Prince Philip: The Mobility and Safety of Elderly Drivers!

The issue regarding elderly peoples’ driving ability has again been highlighted in the media since the Duke of Edinburgh’s recent car crash. It is argued that people well into their 80s are quite capable of driving cognitively and astutely and will take due amount of care on the road. Also, most would be able to make adjustments and driver slower if they need to. However, many older drivers have a feeling of trepidation and fail to inform the relevant authorities of medical issues that can affect their driving therefore putting themselves and others at the risk of a crash. This article looks at the health risks associated with older drivers and also, the economic and social benefits of the car for older drivers. Finally, measures that contribute to reducing older drivers’ crash involvement and fatality will be examined and some advice on the steps to be taken prior to the older drivers’ cessation of driving.

“Drivers over 70 years of age are more likely to be at fault when it comes to an accident on the road”. (RoSPA)

Introduction
For most of us, driving represent freedom, control and independence. Driving allows us to go places we want or need to go. For many of us – even as we get older – driving is important economically. We drive to get to and from work, and sometimes as part of our jobs. Driving is important socially; it lets us stay connected to our communities and favourite activities. Driving appears to be relatively easy, but in fact it’s a complex skill. Our ability to drive safely is affected by changes in our physical and mental conditions. Many of these changes take place as we get older though in different ways and at different times. Research shows that age is not the sole predictor of driving ability and safety. But there is ample evidence to show that most of us experience age-related declines in our physical and mental abilities – declines that can signal a greater crash risk. So, would you ‘shop’ your 80-year-Mom or Dad for being dangerous drivers? That is the difficult question facing many families who recognise their parents’ driving has significantly deteriorated with the onset of age. Being told you are not fit to drive would have provoked outrage in many older drivers, especially men, and could be seen as an assault on their very manhood. Also, many older drivers may not agree with their family’s view or a gerontologist’s findings, that the ‘end of the road’ may be beckoning them. Many families do report their Mom or Dad and in doing so, protect them from injuring themselves or other road users. With the Duke of Edinburgh’s recent car accident, the focus has once again shifted on older drivers and their safety behind the wheel. His recent accident has prompted and renewed much discussion about elderly drivers’ capabilities to remain safe while driving.

In the Driver’s Hands!
As the population ages, the percentage of elderly drivers increase and also there is a tendency to pick up bad driving habits which are not conducive to safe driving. Also, we may not recognise or may tend to ignore health issues that may affect our ability to drive safely. If you’re 70 years of age, and passed you’re driving test at say 17/20, it’s been a long time since your driving was last assessed. Driving is highly important to many older people, and deciding to give up the car can have a huge detrimental effect on them. The decision to give up driving is entirely in the drivers’ hands as there is no legal requirement to stop. However, if you are in a state of trepidation or having trouble driving, or don’t feel as confident or safe or not simply comfortable driving, then talk to family, friends and your doctor and consider whether you should continue to drive or not. However, many elderly drivers will feel piqued at the thought of giving up driving and the joie de vivre when they feel they are still capable of driving safely. Of course, older drivers could undergo an assessment (and some training if necessary) of their driving and that also will help them to make a decision whether to continue driving or not.

‘Health Time Bombs’
Driving requires a multitude of physical capabilities that are adversely affected by ageing, such as hearing, vision, strength, reflexes and coordination. Cognitive skills essential to safe driving may also deteriorate. These include the ability to judge speed and distance, maintain attention span, respond quickly to unexpected stimuli or hazards, and interpret signals, including other drivers’ behaviour. Dementia exacerbates the decline of the cognitive abilities and the associated memory loss can cause disorientation. Older drivers are sui generis, posing a danger on Ireland’s and Britain’s roads as more than one million over 65s are failing to disclose serious medical conditions. By law, in both countries, motorists must inform the Driver Vehicle and Licensing Agency (DVLA) (GB) and in Ireland the Road Safety Authority (RSA) if they have a condition which could affect their ability to drive safely.

But a study has found that despite almost one in three older motorists who are potential ‘health time bombs’; nearly half (49pc) have failed to report their condition(s) to the DVLA or the RSA.

‘End of the Road’
In GB, as well as risking a £1,000 fine and a prison sentence, older drivers are putting themselves and other road users in danger. All drivers, no matter how old they are, must notify the relevant authorities of the onset or worsening of a medical condition which may affect their ability to continue driving. Medical conditions such as: defective eyesight; diabetes; epilepsy; heart problems; Parkinson’s disease; dementia and limb problems must be reported. Once you have passed you’re basic driving test, providing you stay in good health or don’t get disqualified you are generally entitled to keep driving until you reach your 70th birthday. At 70, in Ireland, you renew your licence but not before you undergo a medical examination and that includes eyesight. However, in GB, it is the driver’s responsibility to decide whether they are salubrious and still fit enough to drive. Ninety days (90) before your 70th birthday, the DVLA should send you a self-assessment D46P application for renewal of your driving licence and you can either fill this in and return by post or you can use the their online service to renew. There is no fee for renewal. Licensing authorities should not assume when the driving abilities of older people begin to decline that they will necessarily be aware of these changes, limit their driving exposure and therefore avoid challenging and unsafe driving situations. Indeed, if older drivers do not have the capacity to accurately assess their own ability, as the self-assessment indicates, any self-regulation is likely to be inappropriate. Self-regulation depends largely on the ability of older drivers to evaluate their own driving. How many drivers of any age do you know that will admit their driving isn’t ‘up to scratch’. Therefore, the success of self-regulation, in terms of driving safety, is influenced by their ability to have insight into their declining driving performance. Unfortunately, the driver himself is often not the best judge at assessing his own driving skills.

