Thanks to all who contributed to our research on what is happening nationwide for those aged 75 and older seeking a Medical Certificate to renew their licence. Your participation ensured that the initial interview on Nine to Noon was followed by 4 radio interviews and a TV interview, plus numerous on-line and newspaper articles on the current issue. My apologies that I was unable to personally answer all the many emails and phone calls from both members and non-members on this contentious issue.
Many seniors dread visiting their doctor for their licence renewal once they reach 75 years of age, and then biannually from age 80.
We have had widespread feedback from our members, with the major issue being that standards are wildly inconsistent around the country. This is because many GP clinics are now utilising a memory/cognitive test to decide whether or not a driving licence should be renewed. Many of us have poor memories, but are still competent and safe drivers.
Four major issues which are causing unnecessary stress and worry for our seniors.
1. Lack of Consistent Standards Nationally
While some GPs are ensuring that eyesight meets standards and having a general chat about how the overall health of the patient, others are insisting on every patient, regardless of their driving history and health to undertake a cognitive test. Often people don’t realise that this is going to take place, are flustered and stressed, so do not remember what they are asked to repeat and then fail.
It also appears that some more senior drivers only need a licence to drive locally, potentially only during daylight hours, but this option is often not offered, and they are sent for an on-road safety test or to an occupational therapist creating more stress and expense.
The widespread variability between doctors is prompting some members to change doctors to be treated more compassionately.
2. Inappropriate use of Cognitive Tests
Cognitive tests are best utilised by those who have been trained in their use and interpretation. Normally they would be used where a doctor sees signs of potential early dementia, or wants to assess someone after an event such as a stroke. Using them to pass or fail all patients presenting for licence renewal is inappropriate. As Dr Crizzle explained in the Nine to Noon interview (see separate section on his comments), the predictive nature of these tests is relatively low, with a significant % failing the test able still to pass a practical driving test. This is putting many seniors through stressful assessments needlessly.
3. Unavailability of On-Road Safety Tests in local communities
Those sent off for an on-road safety test usually face waiting times of up to 8 weeks or more. Quite simply qualified testers are relatively rare and are located in larger centres – often 40km or more away from the driver’s home.
The local Driving Instructors who teach our young people to drive safely are “not qualified” to assess senior drivers. Nor are the Driving Instructors conducting the AA Senior Driver Coaching Sessions. They can provide useful practical hints to improve your driving, but not a certificate to take to your doctor.
4. Unacceptable costs for some of our members.
While the costs to complete an on-road safety test are reasonable, although potentially stressful, being sent to an occupational therapist is expensive. Members reported costs ranging from $650 to $1200 to have this assessment. For those dependant on NZS as their dominant source of income such costs force them to give up their licence.
We had one respondent who had been referred to an occupational therapist, paying over $1000, and passed. Next year they have to see their doctor for another assessment and if they are referred to an occupational therapist are not prepared to spend this much again and would very reluctantly surrender their licence.
Others reported significantly higher GP visit costs of up to $98 for a licence renewal, compared to $19 a visit on a Community Card.
A Radio NZ Nine to Noon interview, on 30 April, with Dr Alexander Crizzle, who has extensively researched the value of cognitive tests to predict practical driving skills, concluded that they were a poor predictor, and that many of those who failed would have passed a practical driving assessment.
Dr Crizzle is Director of the Driving Simulation Laboratory, School of Public Health at the University of Saskatchewan, and has published extensively on these issues.
The consequences of failing the test can be devastating for seniors who often feel demeaned by having to remember addresses and grocery items that have zero relevance to their driving ability, and often no questions on the road code, or their driving history and accident record.
When a GP fails a patient, they may be referred for an on-road driving test, or to an occupational therapist for a full evaluation. This creates more stress on an overloaded system – especially when a significant proportion will pass their practical driving assessment.
The on-road safety test is only available through certain centres, so those in smaller towns or in rural areas may be forced to travel 40 km or more to sit a practical test in an area that is unfamiliar to them when feeling stressed at the potential cancelling of their licence.
Are seniors being discriminated against?
From the feedback many seniors with a great driving history have felt demeaned and discriminated against by the compulsory use of cognitive tests.
