Speaking to an older patient and their family about fitness to drive can often be an uncomfortable experience, especially for GP registrars and GPs early in their career
A simple toolkit focusing on older patients’ cognitive, sensory, and motor function could help with common problems GPs face in making a fitness to drive assessment, researchers say.
Speaking to an older patient and their family about fitness to drive can often be an uncomfortable experience, especially for GP registrars and GPs early in their career.
This may be because the GP hasn’t known their patient for very long, or is worried about how their recommendation might affect their ongoing relationship.
But according to a perspective study recently published in the MJA, an objective assessment toolkit could help GPs to assess whether the health of an older driver meets medical standards and doesn’t unduly increase their crash risk.
“In practice, GPs often use the relevant state or territory medical assessment form to guide their assessment and make their recommendation based on clinical judgment, sometimes informed by a single cognition test,” the study authors said.
“However, despite their widespread use in clinical practice, single screening tests do not reliably predict driving risk.”
The toolkit the authors propose comprises three composite tests, which can be completed in a single GP consult, with little time and equipment required.
The first is a vision acuity test using the Snellen chart, which most GP practices have on hand.
The second assessment is the Functional Reach Test, where clinicians get the patient to stand against a wall, unaided, and measure how many centimetres they can reach forward without losing balance.
GPs then use a road signs recognition test, which is also used in the Stroke Drivers Screening Assessment, to test patients’ cognition.
Associate Professor Katharine Wallis, co-author and GP academic, said while no toolkit was perfectly sensitive or specific, an objective measure could support GPs clinical judgment and aid discussions about the need for an on-road test, or driving cessation.
“The feedback so far from practices that have trialled the toolkit is that it’s quite feasible to do it in practice and doesn’t take very long,” she said.
“And patients and GPs both seem to find that it’s quite useful and acceptable to do.”
But the study authors said while GPs could trial the toolkit on a voluntary basis, a larger scale study was needed to test its outcomes against on-road driving tests.
“A toolkit used regularly, say annually, might demonstrate change over time, which could guide discussions about the need to plan for eventual driving cessation,” they said.
