. 2023 Dec 1;78(12):2348-2355.

doi: 10.1093/gerona/glad044.

Candrive-Development of a Risk Stratification Tool for Older Drivers

Shawn Marshall^{1

2}, Michel Bédard³, Brenda Vrkljan⁴, Holly Tuokko⁵, Michelle M Porter⁶, Gary Naglie^{7

8}, Mark J Rapoport⁹, Barbara Mazer^{10

11}, Isabelle Gélinas^{10

11}, Sylvain Gagnon¹², Judith L Charlton¹³, Sjaan Koppel¹³, Lynn MacLeay¹, Anita Myers¹⁴, Ranjeeta Mallick¹, Tim Ramsay¹, Ian Stiell^{1

15}, George Wells¹, Malcolm Man-Son-Hing^{1

16}

Affiliations

¹ Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, Ontario, Canada.
³ Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada.
⁴ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Psychology, University of Victoria, Victoria, British Columbia, Canada.
⁶ Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
⁸ Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
¹⁰ School of Physical & Occupational Therapy, McGill University, Montreal, Québec, Canada.
¹¹ Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada.
¹² School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia.
¹⁴ School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
¹⁵ Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁶ Island Health, Campbell River, British Columbia, Canada.

PMID: 36794785
PMCID: PMC10692431
DOI: 10.1093/gerona/glad044

Candrive-Development of a Risk Stratification Tool for Older Drivers

Shawn Marshall et al. J Gerontol A Biol Sci Med Sci. 2023.

. 2023 Dec 1;78(12):2348-2355.

doi: 10.1093/gerona/glad044.

Authors

Affiliations

¹ Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, Ontario, Canada.
³ Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada.
⁴ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Psychology, University of Victoria, Victoria, British Columbia, Canada.
⁶ Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
⁸ Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
¹⁰ School of Physical & Occupational Therapy, McGill University, Montreal, Québec, Canada.
¹¹ Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada.
¹² School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia.
¹⁴ School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
¹⁵ Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁶ Island Health, Campbell River, British Columbia, Canada.

PMID: 36794785
PMCID: PMC10692431
DOI: 10.1093/gerona/glad044

Abstract

Background: Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults.

Methods: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures.

Results: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81-9.84) compared to the lowest risk group.

Conclusions: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Keywords: Driving issues; Geriatric assessment; Primary care.

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Conflict of interest statement

M.B. was supported by a Canada Research Chair in Aging and Health during the development phase of this study. G.N. was supported by the George, Margaret and Gary Hunt Family Chair in Geriatric Medicine, University of Toronto, received a grant from the Canadian Consortium on Neurodegeneration in Aging and served as Chair for the Canadian Institutes of Health Research Institute on Aging Advisory Board. M.J.R. was supported by the Sunnybrook Psychiatry Partnership, received grants or contracts from the Canadian Institute of Health Research, Canadian Consortium of Neurodegeneration and Aging, and Centre for Brain Health Innovation, participated on a Data Safety Monitoring Board for a study on multiple sclerosis and exercise, and served as Program Director for Geriatric Psychiatry at the University of Toronto. M.M.P. received grants or contracts from the Social Sciences and Humanities Research Council, Natural Science and Engineering Research Council, Aging Gracefully across Environments using Technology to Support Wellness, Engagement and Long Life Networks of Centres of Excellence Inc., Canadian Institutes of Health Research, New Horizons for Seniors Program, Winnipeg Foundation, Riverview Health Centre Foundation, Mitacs, University Research Grants Program and served as Chair of the Board for Transportation Options Network for Seniors in Manitoba. S.K. served as a Board Member of the Association of the Advancement of Automotive Medicine. The other authors declare no conflict.

Figures

**Figure 1.**
Flow diagram for variable selection for Candrive risk stratification tool from the Candrive prospective older driver study. MOCA = Montreal Cognitive Assessment; MVPT-3 = motor-free visual perception test-3; RST = risk stratification tool.

**Figure 2.**
Nomogram using objective variables (at-fault collisions). MOCA = Montreal Cognitive Assessment.

**Figure 3.**
Risk stratification tool categories demonstrating relative risk of at-fault collision adjusted for kilometers driven on older drivers.

See this image and copyright information in PMC

Cited by

Validation of the Candrive Older Driver Risk Stratification Tool for Assessing Medical Fitness-to-Drive in Older Australian Drivers.
Charlton JL, Koppel S, Stephens A, Bedard M, Howcroft J, Darzins P, Di Stefano M, Gagnon S, Gelinas I, Man-Son-Hing M, Myers A, Naglie G, Porter MM, Rapoport M, Vrkljan B, Marshall S. Charlton JL, et al. J Gerontol A Biol Sci Med Sci. 2025 May 5;80(6):glaf071. doi: 10.1093/gerona/glaf071. J Gerontol A Biol Sci Med Sci. 2025. PMID: 40195578 Free PMC article.
Older Drivers Reduced Engagement in Distracting Behaviors Over a Six-Year Period: Findings From the Candrive Longitudinal Study.
Bédard M, Maxwell H, Weaver B, Stinchcombe A, Gélinas I, Mazer B, Naglie G, Porter MM, Rapoport MJ, Tuokko H, Vrkljan B, Marshall S. Bédard M, et al. J Gerontol B Psychol Sci Soc Sci. 2024 Feb 1;79(2):gbad168. doi: 10.1093/geronb/gbad168. J Gerontol B Psychol Sci Soc Sci. 2024. PMID: 37934029 Free PMC article.

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Candrive-Development of a Risk Stratification Tool for Older Drivers

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Candrive-Development of a Risk Stratification Tool for Older Drivers

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