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Driving and the older adult
Fitness to drive depends on function, not age: vision, cognition (attention, executive function, visuospatial skills), movement and medications; the doctor identifies risk signs, treats what can be treated, and in Israel must notify the Medical Institute for Road Safety about a driver whose medical condition may endanger others.
Why it matters in the exam
The exam presents an older adult with mild dementia whose family reports that he got lost while driving and that there are new scratches on the car, and asks what to do: assess driving risk, talk with the patient and family, refer for a practical driving assessment and report as the law requires. In moderate or worse dementia — the patient is not fit to drive.
Risk signs that are asked about, according to the American Academy of Neurology: a CDR rating of 1 or more, a family member's report of unsafe driving, crashes or fines, self-restriction of driving and an MMSE of 24 or less. Other conditions: reduced visual acuity or field, stroke with neglect, seizures, unexplained syncope, sedating drugs, weakness or neck restriction.
Older adults usually drive carefully and limit driving at night, in rain and on fast roads, but declining vision, attention and reaction time increase the risk of crashes at junctions and turns. Stopping driving is linked to isolation, depression and reduced activity, so advice to stop driving comes together with a plan for alternative transport and for keeping social contacts. The conversation is sensitive and is best held with a family member present.
A periodic eye test is an important part of following up an older driver.
Key points
- Fitness to drive depends on function, not age.
- Vision, cognition, movement and medications.
- Risk signs in dementia: CDR of 1 or more, family report, crashes, MMSE of 24 or less.
- Moderate dementia — does not drive.
- In Israel: the doctor must notify the Medical Institute for Road Safety.
Summary table
| Domain | What is checked | Risk sign |
|---|---|---|
| Vision | Acuity and visual field | Cataract, glaucoma, AMD, visual neglect |
| Cognition | Attention, executive function, spatial skills (for example clock drawing, Trail Making) | Moderate dementia — does not drive |
| Family report | Getting lost, scratches on the car, near misses | A strong risk sign |
| Movement | Strength, neck range of motion, reaction time | Restriction that prevents looking back |
| Drugs and diseases | Sedating drugs, seizures, syncope, hypoglycaemia | Treat or adjust before returning to driving |
| Law in Israel | Physician notifies the Medical Institute for Road Safety | Mandatory when a medical condition may endanger driving |
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Sources
- Israeli Traffic Ordinance — physician's duty to report a driver medically unfit to drive (section 12A) and the Medical Institute for Road Safety, current version — Reporting and fitness to drive
- American Academy of Neurology practice parameter update — Evaluation and management of driving risk in dementia, 2010 — Risk indicators
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — The older driver
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.