• Dr. Felicia Presenza MD CCFP

To Drive or Not to Drive: How to Make the Call


  1. List TWO classes of medication that can affect ability to drive, other than opioids.

  2. List FIVE history questions to determine whether a patient can drive.

  3. List the gold standard for driving ability assessment.

Answers are in the blog post below.

Dementia and Driving

Drivers with dementia are at an increased risk of crashes. If driving SAFETY is suspected, use the mnemonic SAFE-DRIVE and use the following questions to make your assessment:

S – Safety record: In the last year, have you had any accidents or near misses or tickets for driving violations (driving too slowly, failure to stop)?

A – Attentional skills: Have there been occasions where you have gotten lost or have been unable to find your way?

F – Family report: (Ask patient's family member) Would you feel comfortable with your children being a passenger when the person is driving?

E – Ethanol: What is your alcohol intake?

D – Drugs: Let’s review your medications to make sure we aren’t prescribing anything that could be affecting your cognition and driving skills (Benzos, anticholinergics, excessive opioids).

If alarm features are present, ask the patient to return for a full exam and look for RIVE:

R – Reaction time: Perform neurologic and musculoskeletal screen.

I – Intellectual impairment: Complete MMSE.

V – Vision: Test for visual acuity.

E – Executive function: Trails A and B, clock draw, pentagon draw/cube draw.

What is the gold standard test if your assessment is not clear?

  • comprehensive on-road assessment

Moderate or severe dementia is a contraindication to driving (inability to perform 2 or more (ADLS or any basic ADL).

Patients with mild dementia should be reassessed q 6-12 months

USEFUL RESOURCES: Wiseman EJ, Souder E. The older driver: a handy tool to assess competence behind the wheel. Geriatrics 1996;51:36-45.

CMA Driver's Guide https://shop.cma.ca/products/dg9d (Free for CMA members at time of writing)

CCMTA Medical Standards for Drivers http://ccmta.ca/images/publications/pdf/Determining-Driver-Fitness-In-Canada-Final.pdf

Highly Rated - Thousands of Attendees
  • Facebook
  • Twitter
  • Instagram

© The Review Course in Family Medicine Inc. | About Us | Privacy Policy

The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.