20 February 2024

While many older Australians value the independence of driving and continue to do so safely throughout their lives, for others, the changes that occur with aging may take them off the road.

Changes in our vision, hearing, mobility and cognitive abilities, such as processing speed, memory and executive function, can impact on our ability to drive safely.1,2

This story is part of our 10 of the Best - fourteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.

'We observe quite big changes in cognition with normal aging, and then on top of that you have eye diseases, cataracts, glaucoma and age-related macular degeneration,' says Professor Kaarin Anstey, a pioneer in the study of ageing, who focuses on the consequences and prevention of cognitive ageing and dementia.

Professor Kaarin Anstey
Professor Kaarin Anstey

Driver health and fitness to drive are critical in supporting the safety of Australians who use the roads, and screening tests for over 75s are part of this in some Australian states. However, Professor Anstey and her colleagues have found that despite several tests being marketed for this purpose, none had a strong evidence base.

Over a decade, Professor Anstey and her colleagues developed a brief off-road test, Multi-D, as a cost-effective and objective tool to screen older drivers. The Multi-D test assesses multiple abilities, including complex reaction time and executive function, good balance, and motion detection, making it highly relevant and sensitive to age-related changes that may affect driving performance. The test was designed to be used in both clinical and driver assessment settings to identify candidates who may require a referral for an on-road test.

Professor Anstey and her colleague, Professor Joanne Wood, received NHMRC funding to validate the Multi-D test, alongside seven others, against an on-road driving test. This was the first time a single study validated multiple tests simultaneously against the costly on-road driving test.

'No one had actually got all the tests together and said, ‘Let's put them all under the same conditions, same people, against the same outcome’ and that's what we did in this study,' Professor Anstey says.

The research team recruited 560 drivers from Canberra and Brisbane, aged between 63 and 94 years old who were potentially at risk of being unsafe drivers due to visual, cognitive or medical problems. The participants took each of the eight off-road driving tests before completing the on-road driving test with an occupational therapist. The study concluded that off-road screening tests could reliably identify older drivers who have a strong probability of failing the on-road driving tests and those who are likely to continue driving safely.

'Ultimately, the more accurate we are at identifying unsafe drivers of all ages, not just older adults, and intervening, the better,' Professor Anstey says.

'We want to prevent injury and crashes.'

Next steps

Professor Anstey is now looking to commercialise the test to allow for its implementation. She is also conducting her third intervention to improve older driver safety, an NHMRC-funded randomised control trial, to assess the effectiveness of education types on safety outcomes for older adults. The relative effectiveness of tailored lessons, road-rule workshops and tailored feedback on on-road driver performance will be assessed.

'There is a whole group of people who we feel would benefit from an intervention to improve their safety to enable them to keep driving. They're not going to fail a driving test, but we know we can make them safer on the road through an intervention.'

'Consumers want to be responsible and do some driving training, but it has to be evidence-based.'

The ‘Better Drive Trial’ was a result of participant feedback, and a consumer need for an intervention.

2Harada CN, Natelson Love MC, Triebel KL. Normal cognitive aging. Clin Geriatr Med. 2013 Nov;29(4):737-52. doi: 10.1016/j.cger.2013.07.002. PMID: 24094294; PMCID: PMC4015335.