Keeping capable elderly drivers on the road

Losing their driver’s licence is one of the most serious issues faced by many senior citizens across Canada. More than simply losing their keys and their wheels, when a physician makes the decision that they can no longer drive, seniors often feel like they’ve lost their life. And the problem isn’t for them alone – this decision can have a major impact on the quality of life for their families and especially their children.

“It’s a huge loss,” says Shawn Marshall, medical director of the Acquired Brain Injury Rehabilitation Program at the Ottawa Hospital Rehabilitation Centre and associate professor of medicine at the University of Ottawa. “It threatens their ability to function in the community, makes an impact on how they live and puts a stress on them and their families.”

Dr. Marshall is co-leader of the Canadian Driving Research Initiative for Vehicular Safety in the Elderly, known as CanDRIVE. It is a five-year longitudinal study funded by the Canadian Institutes of Health Research involving 932 drivers aged 70 and older across seven sites. CanDRIVE is the most comprehensive look at elderly driving ever performed.

There is clearly a need for research. More than four million Canadians are older than 65, and 2.8 million of them hold a driver’s licence. Studies have shown that the at-fault collision rate begins to climb dramatically at age 70.

The lion’s share of the responsibility for determining when a senior is unfit to drive falls to family physicians, who in most provinces are required to “pull” an elderly person’s licence when their expertise tells them that they must do so. It’s a heavy burden, and it can lead to conflict in the examination room, something that Dr. Marshall has experienced personally in his own practice. “It’s a tough issue to deal with,” he says. “I’ve even had some dramatic examples of people who made threats against me.”

Until now, the methods used for the task have not been evidenced-based and have been plagued by a very high rate of false positives, identifying drivers as unsafe when further evaluation proves that isn’t the case. The primary goal of the CanDRIVE study is to equip doctors with an effective, evidenced-based screening tool to help them make the call.

Now nearing its midway point, all of the project participants in Canada (plus an additional 250 in Australia and New Zealand) have been recruited and had their cars outfitted with a GPS tracking device. The GPS will record data on a variety of elements involved in driving, such as braking and the types of roads chosen by the driver. Researchers also are gathering a great deal of data on participants’ health and behavioural and cognitive functions.

A number of related projects are under way at all seven study sites involving researchers from the universities of Manitoba, Victoria, Waterloo, Western Ontario, Ottawa, McGill and Lakehead. These projects include an attempt to evaluate automobile features that best meet the needs of older drivers and a study on the influence and interaction of factors like confidence, motivation, beliefs and attitudes on driving decisions.

At Lakehead University, Michel Bédard is trying to create a simulator that can provide a standard mode of assessment no matter where the test is performed and, at the same time, introduce specific challenges in a safe environment that can reveal important information about a driver’s abilities.

“Often, the on-the-road assessment is considered the gold standard. But it’s very difficult to have a standardized on-road assessment across [geographic] areas – you never have the same circumstances,” explains Dr. Bédard, director of the Centre for Research on Safe Driving and holder of a Canada Research Chair in Aging and Health at Lakehead. “In the simulator, we can challenge the drivers to see how people react in different situations, without any negative consequences.”

The goal, say Drs. Marshall and Bédard, is to keep capable elderly drivers on the road. When not hampered by health and cognition problems – including declines in motor function and visual attention or degenerative diseases like Alzheimer’s – seniors, with their wealth of experience at the wheel, can be some of the safest drivers around.

The simulator will help provide nuanced information on areas that seniors need to work on, says Dr. Bédard. Dr. Marshall adds that overall, the study should help determine when a simple refresher course or a conditional or restricted licence may be more appropriate than pulling the licence completely. Better tools of assessment will benefit everyone, he says. “Safer roads are what we’re all looking for.”