Grey Power Immediate Past Vice President Pete Matcham recently made a presentation to the New Zealand Association of Gerontology’s annual conference. The conference aimed to celebrate older people and their essential contributions to society and to address ageism. His report summarises the highlights of his presentation, “Driven to Distraction: the failure of cognitive impairment tests as a proxy for driving ability” and outlines other significant areas relating to Grey Power Federation policy as well as summarising other speakers’ key points.
Delegates I spoke to and who presented, shared a pessimistic outlook so far as the position of older people in the value hierarchy of political parties.
In summary the lack of interest or attendance by any Ministry or Department apart from the Office for Seniors, was indicative of either a complete failure to understand the implications of demographic changes over the next 40 years or an indifference to the plight of older people. At the political level this indifference is even more marked as exemplified by current campaigning messages in which children and older people are invisible.
From presentations, which allowed comparison with Europe and the UK, it was clear that successive NZ Governments continue to be 20 years behind in their thinking regarding the issues relating to older people.
My presentation
My presentation was well-attended and generated a lot of comment and questions both at the end of the presentation and later in informal discussions. With one exception, all feedback was positive and there was a consensus that the work was a valuable addition to the evidence base and needed to be followed up. Several contacts were made with agencies and individuals who were willing to help.
The one exception was a person who spoke to me the following day (presumably they did not actually attend the presentation). They identified themselves as working with Alzheimer’s and I believe they had misunderstood the results presented since their concern was to point out that there was a known correlation between inattention when driving and a confirmed clinical diagnosis of dementia. A relationship that was not explored in my research.
NB: Driven to Distraction: the failure of cognitive impairment tests as a proxy for driving ability (PowerPoint presentation to the Association of Gerontology by Pete Matcham – A Messy Problem: getting a balance)
1. Older people have a high risk of deaths and serious injuries (DSI)
It is a measure of the safety risk on the roads, based on the number and severity of crashes that have occurred. DSI casualty equivalents are an estimation of the number of deaths and serious injuries likely to occur at an intersection or on a corridor based on the total number of injury crashes that have occurred (nzta.govt.nz).
2. DSI from driving accidents
- 85+ age band has the highest rate of DSI crashes for both sexes.
- 75-84 age band has the second highest DSI rate for women, and third highest for men.
- To be safe many restrict their driving to ‘local roads’ BUT that’s where 52% of DSI crashes occur.
- The social and personal costs of having to stop driving are well-documented:
loss of self-esteem, increased loneliness, increased depression, increased likelihood of entry into long-term care facilities.
3. Testing times
- Age related assessment of driving ability is carried out by General Practitioners.
- At the GPs discretion they may include some form of cognitive assessment.
- Assessments used are intended to assist with diagnosis of dementia, not the cognitive and behavioural skills identified as key to safe driving.
4. Survey of Grey Power members
- Two articles outlining the problem have been published in Grey Power quarterly magazine and members were invited to send in their experiences.
- 56 responses were received and the most common concerns were stress (58%), irrelevance of tests to real world driving (71%) and inconsistency in application of the cognitive test (28%).
5. Stress reported was independent of outcome
Many respondents reported that their anxiety skyrocketed and blanked out their brains. They said:
- “My quality of sleep was affected … for over a fortnight or more.”
- “Stress levels as the test date approached were, in my view, a serious health hazard.”
- “I am struggling to calm my 85-year-old wife … pending a re-sit of the dreaded Simard test.”
- “I was in a state of some anxiety.”
- “I was very upset … this amounts to elder abuse.”
- “I had [high] blood pressure and was humiliated and upset.”
6. 71% of participants queried relevance of tests used
They said:
- “It was nothing but a joke.”
- “Real world driving cues are visual but the test is oral.”
- “It is not fit for purpose.”
- “It is a farce.”
- “None of these tests looks at the critical factor – driver attitude.”
- “It has nothing to do with driving. It is part of a standard dementia test and not a very good one at that.”
- “My very elderly mother …was able to pass with ease but was taken to Middlemore that same night … clearly demented.”
7. Of respondents reporting having their licence withdrawn based on their cognitive assessment
- 64% reported that their licence was restored after a further assessment or practical test.
- “The [practical] re testers could not find any reason for my failure.”
- No respondent considered they should not have had their licence renewed, but more than one respondent’s reply indicated a false positive outcome e.g. “…I could never pass a real test.”
