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The editorial on driving and seniors1 addresses some of the problems that are often overlooked when discussing driving assessment for senior citizens. People are often even more dependent on being able to drive than when they were younger and more able to walk and take public transportation.
One of the most difficult problems is deciding when a patient with cognitive impairment is no longer safe to drive. Routine neuropsychology tests are probably not going to detect borderline cases, and everyone who has memory problems is not necessarily a safety risk. In my mind, the gold standard is a lengthy on-road driving test. There was a time when governments covered this but it is now downloaded to private companies, who charge between $500 and $800. One idea that I have never heard discussed is having the insurance companies pay for testing. When you have a major accident or loss of life they pay thousands if not millions. Why do they not insist that they first assess your driving abilities and make a risk assessment before they insure you?
For the full letter, go to: www.cmaj.ca/cgi/eletters/cmaj.100273v1#321774