Medically At-Risk DriversEvidence-Based Decisions

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.

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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 Fau

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rash

Ris

kAt 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

www.DriveABLE.com.au