The value of off-road driving assessment for
elderly driving safety
Driving assessment tools are gaining traction, as a way to accurately predict an individual’s capacity to drive without ever leaving the health professional’s office. In this article, we explore off-road driving assessment and speak to two experts about its value for safety, social inclusion and independent living.
For many of us, a driving license is more than just an official card in our wallets. It’s the hallmark of adulthood, and represents our independence and the ability to go places. In other words: freedom. It’s understandable then, the concern that sets in when an individual may not be cognitively, physically or mentally fit to drive. Particularly when they are in their old age and have been driving most of their lives.
As crucial as the safety of our roads are, it’s undeniable that taking someone’s driving license from them is a significant event. And feelings can be heightened when the client is impaired.
That’s why it’s important to get it right but, in many cases, the avenues for testing a person’s driving ability are limited. On-road assessments are costly, time-consuming and in some cases, can be demoralising.
A solution has emerged, one that revolves around testing an individual’s cognitive capacity for driving, without entering the road.
DriveSafe DriveAware (DSDA) is an objective, evidence-based measure of cognitive fitness to drive that accurately predicts the driving ability of elderly or cognitively impaired patients. It does this by prompting them to use their safety and judgement, and to make decisions. The result of those prompts is a report that identifies the likelihood of an individual passing or failing an on-road driving assessment.
The driving tool is broken down into three subtests: DriveSafe, which involves identifying and recalling hazards at various intersections; DriveAware, which measures self-rating and everyday driving, against actual test performance and the clinician’s rating; and Intersection Rules, an optional subtest to test for the client’s knowledge of ‘right of way’ at intersections.
The test takes approximately ten minutes to administer and is being used by health professionals, occupational therapists (OT), psychologists and neurologists alike, as a cost-effective precursor to on-road driving assessments. It’s been particularly popular in the public hospital system, where referrals for on-road assessments can take up to six months.
Clinical Lead Occupational Therapist and Driver Trained Occupational Therapist at Lime Therapy in Melbourne, Lynette Preston, uses DSDA in her everyday role and has found it to be an incredibly valuable part of her off-road assessment.
“Our non-driver trained Occupational Therapists use DSDA across the inpatient and community programs that we deliver OT services in, to guide GPs and other medical professionals’ decision making around return to driving, following a period of illness and injury, and the need for referral to a Driver Trained OT,” she said.
"DSDA presents a really good opportunity to try and support the individual, by having an understanding around how their condition may be affecting, or impacting upon their ability to drive.”
“The off-road assessment is not a pass or fail, which can be their expectation, but it may be that we find that their health conditions are affecting their ability to drive the way they've always driven and therefore we might have to make a difficult decision to retire from driving.”
Professor Joseph Ibrahim, Head of the Health Law and Ageing Research Unit at Monash University, said that it was his understanding that there are not many instruments that are reliable for off-road driving assessment.
“We normally use these tools to inform the patient about the likelihood that they might pass an on-road assessment, because the on-road assessments are quite expensive,” he said.
“Also, if you do the on-road assessment and fail, I think that's also confronting, and so sometimes the best way, also the nicest way, or the way that makes it easiest to accept, is voluntarily giving up your license.”
Professor Ibrahim continued, saying that the significance of a driving license, to an elderly individual, or any individual that is cognitively impaired, cannot be denied.
“We've had a fair bit of discussion about how your license means much more than owning a car or being able to drive,” he said.
“Your license, much the same as voting is, ‘I have arrived, I'm independent, I'm in charge of my own life’, and being told you can't do something at any age is a knock to your confidence. Being told you can't do something at eighty, that you've been doing for sixty years, is really hard to take.”
“So, being able to talk to them about their diagnosis, their functional state, what their concerns are, and to have something that is reliable, is important.”
With its versatility, accuracy and flexibility, off-road driving assessment tools like DSDA could be valuable for health professionals, patients, and their families, when confronting this difficult situation.
Evaluating an elderly person’s ability to drive, and having accurate data and information to corroborate that evaluation, is difficult, and DSDA provides a quick, cost-effective pre-cursor to costly and slow on-road assessments.