Q&A with two of Canada's leading experts on elderly drivers

With over 4 million Canadians now over the age of 65, more seniors are getting into automobile accidents. The number of elderly drivers in car crashes will only go up as baby boomers start to reach that golden age and as more people live longer, more active lives.

May 12 to 18 is Road Safety Week in Canada - a good time to consider the often emotionally charged debate over the safety of elderly drivers. How safely do seniors drive?

Funded by the Canadian Institutes of Health Research (CIHR), Drs. Malcolm Man-Son-Hing and Shawn Marshall of the University of Ottawa are beginning what will be the most detailed investigation into seniors' driving habits ever undertaken anywhere: a five-year study of 1,000 drivers aged 70 and older. The two leaders of the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE) share their thoughts on road safety and the elderly driver.

CIHR: Some doctors have said that having to tell their patient they can no longer drive is almost as difficult as telling them they have a terminal illness. Has that been your experience?

Dr. Hing: It can create huge conflicts between patients and doctors. The patient sometimes gets angry at the medical staff - their doctors and any other staff involved in the decision - if they feel it's unfair. Often patients who have cognitive deficits are unaware of the extent of their deficits. It can lead to complaints to the College of Physicians and Surgeons or to the doctors' hospitals. And these are just doctors doing something they are legally mandated to do.

CIHR: Currently, seven of the 10 provinces require doctors to "pull" a licence when a patient appears incapable of driving a vehicle.¹ What kind of pressure does that policing role put on MDs and what does it do to the doctor-patient relationship?

Dr. Hing: I can see both sides of the coin on this. Many of the provincial medical associations resist the idea of physicians being legally responsible for determining their patients' fitness to drive. They believe doctors are ill-equipped to do so and that it strains the doctor-patient relationship. It's been suggested that patients are less likely to go to their physician with a medical condition if they think it may mean possibly losing their licence. But from the jurisdiction's point of view, who else is better position to judge medical fitness to drive than a person's family doctor? They know the patient. They know the patient's medical status.

"If you tell people they can't drive for physical reasons - that they have bad arthritis or their eyesight isn't very good - that's not usually very controversial. It's when you're talking about cognitive deficits that can lead to poor judgment and, poor visual-spatial skills. A lot of these patients have little insight into their deficits; they think they're perfectly normal. When you tell them they have these problems and you're going to take away their licence, they don't understand. And that leads to the conflict."
Dr. Malcolm Man-Son-Hing

CIHR: As a society, we have no problem setting an arbitrary age when people can begin to drive - usually 16 - even though teenagers mature at different ages. But we don't feel comfortable fixing an endpoint to driving. Why is that?

Dr. Hing: Younger drivers and older drivers crash for different reasons. Younger drivers crash because of poor judgment or risk-taking behaviour. As they get older, they don't take those risks. Older drivers crash because they develop medical, functional and cognitive conditions that impact upon their driving skills. Healthy seniors are some of the safest drivers on the road. They have the most experience and they don't take risks. It's only when they develop medical conditions that they have higher crash rates. Pure age restriction on driving at the upper age limit is completely inappropriate.

CIHR: Graduated licensing systems in which new drivers get more privileges over time are quite common. Do you see a place for a reverse of that practice as an option for elderly drivers?

Dr. Marshall: It's called conditional or de-graduated licensing. It means bringing the driving environment into alignment with a person's driving ability. In Ontario, other than some people having to wear glasses, there is no conditional licensing and elderly drivers can drive on any road at any time, anywhere in the province. But there are some provinces and states with conditional licensing, which could mean a driver can drive only during daylight hours, can only drive outside of city limits, within a radius of home, or only on certain classes of highways. The aim is to allow a driver who may have some medical impairment to drive in a safer, lower-risk environment. Under certain conditions, these licences can be very helpful. It's one of the strategies to extend the driving period.

"Everyone thinks we've got to get older drivers off the road. The actual issue is keeping them on the roads and as safe as possible. The loss of the ability to drive has huge implications on peoples' independence in their communities and their overall health and well-being. It has implications on families who have to support these older people after they lose their licence."
Dr. Shawn Marshall

CIHR: In your study, you'll be looking very closely at the driving habits of 1,000 elderly Canadians. What do you hope to find and what will you do with those findings?

Dr. Marshall: We hope to develop a screening tool that can be used by physicians to make an objective decision about fitness to drive. Instead of just having to guess how a condition might affect an older person's ability to drive, we want to look at some hard indicators that show that a person might be at risk. This will be the most comprehensive look at elderly driving. No other country that we know of is doing what we'll be doing here.

CIHR: You have said that while unsafe elderly drivers often get the most attention, we should also be concerned about seniors who quit driving prematurely. Why is that an issue?

Dr. Hing: These are mostly older women who lose confidence and stop driving. That impacts on their quality of life. There are programs available to help them in terms of their driving skills. It can boost their confidence when they pass these refresher courses.

CIHR: What do you see as the most pressing issue about elderly drivers and road safety?

Dr. Hing: Driving with dementia is one key issue that needs to be addressed. That seems to be the most vexing clinical problem out there. A lot of people with cognitive difficulties with dementia have no insight into their deficits. Finding a way to address that is very important.

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Sources:

• * Driving Characteristics of the Young and Aging Population, by John Nicoletta Transportation Division, Statistics Canada, 2002.
• ** Driving Characteristics of the Young and Aging Population, 2000-2004 Joseph Dunlavy, Transportation Division, Statistics Canada
• *** Mature Drivers in Casualty Motor Vehicle Collisions, 1988-1998, Transport Canada, 2001
• **** Aging Driver Strategy 2006-2010, Canadian Council of Motor Transport Administrators, referencing the Insurance Corporation of British Columbia's Issues Concerning the Safety of Older Drivers, 2002

1. See special feature "Conditional Licencing in Canada" for a list of practices across Canada.