Fitness to Drive
Driving is a complex activity that requires a combination of physical and cognitive skills that can be adversely impaired by a wide range of fitness and health conditions. These conditions can affect the driver’s performance and increase their crash and/or injury risk.
A condition that impairs perception, cognition (including alertness, attitude to risk, or memory) or motor function has the potential to impair a person’s ability to drive safely. It may be constant (such as a vision defect), episodic (such as a sudden loss of consciousness), or temporary (such as a severe cold or migraine). It may be a condition that becomes worse over time, such as a neurological disease.
The DVLA sets minimum medical standards and rules for all drivers, including conditions that must be reported to the DVLA. The medical rules for Group 2 drivers (large vehicles over 3,500kgs, minibuses and buses) are more stringent than the rules for Group 1 drivers (cars and motorcycles).
Drivers are legally responsible for ensuring that they are fit to drive, and in some circumstances informing the Driver and Vehicle Licensing Agency (DVLA) if they develop a condition that affects their fitness to drive. A driver may have their licence refused or revoked if the DVLA considers they are a likely source of danger to the public when driving because of a health problem that affects their fitness to drive.
A list of health conditions that may require drivers and motorcyclists in the UKto report to the DVLA is available at https://www.gov.uk/health-conditions-and-driving.
The DVLA’s “At a Glance Guide to the Current Medical Standards of Fitness to Drive”, available free at http://www.dft.gov.uk/dvla/medical/aag.aspx, also outlines the conditions that must be reported.
Drivers and motorcyclists can be fined up to £1,000 if they do not tell DVLA about a medical condition, including eyesight problems, that affects their driving. They may also receive penalty points or be disqualified from driving. The penalties for continuing to drive after being refused a licence or having a licence revoked on medical grounds include a possible prison sentence of up to six months, penalty points or disqualification and a fine of up to £5,000.
Not all reportable medical conditions will result in a licence being revoked or refused. Some drivers may be granted a restricted licence that is valid for up to three years, after which they must re-apply for their licence. Others may be unaffected provided that they are managing their condition appropriately. The DVLA assesses over 700,000 fitness to drive cases each year, of which around 49,000 result in a licence being revoked or refused.
Road Accidents and Casualties Caused by Health Problems
Medical conditions do not appear to play a major role in crash risk or crash responsibility. Well known crash causation factors, such as night time driving, being male and aged less than 25 years, alcohol consumption and riding motorcycles are more common risk factors (Carter 2006, Hours et al 2008). However, many conditions do impair driving, as detailed in this review.
It is very difficult to obtain reliable estimates of crash risk, or number of crashes, involving drivers who have, or were impaired by, specific health problems because road accident data does not normally include information about the medical status of those involved, and indeed it would be very difficult for it to do so.
In 2016,”illness or disability, mental or physical” was reported as a contributory factor in 108 (7%) reported fatal road accidents, 559 (3%) reported serious road accidents, and 2,240 (2%) reported road accidents in total (see Table 1). These accidents resulted in 115 people being killed, 697 being seriously injured and 2,643 road casualties in total (see Table 2).
Contributory factors are largely subjective, reflecting the opinion of the reporting police officer, and are not necessarily the result of extensive investigation, and subsequent enquiries could lead to the reporting officer changing his/her opinion. (DfT, 2011)
Table 1: Contributory Factors in Reported Road Accidents in Great Britain in 2016 (RRCGB 2017)
Illness or disability, mental or physical
|108 (7%)||559 (3%)||1,573 (2%)||2,240 (2%)|
Table 2: Contributory Factors in Reported Road Casualties in Great Britain in 2016 (RRCGB 2017)
Illness or disability, mental or physical
|115 (8%)||697 (4%)||2,236 (2%)||2,643 (2%)|
Health professionals play a key role in mitigating health-related impairment and so reducing the risk of crashes, while enabling as many people as possible to stay safely mobile. There are many options for address fitness to drive problems:
Self-regulation (for example, drivers compensate for the impairment by changing when, where and how they drive, such as not driving at night)
Restricted licences (for example, a licence being valid for only three years; in some countries, the driver is not permitted to drive in certain situations, such as at night)
Medical treatment to address the cause of the problem (for example, medication or surgery)
Stopping driving, either for a temporary period or permanently
Driver rehabilitation training to help the driver cope with the impairment
Driver education to help the driver understand the effect of the impairment
Vehicle adaptation (for example, modified controls to enable the driver to drive with their impairment)
ASSESSMENT TOOLS AND MEASURES OF FITNESS TO DRIVE
Assessing fitness to drive is a very complex task and presents distinct challenges according to the different aspects that can impair a person’s cognition, vision, perception, physical or psychological ability to drive. Most of the time, complex tools, and joint work between medical specialists and on-road assessors is needed in order to obtain reliable assessment results.
