Usefulness of off-road screening tests to licensing authorities when assessing older driver fitness to drive.

INTRODUCTION: There is a growing interest in quick and convenient, off-road tests of fitness to drive to assist licensing authorities in identifying the minority of older drivers at heightened crash risk. Two screening tests have been identified and assessed for their usefulness in a licensing context.
METHOD: The research literature has been examined to identify available evaluation evidence relating to the two tests. In particular, studies that have quantified any association between test results and crash involvement in terms of relative risk have been analyzed for licensing implications.
RESULTS: Performance on two tests--UFOV and MaryPODS--has been shown to have a consistent and statistically significant association with crash risk, including at-risk crashes. Overall, poor test performance has been associated with a two times or higher relative risk of crash involvement on both retrospective and prospective bases. This statistical association is seen as a necessary first step in further developing off-road screening tests. It is demonstrated, however, that the tests are presently too inaccurate to be used as a form of age-based assessment on a simple pass/fail basis and would result in large numbers of older drivers being needlessly taken from the road. It is also argued that these tests may hold promise when used for preselected groups of at-risk older drivers and when used to produce a threefold outcome ("pass," "'fail," and "uncertain, requiring further assessment").
CONCLUSIONS: At this time, no off-road screening test of fitness to drive currently can be justified if applied on a simple pass/fail basis to all drivers reaching a threshold age, as the sole determinant of licensing status.