Medical screening of older drivers is not evidence basedBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6371 (Published 25 September 2012) Cite this as: BMJ 2012;345:e6371
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This article makes a plausible case for rethinking attitudes to older drivers, however the author is misleading in his description of key current literature in the first sentence: “the risk of serious injury to children is halved if driven by grandparents rather than parents ”.
It would not be apparent to the reader unless they read the source paper that the risk being referred to is contingent on being in an automobile accident. It is not the risk per journey, or per distance travelled, but is a measure only of the consequences of a crash occurring. Let me quote the final sentences of the source paper. “Finally, our study does not include information about non-crash exposure to vehicle travel. Therefore we cannot estimate the overall risk of crash occurrence or child injury for grandparent versus parent driven child passengers; rather, we can only compare this risk of injury for those child passengers involved in crashes.”
Competing interests: No competing interests
As older drivers make up an increasing proportion of the driver population, they are an important consideration when designing future evidence-based traffic safety policies (1).
“Medical screening of older drivers is misguided and typifies a worrying lack of due diligence” (2) Recent Cochrane systematic review also demonstrated that existing screening tools to identify high risk drivers fail to demonstrate the benefits of driver assessment for either preserving transport mobility or reducing motor vehicle crashes (3). There is sufficient evidence to suggest that age-based screening for fitness to drive does not produce any safety benefits (4).
There is great concern among physicians and the global transportation safety research community, as the proportion of older drivers aged 65 years and over will increase significantly by 2025. The accumulating evidence shows that current screening tools cannot identify safe and unsafe older drivers. Some world leading older driver safety experts argue that these tests would have greater utility at identifying unfit drivers if they were applied only to drivers with signs of increased risk and allowed for multiple outcomes rather than a simple pass/fail system (5).
Even though driver licensing agencies rely heavily on medical advice from clinicians in order to exercise their statutory responsibility to ensure the competency and safety of their license holders, a recent article in the Australian Medical Journal (AMJ) shows that the assessment of medical fitness to drive can be a sensitive and difficult task (6). Similarly, a recent study showed that Australian family physicians lack confidence in performing driving assessments and noted many negative consequences of reporting unsafe drivers (7).
Comprehensive literature shows that the current tools assessing fitness to drive, available to clinicians, are also weak. Driving legislation and recommendations from medical practitioners requires evidence-based tools. Therefore, there is an urgent need to develop evidence-based screening tools (8, 9 ). Unrestricted mobility right of our healthy older drivers depends largely on results of current screening tools and clinician reports exclusively based on currently available tools (8, 9, 10).
Recently, the NHTSA released a report that explores ways for the US to address the safety needs of older drivers over the next five years. As clearly outlined in their strategic plan, it is important to distinguish between medically at-risk drivers and healthy older drivers. Without this distinction, it often leads to reactive legislative attempts that overly restrict older drivers’ driving privileges and their right for free mobility (11).
Many motorized countries now offer restricted driver licenses to the aging population with medical conditions. License restrictions may be an effective alternative to premature driving cessation and provide drivers additional time on the road and hence, continued mobility and independence (12). Most Canadian physicians surveyed were supported restricted licensing (13).
Global road safety paradigm shift is necessary to safeguard our older driver’s safe mobility.
(1). Langford J. Usefulness of off-road screening tests to licensing authorities when assessing older driver fitness to drive. Traffic Inj Prev, 2008; 9, 328-335.
(2). O'Neill D. Medical screening of older drivers is not evidence based. BMJ, 2012; 345 (sep25 2): e6371 DOI: 10.1136/bmj.e6371
(3). Martin AJ. Marottoli R.O'Neill D. Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database Syst Rev, 2009; 21, CD006222.
(4). Grabowski DC, Campbell CM, Morrisey MA. Elderly licensure laws and motor vehicle fatalities. JAMA, 2004; 16, 291, 2840-2846.
(5). Langford J, Braitman K, Charlton J, Eberhard J, O'Neill D, Staplin L, Stutts J. TRB Workshop 2007: Licensing authorities' options for managing older driver safety- practical advice from the researchers. Traffic Inj Prev, 2007; 9, 278-281.
(6). Somerville ER, Black AB, Dunne JW. Driving to distraction –
certification of fitness to drive with epilepsy. Med J Aust, 2010; 15, 192, 342-344.
(7). Wilson LR, Kirby NH. Individual differences in South Australian general practitioners' knowledge, procedures and opinions of the assessment of older drivers. Australasian J Ageing, 2008; 27, 121-125.
(8). Marshall, S. Assessing medical fitness to drive in the older driver. Retrieved from Canadian Medical Association, 2005: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/WhatWePublish...
(9). Molnar FJ, Byszewski AM, Marshall SC, Man-Son-Hing M. In-office evaluation of medical fitness to drive: practical approaches for assessing older people. Can Fam Physician,2005; 51, 327-328.
(10). Fleming RB, Curti TA. Older drivers and state laws: A few things to consider. Elder Law Issues, 2003; 10, 37.
(11). National Highway Traffic Safety Administration (NHTSA). (2012). Older driver program- five year strategic plan 2012-2017. Retrieved from US Department of Transport: http://www.trb.org/Main/Blurbs/Older_Driver_Program_FiveYear_Strategic_P...
(12). Braitman KA, McCartt AT. Characteristics of older drivers who self-limit their driving. Annu Proc Assoc Adv Automot Med, 2008; 52, 245-254.
(13). Marshall SC, Gilbert N. Saskatchewan physicians’ attitudes and knowledge regarding assessment of medical fitness to drive. Can Med Assoc J, 1999; 160, 1701-1704.
Competing interests: No competing interests