Objectives To develop a cognitive and functional screening battery for the on-road performance of older drivers with dementia. Design A prospective observational study. Setting On-road driving evaluation clinic at an academic rehabilitation center Participants Ninety-nine older people with dementia (63% male, mean age = 74.2 years, SD= 9), referred by community physicians to an Occupational Therapy driving clinic. Measurements The outcome variable was pass/fail on the modified Washington University Road Test. Predictor measures were tests of visual, motor and cognitive functioning, selected for their empirical or conceptual relationship to the complex task of driving safely. Results Sixty-five (65%) of participants failed the on-road driving test. The best predictive model, with an overall accuracy of up to 85% when participants were blinded, included AD-8 score, the Clock Drawing Test score, and the time to complete either the Snellgrove Maze Test (SMT) or Trail Making Test A. Visual and motor functioning were not associated with road driving test failure. Conclusion A screening battery that could be performed in less than 10 minutes predicted with good accuracy a failure rating on the on-road driving test in this sample of older drivers with dementia. A “probability of failure” calculator is provided from a logistic regression model that may be useful for clinicians in their decision to refer impaired older adults for further testing. More studies are needed in larger community based samples, along with discussions with patients, families and clinicians, in regards to acceptable levels of test uncertainty.

In its present form, the ADReS has limited utility as an office screen for individuals who should undergo formal driving assessment. Improved scoring methods and screening tests with greater diagnostic accuracy than the ADReS are needed for general office practice.

OBJECTIVE. The aim of this study was to develop a brief screening battery to predict the on-road performance of drivers who had experienced a stroke. METHOD. We examined 72 people with stroke referred by community physicians to an academic rehabilitation center. The outcome variable was pass or fail on the modified Washington University Road Test. Predictor measures were tests of visual, motor, and cognitive functioning. RESULTS. The best predictive model for failure on the road test included Trail Making Test Part A and the Snellgrove Maze Task®. CONCLUSION. A screening battery that can be performed in less than 5 min was able to assist in the prediction of road test performance in a sample of drivers with stroke. A probability of failure calculator may be useful for clinicians in their decision to refer clients with stroke for a comprehensive driving evaluation.

Attention has turned to the competence and safety of the older driver, particularly the older driver with dementia. Patients and their families frequently require general practitioners (GPs) to treat dementia, and maintain the patient at his/her highest functional level. Included in this maintenance may be the permission to continue driving. The aim of this unique study was to explore the knowledge, attitudes, and clinical practices of GPs in South Australia concerning driving and dementia. A postal survey design was utilised. A total of 1240 practicing GPs were invited to anonymously complete and return an 18-item specifically developed questionnaire. Data were returned by 485 GPs (39.1%). Demographic characteristics of the sample were broadly representative of the population of practising GPs across South Australia. Main analyses were descriptive. Non-parametric methods were used to determine associations. GPs reflected a positive attitude towards the problem of driving and dementia. GP knowledge regarding relevant Driver Licensing Authority legislation was modest. A variety of clinical practices are employed by GPs around driving and dementia. Recommendations are made that may contribute to the development practically useful strategies to help GPs in making decisions about the driving capacity of older people with dementia, and ultimately contribute to improved individual and public safety. Aim:To determine how the syndrome of confusion is being recognised, diagnosed and managed in acute public and private hospitals. Method:A case note audit to identify 50 patients in each of 3 hospitals (2 public and 1 private) with confusion and collect data on relevant parameters. Results:Of the 150 patients, confusion was one of the presenting complaints in 53 (35%), developed during the admission in 34 (23%) and was a co-morbidity in 63 (42%). Of the first 2 groups respectively 7 (13%) and 19 (56%) were not given a specific diagnosis, 33 (62%) and 12 (35%) did not have a collateral history documented and 23 (43%) and 7 (20%) did not have an objective measure of cognition recorded. Referrals to allied health were varied between the hospitals ranging from 6/50-36/50. Behavioural disturbances were documented in 55/150 (37%) and psychotropic medications were commenced in 33/150 (22%). All 3 hospitals were dissimilar in practice to each other with no clear trends between the public and private sector. Conclusion:The syndrome of confusion is not being managed comprehensively in acute hospitals. A significant proportion of patients are not having their confusion addressed by medical staff, are not given a specific diagnosis and are not having collateral history and objectives measures of cognition documented. With the wide variation in allied health referrals it would appear that not all patients are being managed with a multidisciplinary approach.