Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia

This prognostic study examines participants' scores on 8 screening tools to identify drivers who are potentially unsafe compared with on-road driving test scores. Importance There is an urgent need to develop evidence-based assessments to identify older individuals who may be unsafe drivers. Objective To validate 8 off-road brief screening tests to predict on-road driving ability and to identify which combination of these provides the best prediction of older adults who will not pass an on-road driving test. Design, Setting, and Participants This prognostic study was conducted between October 31, 2013, and May 10, 2017, using the criterion standard for screening tests, an on-road driving test, with analysis conducted from August 1, 2019, to April 2, 2020. A volunteer sample of older drivers was recruited from community advertisements, rehabilitation and driver assessment clinics, and an optometry clinic in Canberra and Brisbane, Australia. Exposures Off-road driver screening measures, including the Useful Field of View, DriveSafe/DriveAware, Multi-D battery, Trails B, Maze test, Hazard Perception Test, DriveSafe Intersection test, and 14-item Road Law test. Main Outcomes and Measures Classification as unsafe on a standardized 50-minute on-road driving assessment administered by a driving instructor and an occupational therapist masked to the participant's clinical diagnosis and off-road test performance. Results A total of 560 drivers aged 63 to 94 years (mean [SD] age, 74.7 [6.2] years]; 350 [62.5%] men) were assessed. Logistic regression and receiver operating characteristic analyses indicated the area under the curve was largest for a multivariate model comprising the Multi-D, Useful Field of View, and Hazard Perception Test, with an area under the curve of 0.89 (95% CI, 0.85-0.94), sensitivity of 80.4%, and specificity of 84.1% for predicting unsafe drivers. The Multi-D battery was the most accurate individual assessment and had an area under the curve of 0.85 (95% CI, 0.79-0.90), sensitivity of 77.1%, and specificity of 82.1%. The multivariate model had sensitivity of 83.3% and specificity of 91.8% in the cognitively impaired group and sensitivity of 87.5% and specificity of 70.8% in the visually impaired group. Conclusions and Relevance These findings suggest that off-road screening tests can reliably identify older drivers with a strong probability of failing an on-road driving test. Implementation of these measures could enable better targeting of resources for managing older driver licensing and support injury prevention strategies in this group. Question Are brief off-road screening measures sufficiently sensitive and specific to identify older drivers who will not pass an on-road driving test in Australia? Findings This prognostic study including 560 drivers aged 63 years and older found that off-road screening tests could identify older drivers who would not pass an on-road driving test with 77% sensitivity and 82% specificity. A combination of measures drawing from multiple skill domains provided the best prediction. Meaning These findings suggest that brief off-road screening tests could be a cost-effective, objective tool to screen older drivers to determine who might be an unsafe driver and to indicate referral for an on-road driving test.