Assessment of Older People's Health and Social Care Needs and ...

Table 3: Process of clinical driving assessment1. History:• patient, family/informant• driving history• medications2. Examination:• functional status• vision• mental status testing3. Diagnostic formulation and prioritisation.4. Remediation.5. In-depth cognitive/perceptual testing.6. On-road assessment.7. Overall evaluation of hazard:• strategic• tactical• operational8. Advice to patient/carer:• driving• insurance• licencing authority10. If driving too hazardous, consider alternative mobility strategies.A cascade system for interdisciplinary assessment is probably the most cost-effective way toapproach the patient (Table 4). For example, if the physician detects visual acuity below thestandard for the jurisqiction, referral to an ophthalmologist and maximal remediation of vision shouldoccur before returning to the assessment cascade. Similarly, should a patient in the European Unionhave a homonymous hemianopia (one of the few absolute medical contra-indications to driving), thenreferral to the social worker for developing strategies for alternative transportation is the next step inthe cascade.Assessment of Older People's Health and Social Care Needs and Preferences