Initial Feasibility and Criterion Validation of an Electronic, Self-Administered, Geriatric Assessment to Facilitate Fitness-To-Drive Evaluations in Older Adults

Background: Geriatric assessments are considered the gold standard for the medical evaluation and management of older adult patients' even though the time required for administration, and additional logistical challenges, has impeded widespread adoption in clinical care. Objective: The current study examines the initial feasibility and criterion validity of a brief, electronic, self-guided (BES) geriatric assessment designed to capture multiple medical and non-medical aspects of a comprehensive geriatric assessment including informing medical fitness-to-drive determinations. Methods: Data was obtained from 49 older adult drivers (34 female, 15 male) aged 50-85. Feasibility was evaluated by determining the ability of older adult drivers to complete the BES geriatric assessment remotely without assistance. Criterion validity was assessed by comparing self-reported responses on the BES geriatric assessment to their responses during a subsequent clinician-led consultation with a geriatrician. Validity was operationalized as concordance (proportion of items requiring no correction) and comprehensiveness (frequency and nature of supplementary details elicited during the clinical interview). Results: Our results support the BES geriatric assessment being a feasible and valid mechanism for the collection of medical and non-medical data related to a comprehensive geriatric assessment used as part of a fitness-to-drive evaluation. All 49 participants successfully completed the BES geriatric assessment without assistance, supporting feasibility of self-administration in this population. Self-reported digital responses demonstrated concordance with clinician-verified data (accuracy: 100%, 95% CI: 92.7%-100%). The geriatrician-led consultation elicited 41 supplementary items across 26 participants (53.1%) that provided additional contextual detail to reported events. All contextual clarifications were consistent with open-ended clinical interviewing, with no contradicted self-reported data reported. Conclusions: The BES geriatric assessment represents a feasible and accurate approach for collecting comprehensive geriatric assessment level data in older adult drivers. This approach has the potential to increase patient access to comprehensive geriatric assessments and streamline medical fitness-to-drive determinations.