The assessment of cognitive function and medical fitness to drive in older adults: A qualitative study with general practitioners

The increasing ageing population has led to a pressing need to develop standardised measures and guidelines for assessing cognitive fitness to drive. With the onus of annual medical assessments for driving falling on general medical practitioners (GPs) in Australia, there is a need to explore their experiences and opinions regarding such assessments. This qualitative study explored the perceptions, opinions and experiences of GPs regarding the assessment of older drivers, with a particular emphasis on the assessment of cognitive function. Six registered GPs within Australia participated in an anonymous telephone interview. Following a constructivist grounded theory approach, themes were generated using gerunds. A total of 5 themes were developed from the data: (1) pre-empting: planting the seed and softening the blow, (2) maintaining the doctor-patient relationship and deflecting pressure, (3) satisficing: doing the best we can with imperfect knowledge whilst balancing competing demands, (4) learning from experience versus formal training and (5) seeking standardised procedures and policy guidance. The findings highlight that medical assessments for driving are complex and challenging for GPs, particularly in terms of screening for cognitive fitness to drive. The need for evidence-based approaches for assessing cognitive fitness to drive, standardised procedures and formal training for cognitive assessments, were emphasised. • Forewarning and planning helps the patient to prepare for driver retirement. • GPs refer to other health practitioners for advice and to deflect pressure. • GPs make decisions to the best of their ability, given available information. • GPs would like formal training and more information on assessing cognitive function. • There is a need for standardised procedures for assessing cognitive fitness to drive.