In-office evaluation of medical fitness to drive: practical approaches for assessing older people.
OBJECTIVE
To provide background for physicians'in-office assessment of medical fitness to drive, including legal risks and responsibilities. To review opinion-based approaches and current attempts to promote evidence-based strategies for this assessment.


METHODS
MEDLINE, EMBASE, CINAHL, PsyclNFO, Ageline, and Sociofile were searched from 1966 on for articles on health-related and medical aspects of fitness to drive. More than 1500 papers were reviewed to find practical approaches to, or guidelines for, assessing medical fitness to drive in primary care. Only level III evidence was found. No evidence-based approaches were found.


RESULTS
Three practical methods of assessment are discussed: the American Medical Association guidelines, SAFE DRIVE, and CanDRIVE.


CONCLUSIONS
There is no evidence-based information to help physicians make decisions regarding medical fitness to drive. Current approaches are primarily opinion-based and are of unknown predictive value. Research initiatives, such as the CanDRIVE program of the Canadian Institutes of Health Research, can provide empiric data that would allow us to move from opinion to evidence.
Molnar
Frank J
FJ
Institute of Aging, Canadian Institute of Health Research, Elizebeth-Bruyère Research Institute, Ottawa, ON.
Byszewski
Anna M
AM
Marshall
Shawn C
SC
Man-Son-Hing
Malcolm
M
D000368:Aged; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D002170:Canada; D019317:Evidence-Based Medicine; D005194:Family Practice; D015577:Geriatric Assessment; D006801:Humans; D008004:Licensure / Q000331:legislation & jurisprudence; D008403:Mass Screening