A shift away from routine mandatory cognitive testing in a GP fitness to drive assessment represents a major change to the testing process for many senior drivers throughout New Zealand.
This was among several changes agreed on at a meeting in July between the New Zealand Transport Association (Waka Kotahi), the Ministry of Health, the Royal New Zealand College of GPs, and the Office for Seniors.
What guidance have GP’s received on use of routine cognitive testing?
Health Pathways is an online clinical information service provided through Health NZ, that is used by health professionals at the point of care. The pathway called “Driver Medical Certificate” has been updated and made available to all GPs nationwide in mid August.
The relevant content is this pathway states the following:-
Consider office-based cognitive assessment, eg Mini-ACE if there are concerns about cognitive function or the patient is not known to you and appears to have cognitive difficulty and there is no available past or collateral history to reassure you that there is no significant cognitive decline.
- Routine screening for cognitive impairment is not recommended or indicated for driver medical.
- There is no screening tool currently available to determine cognitive fitness to drive.
Going forward seniors due for assessment, are advised:
- That it is best to see a health professional from their usual practice, someone who knows them and their medical history well.
- If the GP or nurse practitioner providing the assessment doesn’t know the person well, they may screen for cognitive impairment especially if they don’t have enough information to be certain there is no impairment.
- If screening identifies cognitive impairment, then there will be further assessment to decide if driving is affected. This might be an on-road safety test (ORST) or an occupational therapy driving assessment. See more on the NZTA website
NZTA have advised that their medical team will not process a licence revocation if the only reason on the medical certificate is a cognitive screening score, in that case the team will follow-up with the GP, and will not automatically revoke the licence.
As we are aware that some of our members have had their licence revoked due to a failed cognitive test, with no other medical issue identified, NZTA is prepared to review the case of drivers who meet these criteria, and would like to now have their licence considered for re-instatement. If the review finds that the licence should not have been revoked, there will still be a need for a new medical certificate confirming fitness to drive prior to re-instatement.
If you feel that you are in this category and want a review, please provide your contact details and the date that your licence was revoked, purely because of a failed cognitive test at the GP practice.
Call our office on 09 299 2113 or email to fedoffice@greypower.co.nz with the subject “Driving Licence Review”. These will be processed on a first come basis, after ensuring that each one meets the strict criteria of eligibility for review.
What health practitioners might discuss with older drivers
- Safe driving depends on many factors – memory, attention, vision, physical abilities, reaction time and overall health. All areas will be looked at together.
- Tests of thinking and memory can help spot concerns but medical history, vision, physical abilities, and feedback from family or support people are also considered.
- If there’s uncertainty about safety on the road, based on the tests done at the clinic, an on-road safety test (ORST) is the best way to check current driving skills.
- The decision regarding fitness to drive is a clinical one, bound by statutory responsibilities. Input and preferences from senior drivers matter in order to make decisions which are fair and safe.
It is important to remember:
- As we age, changes in health, vision, and thinking can affect driving safety. A doctor’s role is to keep seniors (and others) safe on the road while supporting their independence.
- A health condition may not necessitate loss of licence to drive. Many people with health conditions can still drive safely. Decisions are made based on overall health and driving ability, not just a diagnosis.
- If seniors are not fit to drive their health practitioner is legally required to inform NZTA of this in writing. See NZTA’s website about driving alternatives.
