Please indicate which of these statements apply to you:
(1) I get lost while driving.
(2) My friends and family members say they are worried about my driving.
(3) Other cars seem to appear out of nowhere.
(4) I have trouble seeing signs in time to respond to them.
(5) Other drivers drive too fast.
(6) Other drivers often honk at me.
(7) Driving stresses me out.
(8) After driving, I feel tired.
(9) I have had more "near misses" lately.
(10) Busy intersections bother me.
(11) Left-hand turns make me nervous.
(12) The glare from oncoming headlights bothers me.
(13) My medication make me dizzy or drowsy.
(14) I have trouble turning the steering wheel.
(15) I have trouble pushing down on the gas pedal or brakes.
(16) I have trouble looking over my shoulder when I back up.
(17) I have been stopped by the police for my driving recently.
(18) People will no longer accept rides from me.
(19) I don't like to drive at night.
(20) I have more trouble parking lately.
The presence of a "yes" response to any of these statements may indicate that the person's safety may be at risk when driving.
where:
• You don't have to be very old to answer "yes" to one or more of these questions. I would personally opt for a higher cutoff score than >= 1.
• Getting lost while driving would be more specific if it referred to the local neighborhood.
• Specifying the reason for being stopped by the police might make the question more specific.
• No age was specified. For the implementation I used 70 years as the cutoff.