Typical comments include the following:-
“Memory Test is very ageist – adds stress, nothing to do with driving – should be abolished.”
“Much fear about tests especially in rural towns with no public transport.”
“How does it affect your driving if you cannot remember ten random names? You can write down an address!”
“Gutted, cheated, powerless, isolated, stranded. Requested local licence but no response received.”
“Anxious & terrified of process compared to Seniors Driving Revision Test. Scary. Terrifying. Makes living more challenging & if inept with computer even worse & socially isolated.”
“Advised to take another test but due to high cost reluctantly decided not to proceed. The tests are irrelevant to driving & a load of bollocks.”
Some of our members have given up persevering to renew their licence and are often resentful at the way they have been treated after years of safe driving.
Waits of two months or more to secure an appointment are not uncommon, so a temporary licence needs to be re-issued.
Grey Power wants to see this service expanded so those referred can be assessed within their own locality. This could be potentially facilitated if licensed driving instructors, who teach our young people to drive, were also certified to conduct an on-road safety test.
For those referred to an occupation therapist, the costs are a significant barrier to many seniors who are dependent on NZ Super as their sole income. Our members have reported costs of $700-$1200 just for the assessment.
For those referred again two years later, the cost and effort often results in them reluctantly surrendering their licence and losing their social connectivity.
The situation around New Zealand is highly variable, as shown in a recent survey of Grey Power members 75 years of age or older.
There is no consistency as to how seniors are evaluated by their GP. Some GPs conduct routine tests such as eyesight, ask how their patient is feeling, and then sign off the statutory form.
At the other extreme some practices have made a cognitive test (such as the Mini-ACE) a mandatory part of every evaluation. The hurdle to licence renewal for seniors is wildly inconsistent nationally.
With NZTA currently reviewing their guidelines for assessing seniors for licence renewals, Grey Power urges that they work collaboratively with GPs, senior advocacy groups such as Grey Power and organisations like AA to develop simpler transparent guidelines for GPs.
Grey Power urges that a cognitive test is never mandatory and is only used as another tool in patients where there is a suspicion of early dementia. To utilise cognitive tests in all patients is demeaning and creating an unnecessary burden on both seniors and our other assessment systems.
How you can prepare for a Medical to renew your licence
Until there are new guidelines and implementation of any of the measures we are recommending, that you consider preparing for your medical by doing the following – preferably 4-8 weeks before your appointment.
1. Read the resources from NZTA including Renewing your driver licence as a Senior. This appears to have replaced the more comprehensive The Road Ahead – Transport Options for Seniors that was published in 2020. Copies may be available at Community Centres, AA, NZTA offices etc but the most recent brochures & assessments are available from NZTA on-line. https://nzta2.cwp.govt.nz/resources/renewing-your-driver-licence-as-a-senior/ and https://www.nzta.govt.nz/driver-licences/renewing-replacing-and-updating/
2. Take an AA 1 hour Senior Driving Assessment which is tailored for your needs and includes on-road driving. This will give you an awareness of any issues you may have prior to having your medical. Costs are $65 for AA members & $80 for non-members from age 65. For those AA members 75 years of age or older the assessment is free and can be repeated every 2 years at no cost. https://www.aa.co.nz/drivers/learn-to-drive-the-aa-way/senior-driver-coaching-aa-member-benefit/
3. Attend a Staying Safe free classroom refresher course run by Age Concern in conjunction with NZTA. This is a great refresher for driving tips and changes to the Road Code. Check with your local Age Concern or Community Centre as to when the next course will be held.
4. Check with your Doctor/Medical Centre to see if you will be required to sit a cognitive test as part of your medical assessment. If you do need to sit a test, ask which test is used and request a copy to review prior to your assessment. If the practice is using the inappropriate SIMMARD-MD test you may prefer to challenge the need for the test as it has been shown scientifically to be a very poor predictor of driving ability. If, instead they are utilising the Mini-Ace test you can find the 3 NZ tests (A different NZ addresses to remember in each version) on-line at https://www.nzdementia.org/Mini-ACE
Related: Listen: Cognitive tests assessing driver impairment in question
