Medical fitness to drive assessment with older drivers: A qualitative study with general practitioners in New Zealand

Introduction: Along with ageing populations, highly-motorised countries have increasing numbers of ageing older drivers. In many of these jurisdictions, health practitioners are responsible for undertaking the screening of older drivers, via medical assessment of fitness to drive (FtD), to ascertain suitability to continue to hold a driver's licence. In New Zealand, all older drivers are required to have a medical FtD assessment at ages 75 years, 80 years and then biennially. This study aims to understand the experience of the assessment practice from the perspective of general practitioners (GPs) responsible for conducting medical FtD assessments. Methods: Interpretive description qualitative methodology was used to guide the research. Design: and data analysis. GPs were purposively sampled and interviewed until saturation of themes was reached (N = 10, 40% rural practitioners). Results: The results indicate that GPs use the FtD assessment as a way of staging a clinical conversation about mobility and driving cessation. But the assessment process challenges a patientcentric approach and can impact GPs' relationships with patients. GPs reported differences in use of tools, such as driving restrictions, to support patients near the end of their driving careers. Access issues were a substantive barrier to the use of specialist driving assessments. Conclusions: GPs carrying out medical FtD assessment in the clinical setting is not evidence-based, but continues to be used in some jurisdictions, including NZ. The assessment process is problematic because it is not patient-centred and can give rise to breakdowns in clinical relationships. This study also demonstrates a lack of training and support for GPs working with patients toward the end of their driving careers. A knowledge and information gap exists among GPs, limiting their capacity to provide best practice FtD assessments and mobility counselling for older adults.