Letters Screening of older drivers

We need evidence based tools to identify medically at risk drivers

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7087 (Published 24 October 2012) Cite this as: BMJ 2012;345:e7087
  1. Ediriweera Desapriya, research associate12,
  2. Yamesha Ranatunga, highly qualified person12,
  3. Ian Pike, assistant professor 12
  1. 1British Columbia Injury Research and Prevention Unit, Developmental Neurosciences and Child Health: Neurons to Neighbourhoods, British Columbia Children’s Hospital, BC, Vancouver, Canada, V6H 3V4
  2. 2Department of Pediatrics, Faculty of Medicine, University of British Columbia, BC, Vancouver
  1. edesap{at}cw.bc.ca

In his personal view, O’Neill argued that medical screening of older drivers is misguided and typifies a worrying lack of due diligence.1 A recent Cochrane systematic review has shown that existing screening tools to identify high risk drivers fail to preserve transport mobility or reduce motor vehicle crashes.2 There is now sufficient evidence to conclude that age based screening for fitness to drive produces no safety benefits.3

Even though driver licensing agencies rely heavily on medical advice to exercise their statutory responsibility to ensure the competency and safety of licence holders, the assessment of medical fitness to drive can be a sensitive and difficult task.4 A recent study showed that Australian family doctors lack confidence in performing driving assessments and noted many negative consequences of reporting medically unsafe drivers.5 Advice is urgently needed on how to assess fitness to drive and how to protect the doctor-patient relationship when reporting does occur.5

In many countries drivers are legally obliged to notify the driver licence authority when they become unfit. However, research has shown that most drivers are unaware of this law, or what qualifies as fitness to drive. Locating this responsibility exclusively with doctors in the form of mandatory reporting is counterproductive to road safety and to the involvement of drivers in understanding and monitoring their own fitness to drive.5

A comprehensive review of the literature shows that the current tools available to clinicians to assess fitness to drive are also weak. Driving legislation, including recommendations from medical practitioners regarding fitness to drive, requires evidence based tools. There is an urgent need to develop evidence based screening tools that adequately distinguish medically at risk drivers from healthy older drivers.2 5 Without them, the result may be legislation that overly restricts older peoples’ driving privileges and their right to free mobility.


Cite this as: BMJ 2012;345:e7087


  • Competing interests: None declared.


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