Adherence to guidelines when evaluating fitness-to-drive in the elderly: a practice review of Swiss physicians
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Summary
This study investigates the extent to which general practitioners (GPs) in Western Switzerland adhere to national guidelines when assessing the fitness-to-drive of elderly patients. The research was motivated by the increasing number of older drivers and the potential safety risks associated with age-related medical declines, such as cognitive or visual impairment. Although Swiss regulations require medical examinations for drivers over 70, existing recommendations are scattered, largely based on expert opinion rather than evidence, and their actual implementation in clinical practice was previously unknown. The researchers conducted a practice review using a paper-based self-completed survey distributed in 2017. The study population included a random sample of 500 GPs from the cantons of Vaud, Neuchâtel, and Jura, along with all 69 certified medical assessors ("experts") from Geneva. Participants reported the frequency with which they performed 20 specific assessment procedures during the previous year, using a five-point Likert scale. Adherence was defined as reporting a procedure was "often" or "always" performed. Statistical analyses compared adherence rates between general GPs and experts, adjusting for sociodemographic factors. Of the 569 invited physicians, 268 completed the survey (47% participation rate). The results revealed significant variation in adherence. The most frequently performed procedures included asking for current medication lists (96%), history of cardiovascular (94%) and neurological diseases (91%), and screening for visual acuity impairment (93%). Conversely, critical assessments were rarely conducted: screening for cognitive impairment in drivers aged 70–80 was performed by only 44% of GPs, screening for mood disorders by 31%, asking for history of license withdrawal by 38%, and interviewing close relatives by just 10%. While most GPs used standardized clinical tests for visual and gait assessments, validated tools were rarely used for screening at-risk drinking (26%) and mood disorders (28%). Experts demonstrated statistically significantly higher adherence than other GPs for six specific procedures, including screening for visual field impairment, neurological history, antidiabetic drug use, gait and balance, traffic accident history, and diplopia. The study concludes that many Swiss GPs do not systematically follow current recommendations for assessing older drivers' fitness-to-drive. While basic medical history and visual screenings are routine, essential evaluations of cognitive status, mood, and social context are frequently omitted. The findings suggest a need for further research to understand why certain guidelines are ignored and to develop strategies to facilitate the consistent use of recommended procedures, thereby improving the accuracy of fitness-to-drive decisions and road safety.
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| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | DOAJ | — | — | 1 | 2026-06-25 |
| archive | success | unpaywall | — | — | 1 | 2026-06-26 |
| extract | success | cached | — | — | 2 | 2026-06-26 |
| clean | success | clean | — | — | 1 | 2026-06-25 |
| chunk | success | chunk | — | — | 1 | 2026-06-25 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-25 |
| promote | success | — | — | — | 1 | 2026-06-25 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 1 | 2026-06-26 |
| tag | success | vector_similarity | — | — | 6 | 2026-06-25 |
| verify | success | — | — | — | 1 | 2026-06-26 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified.
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- Methodological Resource: validation psychometrics