For many Australians, driving is not simply a way to get from one place to another – it is tied to identity, independence, and the freedom to participate in daily life. Visiting family, attending appointments, shopping for groceries, and staying connected to community all hinge on access to personal transport. Yet as we grow older, subtle changes in vision, physical function, and cognition can gradually affect the way we drive, sometimes before we or our loved ones are fully aware of it.
Why Does Driving Safety Change as We Age?
Age itself is not a barrier to safe driving. Many Australians drive confidently and safely well into their 70s, 80s, and beyond. However, the physiological and cognitive changes associated with ageing can progressively affect several of the skills that safe driving demands.
Vision
Vision underpins nearly every aspect of driving. Age-related changes in visual acuity, contrast sensitivity, glare recovery, and peripheral vision all develop gradually and can significantly affect how well a person detects and responds to hazards. Conditions such as cataracts, glaucoma, and age-related macular degeneration become more prevalent with age and carry specific implications for driving safety. Research indicates that a median 70-year-old driver may detect a low-contrast object at approximately one-third the distance of a younger driver – a gap that matters enormously on the road.
Physical Function
Reduced muscle strength, limited cervical range of motion, slower reaction time, and diminished coordination all affect a driver’s ability to operate vehicle controls, check mirrors, and respond in emergency situations. Musculoskeletal conditions affecting the neck, back, upper limbs, and lower limbs are particularly relevant when considering driving capacity.
Cognitive Function
Processing speed, divided attention, executive function, visuospatial skills, and working memory all show age-related changes. Driving is fundamentally a complex cognitive task – it requires the simultaneous management of vehicle control, navigation, hazard perception, and decision-making. Cognitive changes that are subtle in everyday life may become more apparent in the dynamic, time-pressured environment of the road.
Medications
Polypharmacy – the use of multiple medications simultaneously – is common among older adults. Many medications, including benzodiazepines, antihistamines, some antidepressants, and narcotic analgesics, can affect alertness, reaction time, and cognition in ways that are directly relevant to driving safety. A thorough medication review is therefore an important component of any driving-related assessment.
Why Is Reviewing Driving Skills with Ageing Clients a Growing Priority in Australia?
Australia’s population is ageing, and so is the driving population. Approximately 92% of adults aged 70 and over hold a driver’s licence, and more than 70% of people continue driving beyond the age of 80. Drivers aged 65 and over now account for approximately 20% of all road deaths in Australia, and over the decade to 2024, deaths in this age group increased by 14.1% – notably above the 7.0% increase recorded across all age groups.
When adjusted for population, drivers aged 75 and over share the highest fatality rate with the 17–25 age group (7.6 deaths per 100,000 people). Crash responsibility also increases significantly with age: research from New South Wales found that 79% of drivers aged 80 and over were responsible for their fatal or serious injury crashes over a five-year period.
These figures are not presented to stigmatise older drivers – they reflect the importance of timely, evidence-based assessment rather than age-based assumptions. The goal of reviewing driving skills with ageing clients is to support safe driving for as long as possible, while identifying when further support, modifications, or change is needed.
What Does an Occupational Therapy Driving Assessment Actually Involve?
Occupational therapists with specialised post-graduate training in driver assessment – sometimes referred to as Driver-Trained OTs – are the only health professionals qualified to conduct comprehensive practical (on-road) driving assessments in Australia. On-road assessment remains the gold standard for determining fitness to drive.
A comprehensive OT driving assessment typically involves two components.
The Off-Road (Clinical) Assessment
This component, which usually takes between 60 and 90 minutes, includes:
Occupational Profile
A detailed review of the client’s medical and driving history, current daily activities, and personal goals related to driving.
Vision Screening
Assessment of visual acuity, visual fields, depth perception, contrast sensitivity, glare recovery, and night vision – all of which are directly linked to driving safety.
Physical Assessment
Evaluation of range of motion and strength in the upper and lower limbs, neck mobility, trunk control, sitting balance, coordination, sensation, and reaction time.
Cognitive Assessment
Standardised tools are used to assess attention, memory, executive function, orientation, and visuospatial skills. These may include instruments such as maze tasks and road knowledge questions.
If vision does not meet the minimum standards outlined in the Austroads Assessing Fitness to Drive guidelines, the assessment does not typically proceed to on-road testing.
The On-Road (Practical) Assessment
This component, typically conducted over 30 to 45 minutes in a dual-controlled vehicle with a qualified driving instructor, evaluates operational, tactical, and strategic driving skills in real traffic conditions. This may include negotiating roundabouts, traffic lights, intersections, and complex local road environments.
At the conclusion of the assessment, the OT produces a detailed report outlining the client’s strengths, any areas of concern, and clear recommendations. These may include a return to unrestricted driving, driving with conditions (such as daylight hours or familiar routes only), a recommendation for driver rehabilitation, vehicle modifications, or, where appropriate, cessation of driving.
How Do Australian Licensing Requirements for Older Drivers Vary by State?
