Are the media running elderly drivers off the road?
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7487.368-a (Published 10 February 2005) Cite this as: BMJ 2005;330:368
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Kenneth Campbell's opinion must be treated with respect but there is another side to the problem which he raises.Perhaps the younger (and faster) drivers on the main road are failing to observe the relevant sections of the Highway Code.
For example: (1999 Ed.)
Para.124: Where there are junctions,be prepared for vehicles emerging.
Para.125: Slow down and hold back if a vehicle pulls out into your path at a junction. Allow it to get clear. Do not over-react by driving too close behind it.
Competing interests: None declared
Competing interests: No competing interests
Many car-hire firms set an upper age limit of 70, without giving any reason.
However, one well-known company has no upper age-limit though it will not hire to anyone under the age of 25. Enough said!
Competing interests: None declared
Competing interests: No competing interests
Dear Sir,
While I sympathize with the plight of an older person whose mobility depends on continuing to drive we must also address the risk to others. I was formerly employed as a Scenes of Crime Officer by a UK police force; in this capacity I regularly saw reports of serious road crashes within the force's area.
One type of crash was a recurrent event - a car pulling out onto a high speed, non-motorway dual carriageway in front of another vehicle the driver of which had no chance to stop in time. Almost without exception the driver of the vehicle pulling out was elderly; tragically often the occupants of the other vehicle were young parents or whole families - in a high proportion of cases the crashes were fatal for all involved.
It is widely reported that one of the consequences of ageing is a reduced ability to judge the rate of approach of a vehicle. Physical evidence and eyewitness reports made it clear that in many cases the elderly driver had sat at the junction waiting to pull out, had markedly underestimated the approach speed of a vehicle on the main road and pulled out so late that the oncoming driver could not possibly brake or take avoiding action.
In response to the specific question posed by the editor - he must balance how he would feel about causing this old lady to lose here license with how he would feel if her erratic driving caused death or serious injury to a child or even a whole family, as well it might.
I am just 51 but I hope that, as soon as I detect impairment of my abilities, I will have the strength of character to hang up my car keys and leave the driving to younger friends and family.
Perhaps the real solution is to restore adequate public transport services to rural areas so that older drivers have an alternative to continuing to drive past their "best-by" dates. This would also benefit rural families who cannot afford cars or who would rather use ecologically friendly transport.
Yours sincerely,
Competing interests: None declared
Competing interests: No competing interests
Older drivers’ safe mobility
Canada’s population is aging, which means that in coming decades there will be a significant increase in both the number and percentage of older people in the population. In fact, Statistics Canada (2002) estimates that by 2021 one in five Canadians will be at least 65 years old (1)—a statistic that is comparable to that of the United States, Australia, Japan and most European countries.
While policy makers in many motorized countries have long recognized the impact of an aging population on health care system and national pension plan, they are unaware of another potential issue—that is, the mobility of the elderly. Recent research has shown that as the populations of the North America, Australia, Japan and some European countries have aged; they have become more and more dependent on the automobile. (2)
Many motorized countries, predicts substantial changes in the proportion of older individuals in the foreseeable future as the current population ages. Furthermore, the older population is itself ageing. As most individuals’ age, they experience some level of functional decline in sensory, physical and cognitive areas.
A recent OECD report shows that while older drivers tend to be safer than commonly believed, causing fewer crashes per capita or per number of motorists than other age groups, older people are also more vulnerable to injury or death. (3) Without new policies in areas ranging from supporting and assessing older drivers to developing safer roads, vehicles and infrastructure, the number of elderly road users injured or killed in crashes is likely to rise.
Motor vehicle crash statistics from the UK have shown that only six out of every 1000 male drivers in the 65-74 age groups were involved in a crash in 1998. The corresponding rate for drivers in the 25-34 age groups, at 21 per 1000, is more than three times greater. Crash rate for older drivers is often lower than for younger drivers, fatality rates tell us a different story. Data from the United States show that the number of road deaths among motorists aged 65 or more in 1997 was 12.7 per 100,000 people in this age group compared to 10.3 for 25-64 year-olds. (3) It has frequently been claimed that older drivers, after adjustment for distance traveled, have a heightened risk of involvement in crashes which result in serious injury and death.
Given both the expected growth in the number of older drivers and their over-involvement in fatal and serious injury crashes, there has been a world-wide call for improved licensing procedures to manage older driver safety. Renewing licensing in person reduces motor vehicle related death among elderly drivers. (4)
Rather than imposing mandatory driving tests once people reach a certain age, the OECD recommends community-based assessments involving doctors, police and social services, as well as the family and friends of older drivers. At the same time, the report argues the need for a better approach to assessing and responding to the disabilities that can hamper safe driving. (3) Family and friends may be in a good position to detect problems and intervene to assist the unsafe older driver to limit or stop driving. Family and friends often look to professionals for help and advice in these matters. Healthcare professionals influence the older driver in driving decision–making, and should play an important role in assessing driving abilities. However, mandatory physician reporting exists in few motorized countries. Family members may expect more help from healthcare professionals than many are able or willing to provide.