The ideal situation however, is self-recognition and the support of a loving family leading to the older person to accept it’s the ‘end of the road’. It’s important to note that most licensing jurisdictions in Australia maintain mandatory assessment programmes targeting older drivers, whereby a driver reaching a specified age is required to prove his/her fitness to drive through a medical assessment and/or on-road testing.

Different Reactions, Speeds & Abilities
Experts in the field of elderly mental health have defended the driving capabilities of older people like Prince Philip who was involved in a car crash close to the Queen’s Norfolk Estate–Sandringham. The 97-year-old British Royal’s Land Rover was involved in a collision with another car, in which two women and a nine-month-old baby were travelling in. Philip’s age has prompted much commentary about whether he should still be driving, but clinical psychologist Nick Kidd says older drivers are just as likely to be as careful as those younger than them. He said:

“Everybody is going to be different in the sense we all have different reactions, speeds and abilities to respond,”

Mr. Kidd, a Chartered Member of the Psychological Society of Ireland added:

“I think it’s very difficult to make a global statement, and you’re going to get older people well into their 80s well able to drive a car cognitively and astutely, and will take their due amount of care around the roads. Most would be able to make adjustments and drive slower if they feel they need to.”
Once drivers reach 70, they are required to produce a medical certificate in order to renew their licence. While cognitive function can deteriorate over time, Mr Kidd insisted it should be dealt with on a case-by-case basis:

“There is no doubt that driving a car is a cognitively demanding task and we know, depending on the experience of the driver, that these things can become second nature. So somebody who has been driving 50 years would have a lot of experience and be able to go through the processes.”

As a clinical psychologist with the Health and Safety Executive (HSE), Mr. Kidd said the isolation older people would face if they did not have a car would be devastating to their wellbeing:

“There is an awful isolation than can come from not having a car, and from working with older adults who can’t drive anymore, there is a real impact on their mental health. People look at situations and media coverage such as this and will make global judgments but there’s a case that people into their 80s and 90s will remain competent.”

Poor Eyesight & Crashes
More than one million drivers aged 65 years and over refuse to admit they are a danger behind the wheel, a survey has revealed. Almost three in 16 older drivers have medical issues that must be disclosed to the Driver Vehicle and Licensing Authority (DVLA), such as visual impairments, diabetes, heart conditions and epilepsy. A survey for Direct Line Insurance shows that 49pc of over 65s with medical issues that would legally prohibit them from driving choose not to disclose them. Such motorists risk a fine of £1,000 and prosecution for failing to disclose serious medical conditions that would legally prevent them from driving. But just 49pc of these drivers have informed the DVLA about their condition, according to the survey for Direct Line. Many older drivers experience abelism and say they do not believe their condition will affect their driving. Also, according to the road safety charity Brake, poor eyesight is thought to be the biggest-related cause of crashes, with 2,900 casualties a year. Poor eyesight was amply demonstrated when GB driver Peter Conlon (73) who is partially blind, was sentenced to two years in prison in 2014, after hitting two women on a pedestrian crossing, killing one and seriously injuring the other. Conlon was wearing his reading glasses and was found by police to be incapable of reading a number plate further than four metres away.
UK drivers over 70 years must fill in a self-assessment form every three years to renew their licences. But critics say the form should be accompanied by a mandatory medical examination or driving test. In Ireland, drivers aged 70 yrs and over must undergo a medical examination – including an eyesight test – before a new licence is issued thus ensuring that they meet basic medical standards. Also professional drivers i.e. bus and truck drivers have to undergo a medical every five years as opposed to ten years previously to continue driving.

Social and Economic Benefits
Commenting on relevant medical conditions a DVLA spokesman said:

“Age in itself is not a barrier to safe driving. However, it’s essential that all drivers, regardless of age, tell us about a relevant medical condition which may affect their driving”.

Caroline Abrahams, charity director of Age UK, said that driving gives “huge social and economic benefits” to older people and called for a national network of mobility centres to advise older drivers. She added:

“In other countries where they have stricter medical rules to address this issue, there is little evidence that it has improved overall safety.
Overall, the safety record of older drivers is good. It doesn’t make sense to judge someone’s skill just by how old they are because ageing impacts on people in such different ways”.

