Validation of the Candrive Older Driver Risk Stratification Tool for Assessing Medical Fitness-to-Drive in Older Australian Drivers

Judith L Charlton¹, Sjaan Koppel¹, Amanda Stephens¹, Michel Bedard², Jennifer Howcroft³, Peteris Darzins^{4

5}, Marilyn Di Stefano⁶, Sylvain Gagnon⁷, Isabelle Gelinas⁸, Malcolm Man-Son-Hing^{9

10}, Anita Myers¹¹, Gary Naglie^{12

13}, Michelle M Porter¹⁴, Mark Rapoport¹⁵, Brenda Vrkljan¹⁶, Shawn Marshall^{10

17}

Affiliations

¹ Monash University Accident Research Centre, Monash University, Clayton, Australia.
² Lakehead University, Thunder Bay, Canada.
³ Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada.
⁴ Eastern Health, Melbourne, Victoria, Australia.
⁵ Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.
⁶ Victorian Government Department of Transport and Planning, Melbourne, Australia.
⁷ School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.
⁸ School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
⁹ Island Health, Campbell River, British Columbia, Canada.
¹⁰ Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
¹² Department of Medicine and Marottoli Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
¹³ Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Faculty of Kinesiology and Recreation Management, and Centre on Aging, University of Manitoba, Winnipeg, Canada.
¹⁵ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
¹⁶ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
¹⁷ Department of Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, Ontario, Canada.

PMID: 40195578
PMCID: PMC12095997
DOI: 10.1093/gerona/glaf071

Validation of the Candrive Older Driver Risk Stratification Tool for Assessing Medical Fitness-to-Drive in Older Australian Drivers

Judith L Charlton et al. J Gerontol A Biol Sci Med Sci. 2025.

. 2025 May 5;80(6):glaf071.

doi: 10.1093/gerona/glaf071.

Authors

Affiliations

¹ Monash University Accident Research Centre, Monash University, Clayton, Australia.
² Lakehead University, Thunder Bay, Canada.
³ Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada.
⁴ Eastern Health, Melbourne, Victoria, Australia.
⁵ Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.
⁶ Victorian Government Department of Transport and Planning, Melbourne, Australia.
⁷ School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.
⁸ School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
⁹ Island Health, Campbell River, British Columbia, Canada.
¹⁰ Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
¹² Department of Medicine and Marottoli Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
¹³ Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Faculty of Kinesiology and Recreation Management, and Centre on Aging, University of Manitoba, Winnipeg, Canada.
¹⁵ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
¹⁶ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
¹⁷ Department of Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, Ontario, Canada.

PMID: 40195578
PMCID: PMC12095997
DOI: 10.1093/gerona/glaf071

Abstract

Background: Assessing older drivers' fitness-to-drive is challenging, with decisions impacting mobility and health. This study aimed to validate the Candrive older driver risk stratification tool for screening medical fitness-to-drive in an independent cohort of older adults from the Ozcandrive 8-year prospective study.

Methods: A convenience sample of drivers aged 75 and older residing in Melbourne, Australia completed the Candrive assessments. Their vehicles were instrumented to collect vehicle and global positioning system data, including trip distance. The first 4 years of Ozcandrive data were analyzed. The primary outcome measure was self-reported at-fault collisions, adjusted per 10 000 km driven. Collision risk status was modeled using Generalized Estimating Equations with Poisson regression using predetermined Candrive risk stratification tool predictor variables.

Results: A total of 257 older drivers (70.8% male) were recruited with an average age at study enrollment of 79.7 years (standard deviation = 3.5). Of the 755 adjusted person-years of driving, 74.1% were in the Low risk category (vs original sample, Candrive: 74.8%) and 10.5% were in the Low-Medium risk category (Candrive: 9.3%). Only 15.4% were in the Medium-High risk category (Candrive: 15.9%), where the relative risk for self-reported at-fault collisions was 1.79 (95% confidence interval = 1.06-3.03) compared to the Low risk category.

Conclusions: This study demonstrates an association between self-reported at-fault collisions and Candrive risk stratification tool scores. This result is promising given the primary outcome measure differed from the original Candrive study that used police-reported, at-fault collisions, and supports Candrive risk stratification tool's use by healthcare providers when initiating fitness-to-drive conversations.

Keywords: Driving issues; Geriatric assessment; Medical fitness-to-drive; Primary care.

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Conflict of interest statement

J.L.C. serves as Chair of the National Road Safety Partnership Program. S.K. serves as a Board Member of the Association of the Advancement of Automotive Medicine. M.B. was supported by a Canada Research Chair in Aging and Health during the development phase of the Candrive 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.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. The other authors declare no conflict.

References

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Validation of the Candrive Older Driver Risk Stratification Tool for Assessing Medical Fitness-to-Drive in Older Australian Drivers

Affiliations

Validation of the Candrive Older Driver Risk Stratification Tool for Assessing Medical Fitness-to-Drive in Older Australian Drivers

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources