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Toward a client-centred approach to fitness-to-drive assessment of elderly drivers

Demographic changes increase the need for fair and valid fitness-to-drive assessment in older drivers. In a self-report survey, 473 older drivers stratified by age (55–64, 65–74, >74 years) were asked about their driving habits, crash history, compensatory driver behaviour, and attitude towards age-based reassessment. The results showed an increase in the proportions of subjects reporting crash involvement and the subjects reporting full legal responsibility for the latest crash in older age groups. The reported use of different compensatory strategies and adaptation techniques was also higher in the older age groups. Medical fitness-to-drive screenings are not able to deal with the complexity of this paradoxical finding, because medical diagnoses do not take into account adaptation and compensation in older drivers. Age-based reassessments limited to medical screenings therefore carry an increased likelihood of false positive classifications that would unnecessarily reduce the quality of life of sufficiently safe older drivers. This risk could, however, be reduced by a client-centred approach focused on practical fitness-to-drive, providing older drivers with the opportunity to show whether they are able to cope with functional deficits in more realistic driving settings. Such an approach is in line with theoretical occupational therapy foundations.