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Driving Risk Questionnaire
Name: Today’s Date:
ARE YOU WORRIED ABOUT YOUR DRIVING?
Driving an automobile for many older adults is not only a privilege but is a symbol of independence.
Driving also provides practical convenience. Unfortunately, older adults are at more risk for crashes
than younger adults. This risk can be increased by poor vision, reduced reaction time, and slowing in
cognitive processing. The driving questionnaire below is not a formal assessment. Instead, it is a
method of screening that can identify potential safety issues associated with driving. It can be self-
administered or used by family members or healthcare professionals as a way of talking about
concerns related to an older adult’s driving. The questions should be answered as objectively as
possible. See the second page for recommendations and next steps.
Answer the following questions based on your driving experience in the last 6 months.
1. Do you experience increased anxiety when driving? Yes No
2. Have you gotten lost in familiar places? Yes No
3. Do you have identified vision problems, such as macular degeneration, glaucoma, or Yes No
contrast sensitivity?
4. Do you experience confusion on exit or entrance ramps? Yes No
5. Have you ever moved into the wrong lane or gone the wrong way down a one-way Yes No
street?
6. Do you have difficulty determining which turn signal to use when turning? Yes No
7. Do you ever confuse the brake and gas pedals, or have difficulty using them? Yes No
8. Have you experienced difficulty reacting quickly [to stop] when someone pulled out in Yes No
front of you, or in avoiding an object in the road?
9. Have you recently hit curbs when parking? Yes No
10. Do you have trouble navigating turns? Yes No
11. Have you noticed scrapes or dents on the car, garage, or mailbox? Yes No
12. Have you had "close calls" when driving? Yes No
13. Have you been in any recent accidents? Yes No
14. Have you recently received a ticket for a driving violation? Yes No
15. Do family members often express concern with your capacity to drive, or refuse to get Yes No
in the car when you are the one driving?
16. Do you find that you tend to drift out of your lane? Yes No
17. Do you ever forget where you are going when driving? Yes No
TOTAL
e: info@[Link]
e-fax: 855.850.8661
BCAT® All Rights Reserved | William Mansbach, Ph.D. w: [Link]
Scoring
Two or more “Yes” answers in the past 6 months may indicate driving safety concerns that should be further
evaluated.
What should you do if you answered “Yes” to 2 or more of the above?
✓ Consider a cognitive assessment by a BCAT® Certified Clinician or consider participating in a BCAT®
Virtual Visit to further assess cognition.
✓ Discuss your results with your physician, geriatric care manager, or other healthcare professional.
✓ Consider obtaining a formal driving evaluation to further assess your driving ability.
✓ Watch this video to learn more about the importance of cognition and driving.
Steps to take to maintain current cognition and overall brain health.
✓ Lead a brain healthy lifestyle ensuring you get enough sleep, exercise, eat a healthy diet, etc.
✓ Learn more about brain exercises here.
✓ Consider workbook-based activities, such as the Brain Health Workout Kit.
✓ Consider digital cognitive exercises, such as the Digital Working Memory Exercise Platform.
Please contact the BCAT® Team at info@[Link] with any other questions.