4 responses to “Driving assessment in older adults”

  1. A relative, who has presumably been driving with the patient, is the expert.
    No one wants to have their relative’s license taken away but they recognize the danger first. If they do not feel safe with the patient, they know best.
    It then is in everyone’s best interest to have the doctor make the move to have the license take away.
    Sometimes doctors have to make difficult decisions.

  2. I remember the day a very elderly patient of mine didn’t show up for his 3pm appointment. He had crashed his car, at high speed, on the Parkway. But he wasn’t alone when he went to heaven: a young motorcyclist, a father of 3, was killed too. I remember that (a) driving is a privilege, not a right (b) we have a duty to protect other members of the public if drivers lack the vision, hearing, cognition and reflexes needed to pilot a high-momentum vehicle.

    When I ask a frail elder with obvious health challenges “how did you get to clinic?”, it is partly in their interest, partly in mine but mostly for the safety of others. “How would you defend yourself in court if you were in an accident (even if innocent)?”.

    Most understand that alternative transport is cheaper (cost, gas, maintainance, insurance, etc) than owning a car. As Diane points out, there are other modes of transport. I can see why a busy physician, unwilling to make enemies, might defer the argument on this topic. But if it is my 6 year old grand-daughter who is the casualty of our lack of professional diligence, I would have strong emotions.
    Is there an appetite for annual road testing after a certain age? Or at least a publicity blast on the topic? Thank you Brenda for highlighting resources for doctors: I will use them. But the key must be verbal engagement, early on.

  3. There is no debate about testing on demand, but most accident researchers are now opposed to age-based testing. They point out that everywhere in the world where there is age-based testing there are fewer older drivers, identical or slightly higher serior crash rates, and significantly higher senior pedestrian and cycling fatalities.
    When used for driving and then compared to subsequent driving test results, the MMSE has a false positive rate of 50%, the MoCA has a specificity of 50%, and a fail on the Trail Making B test could lead to a wrong diagnosis nine out of ten times.
    We can express older driver risk from different statistical perspectives, but the fact remains that in terms of crashes per capita older drivers have a relative risk of about 50% and that age-based testing does not reduce crash rates.
    When older drivers crash they are more often at fault, but they crash so rarely that they have fewer at-fault crashes than any other age category. Also, they are driven into three times as often. Defensive driving bias should be an important consideration.
    There is an alarming trend with older people dying on our roads, but it isn’t about older drivers, it is about younger drivers killing older pedestrians. In Ontario, older driver crash rates have remained enviable and flat, but pedestrian fatalities keep going up until they are now at 23% of total road related fatalities. In Toronto, in 2016, 70% of pedestrian fatalities involved seniors. In 2017 and 2018 senior involvement in pedestrian fatalities went up to 80%.

    Bill Bears
    Maple Ridge

  4. Dr Villanyi,

    Candrive, which is funded by the Canadian Institutes of Health Research, has discovered that all current cognitive tests are much too severe and not associated with at-fault crash rates. This at least shows us what is associated with actual crashes. There is a warning that these tests are to be used “only when there is genuine uncertainty by the primary care provider regarding fitness-to-drive.” Candrive, and most accident researchers are opposed to age-based testing. All jurisdictions have targeted testing when there is a genuine concern, but they haven’t been using decent tests. There will be more because Candrive has discovered more: the driver’s record, the ability to work the steering wheel and the pedals, the ability to see patterns (motor free vision test), and not being too nervous should follow. Candrive is very cautious, so the results are very slow to be released.


    Bill Bears
    Maple Ridge

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