I think the biggest problem is not if you are/are not fit to drive.
People, especially those in rural areas with no transport are much more likely to keep driving even when they should not, and relatives are forced to take the keys off them, to prevent an accident.
When they done a road side test for eyesight only, 1/3rd of cars got further attention, some got taken off the road there and then and had to get someone else to come and drive the car, for those who had no one the car was impounded.
What does this tell us, that there are a large minority of drivers that, simply put, cannot be trusted to give up driving when they should.
Until all drivers that require a medical form to continue driving is done by a doctor, then having people medically unfit to drive is something we will all have to live with, or die from.
Buses and lorries have to get it done by a doctor every 5 years, I see no reason why all drivers should not do the same, for the older people because the body becomes too knackered to cope, for younger people a special test for traces of drugs or any illegal substances.
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