A recent study comparing the motor vehicle crash and fatality rates among older drivers in Finland, where age-related medical screening is strictly enforced, and Sweden where there is no such screening conclude that age-related medical screening has no impact at all on the safety of older drivers. (5)
Several other strategies can be envisaged that might be used to improve road safety among older drivers. For example, measures might be introduced that raise drivers’ awareness of the problems they are likely to encounter as they grow older, together with advice concerning how to recognize and deal with them. It might also be possible to make available to the older driver some way of more formally assessing their own capabilities. Alternatively, a system requiring some sort of assessment or test of driving abilities following a negative driving event could be introduced. Whatever measures are introduced, if they are to be workable it is important that they are deemed fair and acceptable to older drivers, many of whom rely on the private car for their personal mobility. (6)
Efforts to intervene on older drivers through a primary crash prevention approach deserve consideration. Educational programs should be developed to promote driver safety among the elderly addressing topics such as common age-related functional changes that impact driving
The introduction of any measure designed to change the way in which road safety among older drivers is assessed will need to be handled with great care. The previous literature shows that older drivers are very sensitive about their mobility issue. The data reported by Lorraine, McDonald and Sutcliffe (7) suggest that older drivers are not likely to find acceptable any measure that takes away from the individual the responsibility for deciding when and how to stop driving. Measures presented as promoting rather than restricting the personal mobility of older drivers are most likely to be met with approval.
Driving cessation or retirement is not to be taken lightly and can have profound effects on older adults, including social isolation and depression. Since a restriction of private car use could lead to greater institutionalization rates (8) and depressive symptoms (9), safe mobility may be a very important issue for older citizens.
There is already a considerable amount of technical information concerning older drivers’ crashes. However, there is a need to combine this information with more general knowledge of older persons’ living conditions and quality of life from their own point of view in order to understand the implications of different mobility options for the everyday life of older persons.
Interventions that help older people to maintain good levels of mobility but protect them from increased crash risk have a contribution to make. These could involve efforts to support older people as drivers, and to improve the quality of access to public transport. Second, interventions that make the road environment safer and easier for users will be especially helpful for older people. Such intervention includes vehicle speed reduction, the provision of crossings, and other physical changes to the road environment. Building communities safe for walking is another promising strategy. Specific needs of older people are to be taken into account in the future design of motor vehicles as well. Another important way to make the road environment safer for older drivers is to educate other road users about their responsibility to protect other people’s safety.
For many older persons, retaining ownership of their own car, even if they do not drive it themselves, provides a symbol of independence. They could keep the car keys and arrange for someone else to drive them. For those who cannot find or hire a personal driver, group ownership of a fleet of automobiles, which are driven by volunteers or by hired drivers is a possibility. Some programs of this type already exist (e.g., [10]) and could be adapted to other countries.
New intelligent transportation system (ITS) technologies in the areas of vision enhancement, collision avoidance, and way finding may also help, but care must be taken that such systems are compatible with the needs of older drivers and do not make the task of driving more complicated and difficult.
References:
(1).Statistics Canada (2001) General Social Survey: An Overview. Catalogue Number: 89F0115XIE. Statistics Canada (2002) http://www.statcan.ca/english/Pgdb/People/Population/demo23a.htm
(2). Rosenbloom, S., Sustainability and automobility among the elderly: An international assessment. Transportation, 2001:28; 375-408.
(3). Organization for Economic Co-operation and Development (OECD) Ageing and Transport: Mobility Needs and Safety Issues. Paris: OECD. (2001)
(4).Grabowski, D.C., Campbell, C.M., Michael, A.B., et al; Elderly Licensure Laws and Motor Vehicle Fatalities. JAMA 2004; 291: 2840-2846.
(5). Hakamies-Blomqvist, K. Johansson and C. Lundberg, Medical screening of older drivers as a traffic safety measure: a comparative Finnish–Swedish evaluation study. Journal of American Geriatrics Society 1996: 44; 650–653.
(6). Martinez, R., Older drivers and physicians.JAMA1995:274; 1060- 1062
(7). Lorraine, D.P., McDonald P.R., Sutcliffe, P., Older drivers and road safety: the acceptability of a range of intervention measures Accident Analysis and Prevention 2003:35; 805-810
(8). Barakat, S.J. and Mulinazzi, T.E., Elderly drivers: problems and needs for research. Transportation Quarterly 1987:41; 189–206.
(9). Marottoli, R.A., Mendes De Leon, C.F., Glass, T.A., et al; Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Journal of American Geriatrics Society 1997:45; 202–206.
(10). Freund, K., Independent transportation network: Alternative transportation for the elderly Transportation Research Board, Washington, DC (1997).
Competing interests: None declared
Competing interests: No competing interests