Can a person be to be too old to drive?
Auto advances – parallel parking assistance, back-up cameras, blind-spot sensors and, of course, power steering – have made driving easier than ever before, including for those in their sunset years wrestling with fuzzier vision, decreased mobility and other harbingers of age.
This year, more than 3.5 million drivers over 65 will strike out on Canadian roads – the highest number in history. That fact is fuelling a simmering debate over whether Canada's provinces ought to have tougher licensing criteria for elderly drivers. Most provinces require drivers aged 80 and up to renew their license and take a written test every two years. None have mandatory in-car driver tests. However, on a per-kilometre basis, seniors are the most collision-prone operators on the road. They are also subject to some of the highest insurance rates, on par with those levied to newly licensed young males.
The problem with those statistics, experts argue, is that they belie much of the grey that muddies the senior driving issue.
"The mere fact that you are old doesn't mean you have a problem," said Dr. Jamie Dow, the medical adviser on road safety for the Société de l'assurance automobile du Quebec, a crown corporation responsible for licensing drivers and vehicles. "The fact that you are older does make you more susceptible to having a problem."
Public health data supports this. In 2010, two thirds of Canadians over the age of 65 were using multiple medications and nearly nine out of 10 suffered from a chronic condition; a quarter of adults in the 65 to 79 age group suffered four or more chronic conditions. In the 80-plus age group, the number jumped to more than a third, according to data published by the Public Health Agency of Canada.
"There is clearly a strong association between age and illness," said Bonnie Dobbs, and Edmonton-based gerontologist who helms the Medically At-Risk Drivers' Centre at the University of Alberta, a research centred devoted to studying the impact of medical conditions on driving. "Age is not the primary determiner of fitness to drive. [But] as we get older, we're more likely to have one or more of the illnesses that can impact our ability to drive."
Nellemarie Hyde, an occupational therapist and program co-ordinator for Saint Elizabeth Driver Assessment and Training service in Ontario, regularly evaluates senior drivers with medical illnesses.
The most common are diabetes, which can impact both vision and sensory function – think ability to gauge force on gas or brake pedals – Parkinson's Disease with its hallmark physical tremors, stroke victims and people living with dementia and other mild cognitive impairments. "Mild memory deficits don't necessarily affect driving directly," she said, adding that she focuses more on a driver's ability to concentrate, focus and multi-task. She also tests for strength, range of motion, co-ordination, sensation and visual perception.
"We want the client to be able to continue driving safely," she said, adding: "The challenge is when a medical condition starts to change how they drive."
Picking up on that condition is where policy makers struggle. In most provinces, doctors are legally mandated to inform licensing bodies when they suspect a patient is no longer competent to drive. However, most doctors are "totally unprepared to do it," said Dow. "Most physicians have no training in evaluating drivers or the effects of medical conditions on driving," he said, adding the subject is rarely touched on by medical schools.
The result is that some provinces are deluged with declarations from physicians. In other cases, physicians barely report at all. Several efforts are under way to provide physicians with tools to easily and efficiently identify medically at-risk drivers without risking discrimination by age. Through the SAAQ in Quebec, Dow runs free seminars for doctors on which exam observations ought to trigger red, road-related flags. Last year, Quebec recorded 16,000 physician declarations, compared with just 1,800 in 2003.
In Alberta, Dobbs and her colleagues have published what she calls a "pencil-and-paper" tool to help physicians identify patients that require road testing. Called SIMARD MD – an acronym for Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers – the five minute test is now used throughout British Columbia and on an ad hoc basis by physicians around the world. It typically picks up eight out of 10 at-risk drivers who are likely to fail a road test due to cognitive impairment. It also flags nine out of 10 who will pass, substantially narrowing the number of referrals for expensive road tests.
In Ontario, Shawn Marshall, an Ottawa-based rehab medicine specialist, is near the end of a five-year, multi-province study called CanDrive, which follows 1,000 drivers over the age of 65 and aims to produce an even more accurate tool.
"You want to have a screening tool that is valid, reliable and has high accuracy. You don't want to identify people falsely," he said, noting it strains provincial systems and unfairly restricts individuals who belong on the road.
"The average 65-year-old is a healthy person," he said. "Driving is important. To maintain your independence in many places throughout Canada, you need to be able to drive."
A four-year-old boy was killed after being hit by a car last week in Mississauga, Ont. Police at the time said they were still conducting tests and an investigation into what happened, and that no charges had been laid. The driver was a 78-year-old man, whose daughter later told CTV News that her father is in good health and has an excellent driving record.
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