Driving and independence for older adults
The decision to withdraw a driver’s licence is complex and high-stakes, but fair and effective medical fitness-to-drive assessments are essential to protecting all road users, writes Dr Beth Cheal.
Older adults identify driving as one of their most valued daily activities, essential for maintaining independence and a sense of self-determination. Most do not have a plan for driving cessation. I asked my 85-year-old mother – a retired registered nurse – why keeping her driver’s licence matters to her. I think many older adults could relate to her response:
“Just to be free to go where I want to go – to pop up to the shops or drop in on a friend who needs me. You are free to be independent and not trouble other people. I think it would be very limiting not to drive anymore; it would knock your self-confidence.”
However, fitness to drive research shows that advancing age can impact driving performance, with drivers aged 85-plus reporting more vehicle crashes. This decline is often due to the onset of medical conditions that can impact driving safety, for example, stroke, dementia and vision disorders. Nevertheless, researchers recommend that fitness to drive be determined based on individual function, not on chronological age.
Adult children who notice changes in a parent’s driving and worry about their safety, might understand how daunting and emotional it can be to start a conversation about giving up driving. Sometimes it feels easier to avoid the conversation altogether.
Attending a driving assessment after many years of driving is something older adults will naturally find very stressful and confronting. The most important concern for someone attending a driving assessment is that the test is necessary, fair – regardless of the tester or testing centre – and genuinely related to real-world driving.
Regulations regarding age-based assessment of fitness to drive vary between states. Some states, such as Victoria and the Northern Territory, do not have age-based testing. Other states, such as New South Wales and Queensland, require drivers aged 75-plus to take annual medical assessments to retain a licence.
In all Australian states and territories, drivers diagnosed with a medical condition that may impact driving must report this condition to their licensing authority. They may be required to attend a medical assessment of fitness to drive with their general practitioner and a practical in-car assessment, typically conducted by an occupational therapy driving assessor.
The decision to withdraw a driver’s licence is complex and high stakes.
Assessing fitness to drive is a challenging area for general practitioners and other health professionals. General practitioners report that conversations with their patients about safe driving can be emotionally taxing, particularly when patients or their families react angrily, which can strain the patient-doctor relationship.
The decision to withdraw a driver’s licence is complex and high stakes. Practitioners are aware that premature driving cessation can lead to restricted mobility, isolation, depression, and poorer health outcomes for their patients. However, allowing unsafe driving to continue poses serious risks for the driver and the wider community.
Practitioners rely on tests performed in the office to predict how well someone will drive a car. This is a lot to ask of a test. The test must relate to the skills required for safe driving, be evidence based, and be practical for clinical practice – brief, portable and user-friendly.
Cognitive assessment is an important component of driver assessment due to the increasing incidence of cognitive decline with age. Survey results indicate that general practitioners are concerned that commonly used cognitive tests – for example, the Mini-Mental State Examination, Montreal Cognitive Assessment and clock drawing tests – have limitations in accurately assessing cognitive capacity for driving.
DriveSafe DriveAware is a cognitive fitness-to-drive test designed for administration by health professionals on a standard iPad. DSDA has evidence of sufficient predictive validity (88 per cent) to accurately determine cognitive fitness to drive. The test can be used with drivers of all ages and categorises drivers based on the likelihood of passing an on-road test – safe, unsafe or further testing.
DSDA was distributed by Pearson Australia until 2023 when it was discontinued. Recognising its value in driver assessment, two clinicians, including myself, who relied on DSDA in clinical practice and research, partnered with a digital technology specialist to ensure its continuity.
In 2024, we founded DriveSafe Diagnostics to keep DSDA available for the driving assessment community. Clinicians across Australia and New Zealand report finding the application helpful in their clinical practice.
Kate Kirkness – an occupational therapy driving assessor who works in rural and regional areas of NSW – says: “I value that DSDA is an objective, standardised measure that I can use with all clients, allowing for a more consistent assessment. I also like that there is a lot of research backing the assessment. The scores combined with my observations of people doing the test provide me with valuable information as to why errors might occur on-road.”
Meiny Erasmus – an occupational therapy driving assessor who assesses drivers in the Wellington, Manawatu and Taranaki regions of New Zealand – reports: “For the older population, my role involves confirming medical fitness to drive following a review by their GP. The iPad’s portability is a significant benefit, allowing me to meet clients in the comfort of their homes. The immediate results enable productive discussions prior to the on-road assessment and make post-assessment feedback more effective.”
Keeping our roads safe is a shared responsibility. A fair and effective medical fitness-to-drive assessment process is essential to protecting all road users. This process should be as empathetic and stress-free as possible for the driver, while remaining rigorous enough to identify those at risk of driving errors and accident.
Health professionals require training in best practice for assessing fitness to drive and need to be supported by gold-standard tests to ensure sound decision-making. One evidence-based option for assessing cognitive fitness to drive is DSDA, which provides valuable support for clinical decision-making in this area.
Find out more about the DriveSafe DriveAware app at drivesafedriveaware.com.
Dr Beth Cheal is a driving researcher and lecturer at Western Sydney University
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