Highlights Dementia and vision screeners are widely used to inform fitness to drive decisions. Older drivers scores on MMSE and Snellen chart were examined against on-road safety. These tests had low sensitivity for detecting unsafe drivers even when used together. Clinicians should use better validated screening tools to identify unsafe drivers.

    Abstract Background/Objectives To examine the validity of high-contrast visual acuity and the Mini-Mental State Exam (MMSE) as tools for identifying at-risk older drivers. Design Prospective multi-site observational cohort study. Setting Community sample drawn from cities of Brisbane and Canberra, Australia. Participants 560 licensed drivers aged 65–96 years recruited between 2013 and 2016, from the community, an optometry clinic and driver referral service. Measurements 50-minute standardized on-road driving test conducted on a standard urban route in a dual-brake vehicle with a driver trained Occupational Therapist assessor masked to participants’ cognitive, visual and medical status. Results Of 560 participants who completed the on-road test, 68 (12%) were classified as unsafe. Binary logistic regression models adjusted for age, gender, site, comorbidity and driving exposure indicated that a 1-point decrease in MMSE score was associated with a 1.35 (95%CI: 1.12–1.63) increase in odds of unsafe driving, and for each line reduction in binocular visual acuity (increase of 0.1 logMAR) was associated with 1.39 (95%CI: 1.07–1.81) increased odds of unsafe driving. However, Receiver Operating Characteristic (ROC) analysis showed low discriminative power for both measures (MMSE: AUC = 0.65 (95%CI: 0.58–0.73), visual acuity: AUC = 0.65 (95%CI: 0.59–0.72)) and typical cut-offs were associated with very low sensitivity for identifying unsafe drivers (MMSE <24/30: 2%; visual acuity worse than 6/12 Snellen (logMAR >0.30): 3%). Conclusion The MMSE and high-contrast visual acuity tests do not reliably identify at-risk older drivers. They have extremely low sensitivity for detecting unsafe drivers, even when used together, and poor prognostic properties relative to validated screening instruments that measure cognitive, vision and sensorimotor functions relevant to driving. Clinicians should select alternate validated driver screening tools where possible.


    Access

    Check access

    Check availability in my library

    Order at Subito €


    Export, share and cite



    Title :

    Inability of the Mini-Mental State Exam (MMSE) and high-contrast visual acuity to identify unsafe drivers


    Contributors:


    Publication date :

    2022-02-04




    Type of media :

    Article (Journal)


    Type of material :

    Electronic Resource


    Language :

    English




    A comparative approach to identify unsafe older drivers

    Dobbs, Allen R. | Online Contents | 1998


    Survey of Visual Acuity of Drivers

    P. A. Davison / A. Irving | NTIS | 1980


    Survey of visual acuity of drivers

    Davison, P. A. / Irving, A. | TIBKAT | 1980


    Making unsafe drivers safe drivers

    McKenna, F. / AA Foundation for Road Safety Research | British Library Conference Proceedings | 2001


    How Well Does High Contrast Visual Acuity Predict Driving Performance?

    Wood, J. M. / Higgins, K. E. / Applied Vision Association et al. | British Library Conference Proceedings | 1999