Assessment of Driving‐Related Skills Prediction of Unsafe Driving in Older Adults in the Office Setting

Objectives To examine the sensitivity and specificity of the A ssessment of D riving‐ R elated S kills ( ADR e S ), a clinical tool recommended by the A merican M edical A ssociation for identifying potentially unsafe older drivers that includes tests of vision, motor function, and cognition. Design Cross‐sectional observation study. Setting Memory assessment outpatient clinic of a university hospital. Participants Drivers with normal cognition (n = 47) and cognitive impairment (n = 75). Measurements A neurologist completed the ADR e S during an office visit. Additional cognitive tests of executive, visuospatial, and visuomotor function were also performed. On a separate day, participants completed a standardized on‐road test, assessed by a professional driving instructor using a global safety rating and a quantitative driving score. Results In this sample of currently active older drivers with and without cognitive impairment, measures of cognition—particularly the T rail‐ M aking T est P art B —were more highly correlated with driving scores than other measures of function. Using recommended scoring procedures, the ADR e S had a sensitivity of 0.81 for detecting impaired driving on the road test, with a specificity of 0.32 and an area under the receiver operating characteristic curve ( AUC ) of 0.57. A logistic regression model that incorporated computerized maze task and M ini‐ M ental S tate E xamination scores improved overall classification accuracy, yielding a sensitivity of 0.61, a specificity of 0.84, and an AUC of 0.80. Conclusion In its present form, the ADR e S 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 ADR e S are needed for general office practice.