Canada's leading general medical journal is calling for a graduated licensing system for the country's seniors, but the suggestion isn't sitting well with at least one elderly driver.
An editorial published this week in the Canadian Medical Association Journal says some seniors keep driving as they age despite "substantial physical or mental deterioration."
The piece points to data from 2009 showing more seniors died in fatal vehicle crashes than any other age group and goes on to suggest a graduated licensing system – like what new drivers work through – to help protect elderly Canadians and others on the road.
"The main motivation here is that road trauma is a serious cause of death and disability in seniors throughout Canada," said Donald Redelmeier, a professor of medicine at the University of Toronto who co-authored the editorial.
"It amounts to about one death per day in the country amongst individuals over the age of 65."
While acknowledging that many seniors are "perfectly fine and skilled drivers," Dr. Redelmeier said advanced technology in cars which make driving easier and the general aging of the population increases the risk of having medically unfit elderly drivers on the roads.
Regulations currently in place across much of the country require physicians to report patients who are likely to be a hazard on the road based on medical conditions. Some provinces also require drivers to be retested once they reach a certain age.
In Ontario, for example, residents 80 and over need to renew their licence every two years and must pass a visual and multiple-choice test on road safety before attending a group education session to brush up on their skills.
The problem with the existing regulations, said Dr. Redelmeier, is that many doctors often don't report patients who might pose a risk on the road.
Dr. Redelmeier says such a graduating licensing program might place restrictions on night-time driving, high-speed roads and blood alcohol concentration.
This isn't the first time the journal has discussed seniors on the road. An April 2010 editorial proposed a driving retirement program for seniors.
The latest editorial suggests a full driver's licence automatically default to a restricted one when seniors reach a certain age, which has yet to be determined. At that point, capable elderly drivers can regain full driving privileges by getting a physician to certify their good health.
"The big point of our article is to reframe the clinical interaction, put it in a positive light specifically as physicians endorsing a full driver's licence rather than physicians imposing a restricted driver's licence," said the 51-year-old Dr. Redelmeier.
"Most senior drivers are perfectly fine and capable and should be allowed to continue driving ...The issue is that there are a few individuals out there that contribute to a disproportionate number of very serious crashes."
The CMAJ's graduated licensing suggestion isn't impressing at least one senior, who has written a commentary in the journal defending older drivers.
"I don't really understand why such a superficial notion would be advanced by such an august body," said Ezra Hauer, a professor emeritus in the department of civil engineering at the University of Toronto, who has researched road safety for years.
The 79-year-old argues that seniors are no different from non-seniors when it comes to road safety and points to data showing the over-representation of older Canadian victims disappearing when figures from all road accidents – and not just fatal ones – are examined.
"We are more frail. We die more easily when we are hit as pedestrians, we die more easily when we are involved in a crash," he said. "This brittleness of our bones has nothing to do with our ability to drive safely."
To Dr. Hauer, the graduated licensing proposal outlined in the editorial is nothing but "age discrimination."
"It's a restriction placed on all older drivers based, basically, on prejudice, misinformation and, to some extent, self-interest," he said, adding that the CMAJ's arguments look at the benefit to physicians and don't fully consider the serious blow restricted licensing would deal to seniors.
"Loss of independence of this kind shortens one's life, degrades one's life."
Rather than restricting seniors, Dr. Hauer suggests provinces focus on making safety improvements which would benefit all drivers, like more illumination on highways and more left turn signals.
He adds that even allowing capable senior drivers to gain an exemption from their physicians wouldn't work well, as doctors lack proper tools to asses whether a person would be a hazard on the road.
The editorial itself suggests that physicians use external tools which are being "actively studied" to help in their fitness-to-drive determinations, but Dr. Hauer notes that such tools simply don't exist at present.
"If they cannot determine who can drive safely, how can they give these letters to certify that people can drive safely," he said. "The whole idea just doesn't hold water in my opinion."