Cognitive testing of older drivers is one of the questions I am asked most often by drivers and their families. Many people believe that reaching age 80 automatically means taking a memory test or losing their driver's licence. In British Columbia, drivers must complete a Driver's Medical Examination beginning at age 80, but cognitive testing is only one part of the medical assessment when it is considered appropriate.
Cognitive screening tests help physicians evaluate whether changes in memory, attention, judgment or other thinking skills could affect a person's ability to drive safely. These tests are screening tools, not driving tests, and the results are considered together with medical history, examination findings and overall functional ability.
The following examples are based on the SIMARD MD, one cognitive screening tool that has been used to assess thinking skills related to driving. I have encountered it frequently in central Vancouver Island through feedback from participants attending my Road Safety for Seniors presentations.
According to the University of Alberta, the SIMARD MD was developed and evaluated against actual driving performance using a scientifically designed driving evaluation intended to identify cognitively impaired drivers who may be unsafe to drive.
What Happens During a Cognitive Screening Test?
The SIMARD MD evaluates several mental abilities associated with safe driving, including memory, concentration, language ability and problem-solving. The test consists of four exercises.
Word Recall
The examiner slowly reads a list of ten words to the person being assessed. After all the words have been read, the person is asked to repeat as many of the words as they can remember in any order. This exercise is then repeated using the same word list.
Number Conversion
The second exercise evaluates the ability to convert information from one form to another. The person is given a list of numbers and asked to write each number as a word. For example, the number 5 would be written as five.
Verbal Fluency
The third exercise asks the person to name as many different items as possible that could be purchased in a supermarket within one minute. The maximum score is achieved by identifying thirty distinct items.
Delayed Recall
The final exercise returns to the original list of ten words. The person is asked to recall as many of those words as possible without being shown the list again.
Why Are Older Drivers Given Cognitive Tests?
Driving is one of the most complex everyday tasks that people perform. It requires attention, memory, judgment, visual processing and the ability to make quick decisions. Cognitive screening helps identify medical conditions that may affect these abilities before they result in unsafe driving.
While these exercises may appear simple, they assess mental abilities that are important for driving safely. Drivers must be able to remember information, divide attention between several tasks, make decisions quickly and respond appropriately to changing road conditions.
Cognitive screening can help a physician decide whether a person appears medically fit to continue driving or whether additional assessment is needed. A screening result is only one piece of information in the overall medical fitness to drive evaluation.
A cognitive test is not a road test and a lower score does not automatically mean that someone will lose their driver's licence. The purpose of screening is to identify situations where further assessment may be appropriate.
Limitations of Cognitive Screening Tests
Research has questioned whether the SIMARD MD should be used as a stand-alone predictor of driving safety. For this reason, medical professionals generally consider cognitive screening results together with other clinical information rather than relying on a single test.
How RoadSafetyBC Uses Cognitive Screening Results
Current RoadSafetyBC guidance emphasizes that no single cognitive screening test should be used on its own to determine whether a person is medically fit to drive. Depending on the patient's medical condition, physicians may use tools such as the Montreal Cognitive Assessment (MoCA), Trail Making Test, Standardized Mini-Mental State Examination (SMMSE), the Global Deterioration Scale (GDS), or other recognized assessments as part of a comprehensive medical evaluation.
When concerns remain about a person's ability to drive safely, RoadSafetyBC may request additional medical information or require further assessment, including a functional driving evaluation.
Medical fitness decisions are based on the individual's overall condition and ability, not simply their age.
Frequently Asked Questions About Cognitive Testing of Older Drivers
Do all drivers take a cognitive test when they turn 80?
No. Drivers are required to complete a Driver's Medical Examination beginning at age 80, but the physician or nurse practitioner determines whether cognitive screening is appropriate.
Can I lose my driver's licence because of one cognitive test?
No. Cognitive screening is only one part of the assessment process. Licensing decisions are based on all available medical information.
Can younger drivers be asked to complete cognitive testing?
Yes. Cognitive concerns can occur at any age. A physician may recommend testing whenever a medical condition raises concerns about driving ability.
What should families do if they are concerned about an older driver's ability?
