A Meta-analysis of Brief, Non-computerized Cognitive Screening Tools for Predicting Unsafe Driving Among Older Adults

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Ward Vanlaar, PhD Anna McKiernan Heather McAteer Robyn Robertson, M.C.A. Daniel Mayhew, M.A. Steve Brown Erin Holmes David B. Carr, MD http://orcid.org/0000-0003-2641-3850


Seniors represent the fastest growing population group in Canada and the United States. Given the expected increase in elderly drivers with dementia, efficient and effective screening for cognitive impairment will become more important. In light of this need, the objective of this study was to systematically review and meta-analyze the literature for brief, non-computerized cognitive screens that were evidenced-based and could be easily adopted in a driver license renewal or fitness-to-drive setting to determine their predictive value to identify unsafe driving. Studies were considered that examined road tests, driving simulator assessment or motor vehicle crashes as primary outcomes and 9 studies identifying 10 separate tests were identified based on our inclusion criteria. A small to medium-sized, significant pooled effect of 1.94 was found, meaning that on average, when cognitive screening tools predict a driver is unsafe, there is a 94% greater chance that this driver will indeed exhibit unsafe driving behavior. These results suggest that brief, paper and pencil cognitive screens may be feasible and efficiently adopted either during routine license renewal or during fitness to drive evaluations. Further studies are warranted in regards to their acceptability, reliability and validity before widespread dissemination.

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VANLAAR, PHD, Ward et al. A Meta-analysis of Brief, Non-computerized Cognitive Screening Tools for Predicting Unsafe Driving Among Older Adults. Medical Research Archives, [S.l.], v. 5, n. 4, apr. 2017. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1035>. Date accessed: 19 july 2024.
cognitive screening; meta-analysis; older drivers; elderly drivers; multilevel model
Research Articles


Anstey, K. J., Wood, J., Lord, S., & Walker, J. G. (2005). Cognitive, sensory and physical factors enabling driving safety in older adults. Clinical Psychology Review, 25(1), 45-65. doi:10.1016/j.cpr.2004.07.008

Ball, K., Roenker, D. L., Wadley, V. G., Cissell, G., Mathews, M., Ball, D., . . . McConnell, K. (2005). Longitudinal Assessment of Older Drivers in a DMV Setting. Paper presented at the Driving Assessment 2005: International Driving Symposium on Human Factors in Driving Assessment, Training and Vehicle Design, Rockport, Maine.

Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J. D., Roth, D. L., McGwin, G., Jr., . . . Dube, T. (2006). Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? J Am Geriatr Soc, 54(1), 77-84. doi:10.1111/j.1532-5415.2005.00568.x

Bedard, M., Weaver, B., Dārzin, P., & Porter, M. M. (2008). Predicting driving performance in older adults: we are not there yet! Traffic Injury Prevention, 9(4), 336-341.

Borenstein, M., Hedges, L. V., Higgins, J., & Rothstein, H. R. (2009). Introduction to Meta-Analysis. West Sussex, United Kingdom: Wiley Online Library.

Carr, D. B., Barco, P. P., Wallendorf, M. J., Snellgrove, C. A., & Ott, B. R. (2011). Predicting road test performance in drivers with dementia. J Am Geriatr Soc, 59(11), 2112-2117. doi:10.1111/j.1532-5415.2011.03657.x

Carr, D. B., & Ott, B. R. (2010). The older adult driver with cognitive impairment: "It's a very frustrating life". Journal of the American Medical Association, 303(16), 1632-1641. doi:10.1001/jama.2010.481

DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled clinical trials, 7(3), 177-188.

Dobbs, A. R. (2013). Accuracy of the DriveABLE cognitive assessment to determine cognitive fitness to drive. Canadian family physician, 59(3), e156-e161.

Dobbs, B. M. (2005). Medical Conditions and Driving: Current Knowledge, Final Report. Association for the Advancement of Automotive Medicine. Retrieved from NHTSA Publication:

Egger, M., Smith, G. D., & Altman, D. (2008). Systematic reviews in health care: meta-analysis in context: John Wiley & Sons.

Foley, D. J., Masaki, K. H., Ross, G. W., & White, L. R. (2000). Driving cessation in older men with incident dementia. Journal of the American Geriatrics Society, 48(8), 928-930.

Grabowski, D. C., Campbell, C. M., & Morrisey, M. A. (2004). Elderly licensure laws and motor vehicle fatalities. Journal of the American Medical Association, 291(23), 2840-2846.

Hakamies‐Blomqvist, L., Johansson, K., & Lundberg, C. (1996). Medical Screening of Older Drivers as a Traffic Safety Measure—A Comparative Finnish‐Swedish Evaluation Study. Journal of the American Geriatrics Society, 44(6), 650-653.

