 2017, using the criterion standard for screening tests, an on-road driving test, with analysis conducted from August 1, 2019, to April 2, 2020. A volunteer sample of older drivers was recruited from community advertisements, rehabilitation and driver assessment clinics, and an optometry clinic in Canberra and Brisbane, Australia.

    Exposures  Off-road driver screening measures, including the Useful Field of View, DriveSafe/DriveAware, Multi-D battery, Trails B, Maze test, Hazard Perception Test, DriveSafe Intersection test, and 14-item Road Law test.

    Main Outcomes and Measures  Classification as unsafe on a standardized 50-minute on-road driving assessment administered by a driving instructor and an occupational therapist masked to the participant’s clinical diagnosis and off-road test performance.

    Results  A total of 560 drivers aged 63 to 94 years (mean [SD] age, 74.7 [6.2] years]; 350 [62.5%] men) were assessed. Logistic regression and receiver operating characteristic analyses indicated the area under the curve was largest for a multivariate model comprising the Multi-D, Useful Field of View, and Hazard Perception Test, with an area under the curve of 0.89 (95% CI, 0.85-0.94), sensitivity of 80.4%, and specificity of 84.1% for predicting unsafe drivers. The Multi-D battery was the most accurate individual assessment and had an area under the curve of 0.85 (95% CI, 0.79-0.90), sensitivity of 77.1%, and specificity of 82.1%. The multivariate model had sensitivity of 83.3% and specificity of 91.8% in the cognitively impaired group and sensitivity of 87.5% and specificity of 70.8% in the visually impaired group.

    Conclusions and Relevance  These findings suggest that off-road screening tests can reliably identify older drivers with a strong probability of failing an on-road driving test. Implementation of these measures could enable better targeting of resources for managing older driver licensing and support injury prevention strategies in this group.

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