Scientifically assessing at-risk senior drivers

The federally funded project involves creating an electronic repository of comprehensive driving evaluations of medically at-risk drivers who’ve been referred to specialized assessment centres in Saskatchewan, Ontario and Quebec.

The information will provide standardized indicators of driving capabilities that subsequently can be used to develop effective screening tools for fitness to drive and interventions that can enhance or maintain driving privileges for a longer period of time.

“We recognize that as you age, you are more likely to get age-related deficits such as decreased vision, slower cognitive processing, as well as medical conditions such as dementia, Parkinson’s disease and stroke that impact your ability to drive safely,” said Crizzle.

“Many people don’t recognize their deficits. Having that discussion, or identifying people with the deficits and tying that into driving is a contentious issue for many to address, but at the same time it’s a road safety issue,” he said.

Crizzle, an assistant professor at the U of S School of Public Health whose research specialties include gerontology, neurodegenerative and neurological diseases, and transportation, has been awarded $803,250 by the Canadian Institutes of Health Research (CIHR) for the six-year project.

The number of drivers over age 65 is expected to double by 2040, and studies indicate that older drivers are disproportionately involved in collisions that cause serious injuries and death, he said. So, determining the best way to identify, screen and assess medically at-risk drivers is crucial.

Many doctors lack the training to do in-office evaluations of driving skills, and would like fast assessment tools that help them at least start a conversation with a patient about the need for a driving test or stop driving, he said. As well, occupational therapists who are usually contracted by licensing authorities to conduct comprehensive driving evaluations, need effective assessment tools.

“We are trying to develop a suite of evaluation tools for different medical conditions or a battery of tools that enable us to make accurate predictions. These are not just for physicians but also for licensing authorities to identify drivers at risk, and to help occupational therapists by giving them some information on what to test and how to test them.”

Crizzle said he got the idea for the project while he was a post-doctoral fellow in rehabilitation sciences at McMaster University in 2012 under the mentorship of an occupational therapist who was involved in driving-related research.

Under Ontario’s system, drivers age 80 and older are required every two years to undergo a mandatory in-person licence renewal that require cognitive screening. Those who fail are required to take a comprehensive driving evaluation. Crizzle learned that the OTs who do the assessments were gathering a lot of data that are useful for driving research, but the information wasn’t being stored centrally and was mostly unused.

He developed a system to capture data from a few occupational therapy assessment clinics in Ontario. It has since expanded to become a wider project that includes all the assessment centres across Ontario, Quebec and Saskatchewan, three provinces with the highest collision rates.

“That will give the ability to analyze data on a large scale because anyone who has been referred for a comprehensive driving evaluation is included,” he said.

Using the Ontario Ministry of Transportation (MTO) IT infrastructure as a model, Crizzle’s team will create a web-based repository that will capture and track evaluations of medically at-risk drivers to develop a set of evidence-based predictors of fitness to drive. The occupational therapists who usually conduct these driver assessments are required to upload the information to the repository.

Crizzle’s research team includes academics and researchers with backgrounds in geriatrics, OT, neuropsychiatry and epidemiology, as well as representatives of provincial licensing authorities in Saskatchewan, Quebec and Ontario, and groups such the Canadian Association of Retired Persons, Ontario and Saskatchewan OT groups, Transport Canada, Saskatoon Council of Aging, Saskatoon Health Region, and the Canadian Medical Association.

The plan is to eventually make this a Canada-wide project, said Crizzle.