The Older Driver with Cognitive Impairment: Perceptions of Driving Ability and Results of a Behind the Wheel Test

Older adult drivers with cognitive impairment pose a potential safety risk to themselves and others. Providers are often uncertain about when to request a formal evaluation of driving ability, leaving subjective reports of concerns by the patient or family as common initiators of objective driving evaluation referral. This observational study evaluated the correspondence of patient and caregiver report of driving concerns relative to objective behind-the-wheel (BTW) testing. Data were analyzed from occupational therapy driving evaluations of older adult U.S. Veterans referred from cognitive disorder specialty clinics between 2005 and 2015 (n = 151). Driving ability was evaluated with a pre-testing interview of the patient and a knowledgeable caregiver, followed by objective BTW testing. Patients referred had a mean age of 77.6 (SD = 8.1) years, were 97% male, and 98% white. Results demonstrated that most patients are evaluated for driving concerns far too late, with only 3% of the sample being evaluated as independent to drive without restrictions, and 38% recommended to retire from driving. Although both patients and caregivers denied specific driving concerns (obey signs and lights) relative to objective testing, caregiver concerns were greater than their respective patient's concerns (p < 0.001) and were associated with road test outcome (p = 0.001).