Licensing requirements for older drivers differ significantly across Australian states and territories, though all are guided by the Austroads national medical standards. The following table summarises the key requirements as at mid-2026.
| State/Territory | Mandatory Medical Assessment | Mandatory On-Road Assessment |
|---|---|---|
| New South Wales | Age 75+, annually | Age 85+, every 2 years (unless modified licence) |
| Queensland | Age 75+, annually (F3712 form must be carried) | Not mandatory |
| Victoria | Not age-based (may be requested by VicRoads if condition reported) | May be requested by VicRoads |
| South Australia | Age 70+ (some classes); Age 75+ (Class C self-assessment) | If recommended by treating practitioner |
| Western Australia | Age 80+, annually | Not mandatory unless recommended by health professional |
| Tasmania | Not mandatory; self-assessment of reportable conditions required | Not mandatory |
| ACT | Age 75+, annually | Dependent on medical condition |
| Northern Territory | Not age-based; self-reporting of conditions required | Not mandatory |
It is important to note that regardless of jurisdiction, all drivers in Australia are legally required to report any permanent or long-term medical condition that may affect their ability to drive safely. Licensing authorities make the final determination regarding licence status.
What Happens When a Client Can No Longer Drive Safely?
Driving cessation is one of the most significant life transitions an older adult may face. The loss of driving is frequently associated with reduced social participation, increased reliance on others, and feelings of grief, frustration, or diminished independence. For this reason, reviewing driving skills with ageing clients is not simply a clinical gatekeeping exercise – it is a holistic, person-centred process that includes planning for what comes next.
Where driving is no longer safe, occupational therapists and allied health practitioners can support clients to explore and access alternative transport options, including community transport services, taxi subsidy schemes, public transport with concession fares, volunteer driving programmes, and home delivery services for shopping and meals.
Starting conversations about driving safety well before cessation becomes urgent allows older adults, families, and practitioners to plan together in a way that preserves dignity and maintains independence in other meaningful areas of life.
Funding and Access for Driving Assessments in Queensland, NSW, Victoria, and Beyond
Access to OT driving assessments has expanded considerably in recent years. Eligible NDIS participants may fund assessments through their Improved Daily Living (Capacity Building) budget. Older adults accessing aged care services may be able to utilise Home Care Package funding for occupational therapy driving assessments. In some circumstances, Medicare rebates may be available with an appropriate GP referral. Private clients can also engage Driver-Trained OTs directly.
Astrad Allied Health provides mobile occupational therapy services across Brisbane, North Lakes, the Gold Coast, the Sunshine Coast (including Peregian Springs, Noosa, Buderim, and Gympie), Sydney, and Melbourne, as well as Telehealth services across Queensland, New South Wales, Victoria, and Tasmania. Assessments are delivered directly to clients in their homes or communities, supporting access for those who may find travel to a clinic challenging.
Driving Safety Is a Shared Responsibility – Not a One-Time Conversation
Reviewing driving skills with ageing clients is not a single event. As conditions evolve and circumstances change, ongoing assessment and open dialogue between older drivers, their families, and their health professionals remain essential. The aim is always the same: to support safe, independent participation in community life for as long as possible – and to ensure that when change is needed, it is managed with compassion, planning, and appropriate support.
When should an older driver have their driving skills reviewed by an occupational therapist?
A review may be appropriate following a significant medical event (such as a stroke, heart attack, or new diagnosis of dementia or Parkinson’s disease), after a near-miss or minor crash, if family or friends have expressed concern, or as part of routine aged care or NDIS planning. Some clients self-refer proactively to gain a clearer picture of their current driving capacity.
Can reviewing driving skills with ageing clients help someone continue driving longer?
In many cases, yes. An OT driving assessment may identify specific areas where skills can be improved through driving rehabilitation, compensatory strategies, or vehicle modifications. Australian research has found that older drivers who received tailored feedback and structured driving lessons showed improved driving skills and higher safety ratings on subsequent on-road assessments.
How are occupational therapy driving assessments funded in Australia?
Funding options include NDIS Improved Daily Living budgets (for eligible participants), Home Care Package funding (for aged care recipients), Medicare rebates (in some circumstances with GP referral), and private payment. Astrad Allied Health works with clients across Queensland, New South Wales, Victoria, and Tasmania to identify the most appropriate funding pathway.
What if a family member is concerned about an older driver’s safety but the driver disagrees?
This is a common and sensitive situation. A formal OT driving assessment provides an objective, evidence-based evaluation that can help facilitate these conversations constructively. It also removes the burden of decision-making from family members, placing it with qualified practitioners and licensing authorities where appropriate.
Is a mandatory medical assessment the same as an OT driving assessment?
No. A medical assessment, completed by a general practitioner, evaluates whether any medical conditions may affect fitness to drive and is required annually in most states from the age of 75 or 80. An OT driving assessment includes a detailed clinical evaluation plus an on-road component conducted in a dual-controlled vehicle. Both serve different and complementary roles in supporting older driver safety.
