When it’s no longer safe to drive

Navigating the hazards of fitness-to-drive assessments

An image of an elderly man's hands holding the steering wheel.

Image: dusanpetkovic1/Adobe Stock

Image: dusanpetkovic1/Adobe Stock

Many older people fear losing their driver’s licence and what it may mean for their independence, but UQ researchers hope a new fitness-to-drive assessment test will help end the confusion and steer difficult conversations in a new direction.

For many older Australians, the prospect of losing the ability to drive can be daunting – a symbol of diminishing independence and a new limitation on life.

Key points

  • A new UQ research project is working to develop a new fitness-to-drive assessment test that can be performed by GPs in their surgeries.
  • Compassion is the key to meaningful conversations with loved ones about when it’s no longer safe to drive.
  • Losing your driver’s licence doesn’t mean losing your independence.

For their loved ones and clinicians, even approaching a conversation about this step can be intimidating. While safety on the roads is paramount, it’s difficult to consider asking someone to give up something they see as the key – quite literally – to their personal freedom.

Exacerbating this challenge is the lack of medical clarity around when an individual crosses the ‘safe to drive’ line. Despite broad acknowledgement that those experiencing the cognitive impairment that can come with conditions like dementia often aren’t safe to drive, there is currently no industry-standard diagnostic tool for identifying when an individual should no longer be behind the wheel.

An image of UQ's Dr Theresa Scott and dementia advocate and UQ alum John Quinn.

UQ's Dr Theresa Scott and dementia advocate and UQ alum John Quinn (Bachelor of Commerce '86).

UQ's Dr Theresa Scott and dementia advocate and UQ alum John Quinn (Bachelor of Commerce '86).

An image of UQ's Dr Theresa Scott and dementia advocate and UQ alum John Quinn.

UQ's Dr Theresa Scott and dementia advocate and UQ alum John Quinn (Bachelor of Commerce '86).

UQ's Dr Theresa Scott and dementia advocate and UQ alum John Quinn (Bachelor of Commerce '86).

Testing breakthrough at UQ

A new UQ research project is hoping to change this. The Navigating Fitness to Drive with Patients with Dementia initiative is working alongside people living with dementia to develop a new fitness-to-drive assessment test that can be performed by GPs in their surgeries.

According to Dr Theresa Scott, the lead researcher on the project and a senior lecturer in UQ's School of Psychology, the current lack of consistency and absence of clear medical guidelines has many negative impacts.

“Flaws in current driving tests mean people living with dementia are sometimes given no formal assessment, or they are told they have to stop driving as soon as they are diagnosed, even when they could continue driving safely,” Dr Scott said.

“Some people don’t accept the decision to stop driving as they feel they haven’t been fairly assessed, and continue driving, which puts them and others at risk.”

The video-based test that Dr Scott and her team are developing is based on the Hazard Perception Test, already used in license testing and initially developed by the UQ School of Psychology's Professor Mark Horswill and Dr Andrew Hill, who are also involved in this new initiative.

A clip from the Hazard Perception Test, used as part of the Queensland Government’s driver licencing system.

“We hope this project will reduce traffic crashes, driving-related referrals and associated costs for health professionals, such as neurologists, geriatricians, and occupational therapy driving specialists”, Dr Scott said.

Limestone Medical Centre Partner and UQ Faculty of Medicine’s Emeritus Professor Geoff Mitchell said the assessment tool would be hugely beneficial for GPs when they assess people living with dementia.

“The tools currently available are blunt instruments, and GPs heavily rely on memory tests and opinions of loved ones”, Emeritus Professor Mitchell said.

“To have a tool that is practical, accepted and reliable will be welcomed by all GPs who look after people living with dementia.”

Emeritus Professor Mitchell said while the current situation leads to confusion, it can also endanger critically important relationships between older people and their trusted clinicians.

“It will help reduce the risk of fractured relationships with patients when refusal to grant a licence occurs or GPs have to refer the person for further testing,” he said.

Having the conversation

What about outside of the clinical setting? How should we approach these difficult conversations with loved ones, if we feel they may no longer be safe to drive?

Professor Nancy Pachana is the Director of UQ’s Healthy Ageing Initiative and Co-Director of the UQ’s Ageing Mind Initiative. Her advice for tackling this issue is simple: start with compassion.

“At a personal level we can support older people by being empathetic, by offering support if and when needed, and by being open and really listening to these difficult transition points, which we may all face one day.”

Professor Pachana said you can also support your loved one by doing some research and bringing together resources that will help them tackle this change in a proactive way. The following resources are great places to start:

Losing your license doesn’t have to mean losing freedom

Professor Pachana said the key message for anyone concerned about losing their license is that it needn’t be the end of freedom and adventure.

“The most important thing for everyone to keep in mind is that a shift from driving your own car for primary transport needs towards other options – like public transportation and ride-sharing arrangements – is a major transition, but needn’t be framed as a loss of independence,” she said.

With a change in cultural mindset, Professor Pachana said we can see this issue in a different light.

“Everyone who uses public transportation, for example, gives up being able to dictate exactly when and where they leave from, but there are gains in terms of being able to read a book while on the train or being relieved of the costs of keeping a private vehicle,”  she said.

“If we focus on independence and lack thereof, we risk sending an implicit or explicit message that the person shifting away from driving has de facto ceded some of their independence and hence now is dependent. This is not the best path to go down.”

Importantly, Professor Pachana reminds us that this issue doesn’t just affect those in the later stages of life.

“As a society, we need to better support the entire range of people needing better public transportation – people with disabilities, people who for whatever reason cannot drive or maintain a private vehicle. We need to get creative about alternate transport solutions, for both regional and urban areas,” Professor Pachana said.

An image of an adult son talking to his elderly father on a couch.

Image: Monkey Business/Adobe Stock

Image: Monkey Business/Adobe Stock

CarFreeMe: a new way of thinking about life after driving

Another UQ initiative that’s working towards this kind of big-picture change is the CarFreeMe project.

“The CarFreeMe research team at UQ has been at the forefront of developing tailored, individually responsive interventions for people across a range of contexts – older people, people living with dementia, people who have had a stroke or a traumatic brain injury,” Dr Pachana said.

“The aim of the project is to help individuals to move with grace and confidence from relying on a private vehicle to reliance on other means of transport to maintain their independence and continue their ability to pursue goals and maintain social connections.”

A major component of CarFreeMe is a coaching program that trains registered health practitioners to deliver workshops for people who need to transition to a car-free lifestyle and want to be as informed and prepared as they can be for this change.

Their coaching sessions are delivered online and consist of 10 sessions that can be completed at their own pace. Sessions are designed to be flexible and local, taking into account the laws and regulations that will impact an individual in their home state.

It’s all part of a bigger vision for helping those facing this change to feel empowered, rather than diminished.

“Supported driving cessation leads to positive mental health and wellbeing outcomes, and that is the change we have been driving,” Professor Pachana said.

Healthy Ageing Initiative

The UQ Healthy Ageing Initiative is a growing community of practice around healthy ageing, incorporating research, research training, curriculum development, student activities, community engagement and partnerships.