Improving the assessment of driving safety in cognitive impairment (IMPASS)

Abstract

Background: It is estimated that two thirds of people aged over 70 in the UK currently hold a driver’s licence. Dementia can impair the cognitive skills that are needed for driving (Camilleri & Whitehead, 2023). Clinicians are expected to advise people on their safety to drive as part of a comprehensive clinical diagnostic assessment, but many feel under-equipped to do this (Bennett, Chekaluk, Batchelor, et al., 2019; Neilson et al., 2019). Aims: The aims were: • Comprehensively review the current evidence for clinical predictors of driving safety • Understand how clinicians currently make a decision about driving safety • To investigate the discriminant ability of routinely collected clinical information to predict driving safety in those who have had an independent on-road assessment of driving • Use this data to develop a simple driving decision aid tool that will classify people as low-risk, indeterminate-risk and high-risk Methods: Clinicians from a broad range of disciplines were interviewed about what information they used to make an assessment of driving safety and what would improve current practice. A retrospective review of clinical notes was performed in people who had an on-road assessment of their driving to identify predictors of driving safety. A predictive driving decision aid tool was developed from the data and tested in an independent cohort to assess the sensitivity and specificity to identify at risk drivers. Results: The developed driving decision aid tool comprised two items, increased age and reduced ACE III visuo-spatial score demonstrating 50% specificity and 95% specificity to detect unsafe drivers. When tested in an independent cohort the tool demonstrated 10% sensitivity and 47% specificity to predict unsafe drivers. Conclusions: It was not possible to predict driving safety in a mild dementia cohort using routinely collected clinical information. Future focus is needed on development of clinical screening tools and comprehensive training for clinicians.