The Importance of the Private Car
Driving a car is important for people in general because it provides status and the opportunity for personal control and independence. In sparsely populated areas, owning a car is even more important, since it provides the only opportunity for travelling long distances due to a lack of public transport. For older people, having more difficulties walking (to the bus stop) and cycling, driving is often the only option for independent mobility. Several studies have found that over 90% of older drivers indicate that giving up driving would restrict their independence and mobility.
The same drivers expressed anxiety about the poor quality of public transport services. This anxiety seemed to be based on reality because 50% of those respondents who already had given up driving felt public transport to be, at least in some measure, inadequate. Before older people stop driving, they usually reduce how much they drive and limit their driving to local journeys in familiar areas and under easier driving conditions. The better the provision of alternative means of mobility, the more likely a driver is to start using them for journeys, long before ceasing to drive. This makes it easier to remain mobile after ceasing to drive. The lack of attractive and feasible transport alternatives to the private automobile, coupled with land-use patterns that make walking difficult or impossible, contributes to the problems experienced by people who have to stop driving, notably in North America. However, similar problems occur in Europe for older people living in suburbs and rural locations, as they increasingly do. In Great Britain, older drivers appear to be more likely to stop driving if they live in urban areas where walking, buses and taxis offer realistic mobility alternatives (OECD, 2001). The ability to go everywhere and do everything without a car is also mentioned in surveys on reasons for driving less. However, the most important factors for ceasing to drive seem to be safety, health, and fitness. Men more often give up driving because of bad health. Women tend to retire from the wheel earlier and for less pressing reasons, such as driving less frequently.

Reduced Physical Ability
While there are no specific traffic rules for older drivers, their reduced physical abilities require them to be especially careful. Elderly drivers are more likely to hurt themselves than putting other road users at risk. The fatality rate for drivers over 75 is more than five times higher than average and their injury rate is twice as high. The higher vulnerability is due to reduced physical abilities of older drivers’ diminished eyesight and hearing, slower reaction time and less day-to-day experience on the road. Several types of measures are available to influence the future number of fatalities amongst older drivers. Given the physical vulnerability of older drivers, measures are needed that can reduce injury severity, such as in active and passive vehicle safety. Measures that can reduce the older driver’s crash involvement also contribute to a reduction of their fatality rate.
Examples of better types of measures include changes to road infrastructure, driver assisted systems, and progressive education and training. In the case of a progressive decline in functions, training and adaptation of the infrastructure and the vehicle can no longer compensate for reduced fitness to drive. Therefore, in addition, a procedure is needed that will lead to a timely cessation of the driving career. Such measures involve licensing procedures and consultation of a medical professional regarding continuing fitness to drive. Older drivers need information on the physical and cognitive changes that accompany ageing and on the implications of ceasing to drive.

Conclusion
Driving a car is important for people in general because it provides status and the opportunity for personal control and independence. In Great Britain and Ireland, older drivers appear to be more likely to stop driving if they live in urban areas where walking, buses and taxis offer realistic mobility alternatives. It seems that obtaining the correct balance between safety and mobility of older drivers is a complicated and sensitive task. Everyone ages differently so there is no arbitrary cut-off point as to when someone should stop driving. According to the DVLA and the RSA, age in itself is not a barrier to safe driving. However, it’s essential that all drivers, regardless of age, tell them about a relevant medical condition which may affect their driving. Some people continue driving when they really aren’t safe, and this is obviously a problem. But many more people stop driving because they are worried, when they could carry on with a little help and advice. Several types of measures are available to influence the future number of fatalities amongst older drivers. Given the physical vulnerability of older drivers, measures are needed that can reduce injury severity, such as in active and passive vehicle safety. Measures that can reduce the older driver’s crash involvement also contribute to a reduction of their fatality rate. Examples of better types of measures include changes to road infrastructure, driver assisted systems, and progressive education and training.

In the case of a progressive decline in functions, training and adaptation of the infrastructure, driver assisted systems, and progressive education and training are beneficial as the vehicle can no longer compensate for reduced fitness to drive. Having a driving assessment is not intended to stop you from driving. It’s designed to help you continue driving and keep you safe. Driver training in real traffic with complex situations (as opposed to a simulator) with a qualified driver trainer is preferred since it has been shown to improve driving skills in older people up to the level of middle-aged drivers.Talking to an older person about their driving is often difficult and crimen injuria must be avoided.

Most of us delay that talk until the person’s driving has become what we believe to be dangerous. At that point, conversations can be awkward for everyone involved. So serious are some cases, when an older driver was forced to stop driving and on being told, committed suicide, But there are things you can do to make these conversations more productive and less tense e.g. collect relevant information regarding cessation of driving, make a plan and follow through on the plan. To many roads safety practitioners, it is quite disconcerting to reveal that more than one million drivers aged 65 years and over refuse to admit – due to various medical conditions – they are a danger behind the wheel.

However, getting older does not necessarily mean a person’s driving days are over. In the interests of safety, it’s important for perspicacious families or carers to plan ahead and take all necessary steps to ensure the safety of their loved ones should they continue driving or not. In addition to the above mentioned safety measures, technology can supplement the abilities of older drivers, and features such as back-up cameras, collision warning systems, and some day in the near future, autonomous or semi-autonomous vehicles may help reduce the greater risk experienced by older adult drivers. Finally, as my generation become geriatrics, something more meaningful than common sense or a voluntary refresher course is needed – not least to deal with an asinine older driver like some older drivers I am proud to be acquainted with.

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