Elderly driving licensing options for improvement

BY PETER MATCHAM - National Vice President, Chair Transport National Advisory Group

Losing their driving licence can have a significant impact on older people’s quality of life, independence, and social connections, so it’s not surprising that concerns about the over 75 driving tests are the most common complaints raised with me as chair of the Transport National Advisory Group.

When considering this, we also have to bear in mind the potential personal and social harm caused by any accident, and the high accident rate for older drivers. The latest statistics I have show that in New Zealand, drivers over 75 have a death rate from a road traffic accident of 10.4 per 100,000 population. Only marginally lower than the highest risk group of 21-24 year olds who’s rate is 10.6 per 100,000. We also know that older people are far more likely to die from involvement in a traffic accident than younger people.

When developing our advocacy, it is important that we acknowledge both sides of the problem.

We want to ensure that people can continue to drive for as long as it is safe for them to do so, but we also have a duty to ensure that those who present a risk to themselves and others are prevented from doing so. The regular tests those over 75 have to take are intended to make sure that a fair and just balance is achieved.

From the number of complaints I receive, it is clear that this balance is not being struck.

Two main issues

Two main issues predominate, the relevance of tests used to determine cognitive impairment to actual driving, and the way they are carried out.

In addressing the first, Waka Kotahi’s publication “Medical aspects of fitness to drive” has a section on cognitive impairment, which states that “Driving may be permitted … provided that the health practitioner is satisfied that there is no significant loss of insight or judgement and an individual does not show signs of disorientation or confusion. Standard tests of cognitive function should be used in assessment.” (my emphasis)

And that seems to be the root of the first problem. The most common complaint that I receive regarding these tests is that they ”…did not seem to be directly related to driving” and my research on your behalf backs this up. There is a growing body of evidence that standard cognitive tests are not good predictors of driving ability.

In my previous article, I mentioned something called “inattentional blindness”. Research has shown this to be a major contributor to accidents, and one that, because it is based on habit particularly affects older people. We choose the routes that are familiar and where we feel comfortable. Ones that we perceive as the safest. Research shows though, that this familiarity and feeling of security leads to a diminished ability to react to unexpected events.

This is clearly a major issue from a road safety point of view, but the good news is that once identified as a problem, rather than having to stop driving, in most cases drivers can be given support and training to overcome it.

So, we need to convince Waka Kotahi that their guidance needs to be enhanced, that existing guidance is inadequate, and suggest tests that do predict driver performance. I have spoken to Waka Kotahi on your behalf, and they have confirmed that they are “not able to instruct Health Practitioners on how to care for and assess their patients”, so the tests used and the decision whether or not to apply one is left to the clinical judgement of individual GPs.

Bearing in mind that as lay people it would be counter-productive to be seen to query doctors’ clinical judgement, we must be sure we present sound and comprehensive evidence that has been thoroughly checked by experts in this subject. This takes time but with the help of members who send me their experiences we are building a case.

The other main complaint that I receive is of the lack of support prior to taking the test, and the stress and anxiety it causes.

We all get stressed when we sit tests, and since for many the thought that they may lose the ability to drive is terrifying, it’s not surprising that many members reports include phrases such as:

  • … experienced extreme stress and distress as a result of not being made aware of what would be expected.
  • The stress levels as the test date approached were … a serious health hazard.
  • Growing distress with the approach of this resit “exam time” has been painful and a poor outcome totally predictable.

    Here our policy is to work with both Waka Kotahi from a funding perspective, and the NZ College of GPs from a service delivery perspective to make sure that those tested understand the relevance of the tests and how to prepare for them mentally. Perhaps a funded prior consultation to explain the procedures and tests used may be a practical option. That of course comes back to funding, so once again we will need a sound evidence base that any extra money needed is more than balanced by the benefits obtained.

To help build our case I hope to gather a wide range of your experiences through a survey in the June edition of this magazine in addition to those you have already sent me. In the meantime, please continue to send me details of your experiences to either national.vicepresident@greypower.co.nz or post to GPF National Vice-president c/o  301 Normandale Road, Lower Hutt, 5010.

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