Families should discuss their concerns with the driver's physician or nurse practitioner. Early assessment can help identify problems while allowing many people to continue driving safely.
Cognitive screening helps physicians make informed decisions about medical fitness to drive. Most older drivers remain safe drivers for many years, and these assessments are intended to support safe mobility rather than remove driving privileges simply because someone reaches a certain age.
Most older drivers continue to drive safely for many years. Cognitive screening is intended to help physicians identify medical conditions that may affect driving ability while allowing people who remain medically fit to continue driving safely. Decisions about licensing are based on the overall medical evidence rather than age alone.
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Given my recent experience with my partner being diagnosed with Alzheimer's by a medical test from his doctor, I believe that 100 percent of the drivers would benefit from a reputable driving school test. Say every three years over the age of 60.
For the past five years I have been trying to get my partner to give up driving and for the past two years I would not be in the car with him unless I was driving. No one would listen to me.
Finally my partner smashed the car and lost his licence. Luckily, I was not there and no one was hurt in the other car. We now have no car and I am not going to replace it.
If he had taken a driving lesson(s) perhaps it would have benefited both of us.
He is 84 and I am 87. I am sure there are many spouses in my situation who are afraid to get in the car if their spouse is driving and afraid to say anything or don't know where to get help.
I am not sure if your GP alone should bear this responsibility.
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Is this still the case?
My grandma is turning 80 and she is asking me to find out what she will need to do.
Could you let me know the steps.
It seems like you are saying she needs to go to her doctor and ask for a medical exam to prove she is fit to drive.
That should be all that is needed unless the medical exam isn't great, in that case she needs to pass a Simard test?
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This article is simply an explanation of one test that doctors in BC use to help determine the cognitive ability of their patients in connection with an examination of their ability to drive a motor vehicle.
That examination, a Driver's Medical Examination Report (DMER), is sent to licensed BC drivers by RoadSafetyBC at age 80 and every two years after that unless there is an identified need for it to occur more often.
Based upon the DMER and other information such as traffic ticket history, collision history or unsolicitied driver fitness reports, RoadSafetyBC may choose to refer a driver to ICBC for an Enhanced Road Assessment or simply take action to limit or prohibit the person's ability to drive.
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I would like to add my two bits worth on this topic, as I am approaching 80.
Regarding the test:
Language: Does the test have to be in English? Can it be in any language of choice? If not, why not? Are we required to be fluent in English in order to drive a car in our old age?; (Does the charter of rights apply here?)
I have a number of elderly friends who have never mastered English, and they are likely to stumble on the test for this reason.
Memory test on 10 words: I have always had a problem remembering words, particularly names. Sometimes to embarrasment. However, I have a propensity for remembering numbers with considerable ease, such as telephone numbers. Accordingly, I could potentially fail this part of the test. This condition has not prevented me from working successfully for 50 yrs, or driving my car without accidents. So, why not allow a choice of say words or numbers? What is so definitive about words? What is wrong with using 10 numbers?
Listing 30 items purchasable from a super market, and under 1 minute: let's take the case of my brother, approaching 80. He has never shopped for groceries in his life, let alone done any cooking at home. This doesn't suggest that he doesn't know what a tomato is, or a potato, but my guess is that, confronted with a 1 minute time factor, he would probably get as far as bread, eggs and bacon, and butter..sugar, tea and milk (which kind of summarizes his meals). So, what is so unique about this part of the test, or perhaps is this simply a very unfair test. My brother has worked all his life and driven without accidents.
I think the Simard test is palpably wrong. It emmanated from a university husband and wife team, as a nice side line business, and the university backdrop is taken by the provinces as being gospel, or perhaps it removes the onus from their shoulders when it comes to dealing with elderly drivers. But don't get me wrong. Yes, as we get older, driving a car has significant liabilities for us seniors. And we need to stop driving when the time is right. For me, the Simard test is not a good way to weed out seniors, as exampled above. I am keeping my fingers crossed that my doctor will find me fit and capable to continue driving when I hit 80 and thus not have to take the Simard test.
I rest my case, and look forward to any replies or comments
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Given my recent experience…