Using pan-Canadian driving and health data of 928 drivers over the age of 70 and collected over seven years, the team developed the Candrive risk stratification tool (RST). Easily administered in a clinical office in just five minutes, the RST provides an objective benchmark for a patient’s collision risk relative to healthy older adults.
“It’s a big responsibility, piloting 3,000 pounds of metal down the highway,” said 88-year old Bill Campbell, who participated in the study. “But deciding when to hang up the car keys shouldn’t just be age related. A one-size-fits-all approach is wrong. We need objective criteria for when someone should have to give up driving.”
Driving is a major form of independence and mobility for aging Canadians, and losing a license is often an emotional and frustrating experience. While certain conditions, such as dementia, are often clear indicators of inability to drive, there is a grey area for many older adults that makes the question of driving complicated.
For many clinicians, assessing an older adult’s ability to drive often comes down to a single critical decision, often around concerns of frailty or cognition. Yet, many existing diagnostic tools only offer a black-and-white picture of driving capacity – yielding fit or not fit to drive as a result – and fail to capture the nuances of driving risk and ability.
“Our population is aging, and clinicians are going to face more cases of uncertainty about who is fit to drive,” said Dr. Shawn Marshall, Full Professor in the Faculty of Medicine and member of the Brain and Mind Research Institute. “Revoking a license prematurely has huge consequences for that person. Unfortunately, none of the tools we have right now actually address risk, and they don’t use a risk stratification approach.”
The lack of objective assessment tools around risk can make it difficult for health care providers to validate any potential uncertainties around an older adult’s driving abilities. Using risk stratification, or categorizing patients by level of risk, enables health care providers to engage with patients based on their personal level of risk, rather than having to rely on an all or nothing recommendation.
Marshall, a physician and investigator at Bruyère Research Institute and The Ottawa Hospital, emphasizes that their team recognizes the benefits of keeping older adults in the driver’s seat for longer, and that this is an opportunity to help health care providers and patients have a conversation around driving in a positive light, and not necessarily have to jump to license revocation.
“It supports the notion that we are better off knowing there is a problem so we can address and monitor it,” said Marshall. “If a clinician sees someone is at twice the risk of being in a crash compared to someone else in their age group, they have an opportunity to help the patient understand why they may be recommending on-road assessments or follow-ups. Crash risk is an outcome that is meaningful to patients, so we hope having an objective measure can help drive productive conversations.”
Campbell said he was motivated to join the study while living in Ottawa because he had personally seen how resistant other older adults in his circle had been to relinquish their license, and how hard it was on their families to insist it was time to stop driving. He thinks a tool like the RST can help health care providers deliver the message, especially when met with resentment, or in jurisdictions that don’t have a formal assessment program for older drivers.
“Most people knew when it was time to quit,” said Campbell of his fellow residents who had ceased driving at the retirement community he now resides at in Arizona. “Either that, or they were in an accident.”
The RST is currently being implemented and validated at Bruyère’s hospital campuses where the Candrive team will be looking at how to support the tool’s adoption and prepare to scale its use across additional health care settings.
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