Cognitive tests to assess driver impairment called into question

Grey Power is calling for a change to elderly driver assessments, claiming the process for assessing driver capability is penalising some of the very people who need their licences the most.

Grey Power acting vice president David Marshall said a nationwide survey of members had revealed a lack of practical driving assessors in the regions and also widespread use of cognitive tests - SIMARD-MD and Mini-ACE - to assess driver impairment.

Canadian driving researcher Dr Alexander Crizzle said there was no evidence to support the continued use of cognitive dementia tests to assess driver capability. In New Zealand, the driver licence renewal criteria require all licence holders to present a medical certificate confirming fitness to drive at age 75, then 80, and then every two years following.

Waka Kotahi NZTA says it does not mandate cognitive tests for elderly drivers and maintains the use of such tools is left to the discretion of health practitioners. Draft guidelines on how to assess medical fitness to drive are currently under review and are expected to be released in June.

Crizzle said the SIMARD-MD test was used to identify drivers who were at risk but there was an argument that the test "does not do a great job at measuring the driving skills needed to functionally operate a vehicle and failure of that test doesn't accurately measure the ability of a person to drive safely".

"The reason why there's so much controversy is because if you some how fail that test, many don't undergo a road test, they just lose their licence and that's been a huge issue for many."

There were two issues with the SIMARD-MD, he said.

"The first is that it doesn't identify people accurately. So you have people that fail the SIMARD-MD but then pass the road test and vice versa - you would have people that pass the road test but then would fail the SIMARD-MD."

There was mounting evidence about whether the test was effective and in some areas it was being pulled, he said.

The Mini-ACE test which is used in New Zealand asks questions like what day, date and month of the year it is, to remember a name and address, to name as many animals as possible in a minute.

Crizzle said the Mini-ACE test is quicker to administer than the SIMARD-MD test, but there was still not a lot of data to support its efficacy.

"The Mini-ACE though is not a perfect test either, it doesn't have a tonne of evidence with respect to people that have various medical conditions."

The tests were designed to identify people with cognitive impairment and were not designed for driving and there was no specific test to understand driving deficits, he said.

Every person was different and there had been studies that showed some people with early stage dementia were still driving and could do so safely, he said.

Better tests were needed to identify the specific deficits and to understand what issues that were occurring when people had cognitive impairment, he said.

From a practical perspective, a SIMARD-MD test could lead to 20 percent of people failing the test, half of the candidates having indeterminate results with 25-30 percent passing the test, he said.

"That means you're testing 70 percent of your clients on the road. And if you put that on a population level, that's a lot of road tests that you're conducting that you shouldn't have to conduct."

It forces people to have the stress of taking a road test when they could clearly pass it, he said.

"We don't have a short test right now that can accurately measure the deficits that you would see in driving."

He said ultimately a road test was really the only way to know whether someone could drive safely or not.

'Many are giving up' - Marshall

Grey Power acting vice president David Marshall said older people who had to seek a certificate from their doctor were getting stressed after hearing about what others had experienced.

"So we find that it's very variable around the country what is happening with the barrier to licence renewal being very high for some and very low for others."

Some GPs were still using the SIMARD-MD test, while others used the mocker test or the Mini-ACE, he said.

"We have surgeries that have mandated that every patient will have the Mini-ACE test and that is really creating a lot of fear and anger even because some just find it insulting."

Some older people who have been driving for years and have had no accidents fail the test but do not see it is relevant to their driving, he said.

GPs were either referring those who failed for an on road safety test which cost about $20, but if the GP referred them to an occupational therapist the cost was around $800 or up to $1200 if the occupational therapist came to see them, he said.

The issue with the road test, particularly in rural areas, was that very few places offered that particular test, he said.

Marshall said the Transport Agency had told him that people who were teaching others to drive were not qualified to do the road safety test, but that it had to be an assessor.

For many who had to sit this test the expense and fear that they may not pass meant they just gave up their licences, he said.

Some in rural areas were having to travel 50km or more to somewhere they were not familiar with to do the road test, he said.

"They see that as too big a barrier and they're worried, perhaps they have to travel on a main highway [when] they normally just travel around in their town or in the rural area."

It was trying to find the best practical way to deal with it, he said.

"We'd like to see that the doctors use their own assessment of the patient and do all of the medical tests that they need to do with eyesight and if people have got other conditions. If they feel the person has got early stage dementia, then use one of these tests to give them more information, but not with all people."