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. 2022 Jun;41(2):282-292.
doi: 10.1111/ajag.13024. Epub 2021 Dec 23.

Mild cognitive impairment and fitness to drive: An audit of practice in a driving specialist clinic in Australia

Claire Spargo  1 , Kate Laver  2 , Zoe Adey-Wakeling  2   3 , Angela Berndt  4 , Stacey George  1
Affiliations

Mild cognitive impairment and fitness to drive: An audit of practice in a driving specialist clinic in Australia

Claire Spargo et al. Australas J Ageing. 2022 Jun.

Abstract

Objective: To describe current practice and outcomes relating to fitness to drive for people with mild cognitive impairment (MCI) attending a specialist driving clinic.

Methods: Retrospective medical record audit from a driving fitness assessment clinic at a tertiary medical centre, South Australia, from 2015 to 2019.

Results: Of 100 notes audited, n = 40 had a documented diagnosis of MCI and n = 60 had subjective cognitive concerns characteristic of MCI. Participants mean age was 80.0 years (SD 6.7), and mean Mini-Mental State Examination score was 26.1 (SD 2.1). Medical practitioners completed a comprehensive initial assessment relating to medical fitness to drive, considering scores from a cognitive assessment battery and non-cognitive factors (driving history, current driving needs, vision, physical abilities and collateral from family). After the initial assessment, most participants (84%) were referred for a practical on-road assessment, before receiving a final driving recommendation. Over half of participants continued driving (51%), most with conditions, while 35% ceased driving. Outcomes for the remaining 14% are unknown as we were unable to determine whether the practical assessment (11%) or lessons (3%) were completed.

Conclusions: Driving outcomes for people with MCI with questionable driving capabilities are variable, with both cognitive and non-cognitive factors important in guiding medical fitness to drive recommendations. There is a need for more driving clinics to provide in-depth assessment for people with MCI who demonstrate uncertain driving capabilities and improved support for decision-making in other non-driving specialist settings.

Keywords: ageing; automobile driving; clinical decision-making; cognitive dysfunction; dementia.

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