title: Determining the validity of the AMA guide: A historical cohort analysis of the assessment of driving related skills and crash rate among older drivers.
abstract: BACKGROUND
  Chronic health conditions associated with ageing can lead to changes in driving ability. The Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive II) is a 5-year prospective study funded by the Canadian Institutes of Health Research aiming to develop an in-office screening tool that will help clinicians identify potentially at-risk older drivers. Currently, no tools exist to directly predict the risk of motor vehicle collision (MVC) in this population. The American Medical Association (AMA), in collaboration with the National Highway Traffic Safety Association, has designed an opinion-based guide for assessing medical fitness to drive in older adults and recommends that physicians use the Assessment of Driving Related Skills (ADReS) as a test battery to measure vision, cognition and motor/somatosensory functions related to driving. The ADReS consists of the Snellen visual acuity test, visual fields by confrontation test, Trail Making Test part B, clock drawing test, Rapid Pace Walk, and manual tests of range of motion and motor strength. We used baseline data from the Candrive/Ozcandrive common cohort of older drivers to evaluate the validity of the ADReS subtests. We hypothesized that participants who crashed in the 2 years before the baseline assessment would have poorer scores on the ADReS subtests than participants who had not crashed.
  
  
  METHODS
  In the Candrive/Ozcandrive study, 1230 participants aged 70 years or older were recruited from 7 Canadian cities, 1 Australian city and 1 New Zealand city, all of whom completed a comprehensive clinical assessment at study entry. The assessment included all tests selected as part of the ADReS. For this historical cohort study, data on all crashes (at-fault and non-at-fault) that occurred within 2 years preceding the baseline assessment were obtained from the respective licensing jurisdictions. Those who crashed were compared to those who had not crashed on their ADReS subtest scores using Pearson's chi-squared test and Student's t-test.
  
  
  RESULTS
  Sixty-three of the 1230 participants (5.1%) were involved in an MVC within the 2 years preceding the baseline assessment. Contrary to our hypothesis, there were no statistically significant associations between abnormal performance on the tests constituting the ADReS and history of crash in the previous 2 years (p>0.01).
  
  
  CONCLUSIONS
  We found that a history of crash in the previous 2 years was not associated with abnormalities on the subtests comprising the ADReS. This suggests the need for prospective analyses of risk factors over time to establish sensitive, valid predictors of crash that can be incorporated in clinical practice guidelines.
authors: Centre for Rehabilitation Research for Rehabilitation Research and Development, Ottawa, Ont., Canada.
authors: Andrew
authors: A
authors: Woolnough
authors: Danish
authors: D
authors: Salim
authors: Shawn C
authors: SC
authors: Marshall
authors: Kelly
authors: K
authors: Weegar
authors: Michelle M
authors: MM
authors: Porter
authors: Mark J
authors: MJ
authors: Rapoport
authors: Malcolm
authors: M
authors: Man-Son-Hing
authors: Michel
authors: M
authors: Bédard
authors: Isabelle
authors: I
authors: Gélinas
authors: Nicol
authors: N
authors: Korner-Bitensky
authors: Barbara
authors: B
authors: Mazer
authors: Gary
authors: G
authors: Naglie
authors: Holly
authors: H
authors: Tuokko
authors: Brenda
authors: B
authors: Vrkljan
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000574:American Medical Association; D001315:Australia; D001334:Automobile Driving / Q000706:statistics & numerical data*; D002170:Canada; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009520:New Zealand; D010808:Physical Examination; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D014481:United States; D014787:Vision Tests
keywords: Automobile driving; Clinical practice guideline; Geriatrics; Health status; Older driver