Clinician Effectiveness in Assessing Fitness to Drive of Medically At-Risk Older Adults.
OBJECTIVE
To model the relative contributions of driver data and clinical judgments to clinical ratings of driver capability for a state licensing authority and to compare ratings with on-road test results.


METHODS
Retrospective, logistic regression.


METHODS
Missouri Driver License Bureau.


METHODS
Adults aged 60 and older (N = 652; 52% male) evaluated by a physician of their choosing and a portion subsequently road tested (n = 286).


METHODS
Clinical data from an evidence-based physician statement (Form 1528). A three-level rating (likely capable, unclear, not capable) was collapsed into two outcomes (0 likely capable; 1 unclear, not capable) as the dependent variable. Independent variables (predictors) were age, sex, driving exposure, recent crash or police action, number of medical conditions, medication side effects, driver insight, and disease functional severity rating for driving.


RESULTS
Three variables in the model (Nagelkerke coefficient of determination = 0.64; P < .001) were significant in the expected direction: disease functional severity for driving (odds ratio (OR = 6.65), insight (OR = 2.35), and age (OR = 1.06). Proportionately more drivers rated likely capable (73%) passed the road test than those rated unclear or not capable (62%).


CONCLUSIONS
Judgments of disease severity, decrements in driver insight, and older age influenced clinician ratings of driving capability. Correspondence of physician ratings to on-road test outcomes was imperfect, highlighting the complexities in translation of clinical judgments to on-road performance. Both means of assessment have important and additive roles in driver licensing.
Department of Sociology, Gerontology and Gender, University of Missouri at St. Louis, St. Louis, Missouri.
Thomas M
http://orcid.org/0000-0003-1970-1651
TM
Meuser
College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri.
Marla
M
Berg-Weger
Division of Geriatrics and Nutritional Science, Department of Internal Medicine, Washington University, St. Louis, Missouri.|Division of Neurorehabilitation, Department of Neurology, School of Medicine, Washington University, St. Louis, Missouri.
David B
DB
Carr
School of Nursing, University of Washington, Seattle, Washington.
Shaoxuan
S
Shi
School of Social Work, Saint Louis University, St. Louis, Missouri.
Daniel
D
Stewart
D000368:Aged; D000369:Aged, 80 and over; D001333:Automobile Driver Examination; D001334:Automobile Driving; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D012189:Retrospective Studies
driver licensing; driving assessment; medical fitness to drive; older driver