8. Outcome – goal transference
Respondents were safety conscious, many taking steps to improve their driving through courses run by the AA, Age Concern, and commercial providers but to regain, or to avoid losing, their licence, respondents identified practicing ‘the test’, not improving driving skills, as the key to success.
9. Where to from here?
- Our research supports other studies that cognitive assessments used by GPs to determine ability to drive safely are not fit for purpose.
- 64% false negatives and at least 12% false positives inferred from respondent’s stories.
- The Royal Australian and New Zealand College of Psychiatrists (RANZCP) consider “… the SIMARD-MD is not an effective driver screening tool for determining fitness-to-drive, as studies have reported poor sensitivity and specificity of the tool in identifying cognitively impaired medically at-risk drivers. Despite this, the SIMARD test is frequently used by GPs
- Waka Kotahi is “…not able to instruct Health Practitioners … therefore no cognitive test is recommended or ‘authorised’ by Waka Kotahi”
- Our research and literature review suggests that use of assessment tools developed to identify potential dementia is not a suitable means to determining fitness to drive safely.
- BUT Waka Kotahi will not direct GPs on what to use, or more relevantly what not to use
ALTERNATIVES
The consensus is that real world driving test is the ‘Gold standard’.
Virtual reality is promising but still being developed.
Screen based tests for inattentional blindness needs validation.
Other areas of interest to GPF policy
Keynote speakers
Prof Chris Stevens presented on the Health, Work and Retirement (HWR) eighteen-year longitudinal study by the HART team at Massey, identifying housing and neighbourhood as key determinants of wellbeing and health for older people.
The key issues for GPF policy were:
- Importance of security of tenure to physical and mental wellbeing,
- Housing quality
- Neighbourhood social cohesion, with the Age Friendly Criteria cited as an ongoing research area, also being explored by OPERAT data through UoA.
Prof Maria Edstrom spoke about ageism and the portrayal of older people in the media and how this creates and maintains prejudice, noting that the majority of people mentally define older people and then see what they expect. The media is obsessed with ‘young’ and ‘new’ possibly a reaction to a fear of mortality, and stories and especially images are exclusively aimed at 20 – 54 age range.
Practical ideas that address GPF policy areas included:
- ‘Chat benches’ Yellow coded seats and benches have been installed in public spaces all over Gothenburg where people can sit and chat to anyone else who sits down.
- ‘Slow neighbourhoods’ again aimed at increasing opportunity for person-to-person
- interaction, building social cohesion and combatting loneliness.
- Senior advisory boards on council
Dr Kingston’s presentation looked at the multifaceted nature of ageing, noting that ageing was inevitable but was a malleable process with key determinants being health, experiences, environment, and social structure across a person’s life course.
The key message was the urgent need for comprehensive proactive planning to address ageing demographics. Other key issues relevant to GPF policy that need to be addressed included:
- Four pillars that affect ageing process: Person, Population, Policy, Partners.
- Inequality in health and wealth, increasing disparity between the well old and the rest.
- Need to plan for significant growth of people in high dependency units, increased comorbidity and dementia by 2035.
- Need to rethink housing – homes for living.
- Focus on fuel poverty – energy ‘prescriptions’ on health service.
Professor McCormack’s presentation largely centred on failing of current academic research paradigms to use a ‘whole of system’ approach, i.e., looking at a person in their environment as opposed to looking at say, their skeletal density. He advocated for greater creativity and decentralised collaboration based on shared values and interests.
Dr Hikaka spoke of the need to open health services to all cultural paradigms. Through the lens of te ao Māori envisioning a health system that places the person at the centre not the clinician and one that does not rely on the patient being an informed advocate. Participation in the health system should be based on an ethical framework of manaakitanga.
Other speakers’ key points:
- Importance of security of housing and neighbourhood to ageing well.
- Importance of maintaining and encouraging personal mobility to health in old age.
- Working in later life can be choice or necessity.
- The continued use of language to portray older people as vulnerable and passive and who can therefore be ignored.
- Sensationalism in reporting research – tentative conclusions of correlation are reported as proven fact.
- Online and talk back radio adept at courting and driving controversy – objective is instantaneous and unthinking reaction, not considered reflection, as this delivers more eyeballs to their advertisers. Older people either portrayed as ‘curiosities’ e.g., participation in elite sports events or passive victims. Young people are even more invisible in the media than the old.