Harbord, R., & Whiting, P. (2009). Meta-analysis in Stata: an updated collection from the Stata Journal.

Hopkins, R. W., Kilik, L., Day, D. J., Rows, C., & Tseng, H. (2004). Driving and dementia in Ontario: A quantitative assessment of the problem. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 49(7), 434-438.

Insurance Information Institute Inc. (2015). Older Drivers. Retrieved from http://www.iii.org/issue-update/older-drivers

Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R., & Schimmel, H. (1983). Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. The American journal of psychiatry, 140(6), 734-739.

Martin, A. J., Marottoli, R., & O’Neill, D. (2013). Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database Syst Rev, 8.

Mathias, J., & Lucas, L. (2009). Cognitive predictors of unsafe driving in older drivers: a meta-analysis. International psychogeriatrics, 21(04), 637-653.

McGwin, G., Sarrels, S. A., Griffin, R., Owsley, C., & Rue, L. W. (2008). The impact of a vision screening law on older driver fatality rates. Archives of ophthalmology, 126(11), 1544-1547.

Palmer, T. M., Peters, J. L., Sutton, A. J., & Moreno, S. G. (2008). Contour-enhanced funnel plots for meta-analysis. Stata Journal, 8(2), 242.

Raedt, R., & Ponjaert‐Kristoffersen, I. (2000). The relationship between cognitive/neuropsychological factors and car driving performance in older adults. Journal of the American Geriatrics Society, 48(12), 1664-1668.

Rasbash, J., Charlton, C., Browne, W.J., Healy, M. and Cameron, B. (2012). MLwiN Version 2.26. Centre for Multilevel Modelling, University of Bristol.

Retchin, S. M., & Hillner, B. E. (1994). The costs and benefits of a screening program to detect dementia in older drivers. Medical Decision Making, 14(4), 315-324.

Robertson, R., & Vanlaar, W. (2008). Elderly drivers: Future challenges? Accident Analysis & Prevention, 40(6), 1982-1986.

Schanke, A. K., & Sundet, K. (2000). Comprehensive Driving Assessment: Neuropsychological Testing and On‐road Evaluation of Brain Injured Patients. Scand J Psychol, 41(2), 113-121.

Sharp, S. (2009). Meta-Analysis Regression. In J. A. C. Stern (Ed.), Meta-Analysis In Stata: An Updated Collection From The Stata Journal (pp. 97-106). College Station, Texas: Stata Press.

Staplin, L., Gish, K. W., Lococo, K. H., Joyce, J. J., & Sifrit, K. J. (2013). The Maze Test: A significant predictor of older driver crash risk. Accident Analysis and Prevention, 50, 483-489. doi:10.1016/j.aap.2012.05.025

Staplin, L., Gish, K. W., & Wagner, E. K. (2003). MaryPODS revisited: updated crash analysis and implications for screening program implementation. Journal of Safety Research, 34(4), 389-397.

StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.

Sterne, J. (2009). Meta-analysis in Stata: an updated collection from the Stata Journal. Meta-Analysis In Stata: An Updated Collection From The Stata Journal-9781597180498-52, 88.

Stutts, J., Stewart, J., & Martell, C. (1998). Cognitive test performance and crash risk in an older driver population. Accident Analysis and Prevention, 30(3), 337-346.

Sutton, A. J., Abrams, K. R., Jones, D. R., Jones, D. R., Sheldon, T. A., & Song, F. (2000). Methods for meta-analysis in medical research: J. Wiley Chichester; New York.

Vanlaar, W. (2005). Multilevel modeling in traffic safety research: two empirical examples illustrating the consequences of ignoring hierarchies. Traffic Injury Prevention, 6(4), 311-316.

Vanlaar, W., Hing, M. M., Robertson, R., Mayhew, D., & Carr, D. (2016). An evaluation of Ontario's Group Education Session (GES) for license renewal of seniors aged 80 and above. Journal of Safety Research, 56, 33-39. doi:10.1016/j.jsr.2015.11.009

Vanlaar, W., McKiernan, Anna, McAteer, Heather, Robertson, Robyn, Mayhew, Dan, Carr, David. (2014). Cognitive Screening Tools for Predicting Unsafe Driving Behavior Among Senior Drivers: A Meta-Analysis. Paper presented at the International Annual Meeting of the Human Factors and Ergonomics Society, Chicago, Illinois, USA.

Weaver, B., Walter, S. D., & Bedard, M. (2014). How to report and interpret screening test properties: Guidelines for driving researchers. Traffic Injury Prevention, 15(3), 252-261.

Whelihan, W. M., DiCarlo, M. A., & Paul, R. H. (2005). The relationship of neuropsychological functioning to driving competence in older persons with early cognitive decline. Archives of Clinical Neuropsychology, 20(2), 217-228.