Which older patients are competent to drive? Approaches to office-based assessment.

OBJECTIVE To review three proposed approaches to office-based assessment of older drivers and to evaluate recommendations made about dementia and driving.

QUALITY OF EVIDENCE The American Medical Association's (AMA's) Physcian's Guide to Assessing and Counseling Older Drivers gives recommendations for office-based assessment of older patients' medical fitness to drive. Other approaches examined were those outlined in the sixth edition of Determining Medical Fitness to Drive produced by the Canadian Medical Association (CMA) and SAFE DRIVE. Recommendations for dementia and driving from these documents and other sources were reviewed. All evidence was level III.

MAIN MESSAGE The AMA document usefully identified ways to detect drivers at risk and key areas for assessment (vision, cognition, motor function). Recommendations on evaluating these areas require validation. .he CMA guide and SAFE DRIVE were overly broad in their recommendations. How best to detect cognitive impairment that tocld affect driving remains unclear.

CONCLUSION Office-based approaches to identifying older drivers who are either unsafe to drive or require more extensive evaluation need to be validated.