This first chapter presents some general findings and considerations for measures and tools of assessment of fitness to drive. The following chapters will also present some tools and their results for specific aspects.
In relation to cognitive impairment, research suggests that there is a need for standard care pathway adopted in clinical settings, and a protocol for GPs and other health professionals to discuss fitness to drive with their patients; also, research is needed into developing a clinically viable desk based assessments of driving safety (Carsten, et al., 2016). The same authors raise the issue of commissioning research to look in more detail at any potential associated risks for safe driving manifested by prescription medicines. The DRUID project (Ravera, et al., 2012) categorizes 1,541 medicines in three levels:
- Level 0 (no or negligible influence on fitness to drive) – 57%
- Level I (minor influence on fitness to drive) – 26%
- Level II (moderate or severe influence on fitness to drive) – 17%.
Before evaluating the assessment tools and measures for fitness to drive, researchers need to raise the question of how well are the rules known by medical specialists (Carsten, et al., 2016). In an audit to find out how well ENT (Ear, Nose and Throat) surgeons in Wales know the legal rules for fitness to drive, research found that all respondents were aware that it is the patient’s responsibility to inform the DVLA (Driver and Vehicle Licensing Agency) regarding their medical condition, but 53% of the respondents were not aware that patients need to inform the DVLA if they suffer with day time sleepiness, and only 37% discuss driving when patients are seen in clinic with vertigo (Yap, et al., 2017).
In another study, most specialists were found to report that fitness to drive is an important issue in their practices, but their confidence in their ability to assess fitness to drive was low and they felt they would benefit from further education (Marshall, et al., 2012)
In Ireland, GPs are confident or very confident in assessing the medical fitness to drive (MFTD) guidelines and they also show a high level of awareness of the new guidelines (Kahvedzic, et al., 2014). On the other hand, another study looking at clinical effectiveness in assessing fitness to drive of medically at-risk older adults found that judgements of disease severity, decrements in driver insight, and older age influence clinician ratings of driving capability (Meuser, et al., 2016). Therefore, particular attention need to be given to the assessment process and tools.
Looking at the assessment process, a literature review research on screening and assessment tools for determining fitness to drive created 10 tables, organised into groups of key research studies. Each table has a summary of important concepts. This way, readers can better understand the research. They are also encouraged to use the reference tables to explore options since an assessment tool may be the best choice in one clinical setting but may not be the most informative choice in another setting (Dickerson, 2014). In another study in Canada, following the development of Fitness-to-Drive screening measures, the authors listed a series of barriers to older driver fitness to drive decisions, and a comprehensive set of resources and recommendations were identified (Classen, et al., 2016).
Some research developed and evaluated tools to assess fitness to drive. The Montreal Cognitive Assessment (MOCA) screening tool was found to give clear cut-offs for people who are more likely to pass (MOCA>27) and for people more likely to fail (MOCA<12) the on-road driving assessment. This suggest that MOCA could potentially be used as a quick cognitive screen for health practitioners (Esser, et al., 2015). Another toolkit based on cognition measures, was also developed in China for assessing coach drivers’ fitness to drive (Wang, et al., 2016)
Even if found to be effective, special consideration needs to be given when using assessment tools since other research suggest that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive; the research suggests using different and focused assessment tools together for specific medical conditions and that behind-the-wheel assessment remains the gold standard (Dickerson, et al., 2014). Other research also supports the effectiveness of off-road skill-specific training and computer-based driving simulator training for drivers’ rehabilitation (Unsworth and Baker, 2014). Research of visual-cognitive tools used to determine fitness to drive advise caution since results suggest that test scores may in some cases reflect age-associated normal biological changes (Bedard, et al., 2016)
Although difficult, fitness to drive needs to be assessed. Standard pathways and protocols seem to come into place and to create the appropriate settings for health, medical and safety practitioners to address and assess the subject.
- Date Added: 03 Apr 2012, 08:12 AM
- Last Update: 11 Jan 2018, 04:59 PM