Standardized Testing for Elderly Drivers - Assignment Example

Kevin Wiley Tschetter English 2 15/07 Elderly Drivers Thesis ment: Physical factors indeed determine the outcome of driving among elderly people; however, standardized testing might only reduce the risk factors allowing the impairments as a partial consideration. Context: Background of the issue: In the United States, various social and personal factors characterize driving by elderly individuals. Although elderly drivers tend to drive fewer miles than younger drivers, their risk of crash involvement is higher per mile driven, and they are more likely to be responsible for the crashes in which they are involved. Changes in perception, judgment, decision-making, and reaction times have all been documented in the elderly, as has the impact of these changes on driving, argues(Fife, 473) Driving impairment related to these normal changes of aging may be compounded by medical illness and associated medications. What happens mostly in western countries is that the proportion of drivers who are elderly is increasing rapidly; over a quarter of the driving population will be 55 years of age or older by the year 2000. Although elderly drivers tend to drive less and may avoid night driving, the number of car accidents and the severity of injuries sustained in such accidents by distance driven increases strikingly after the age of 65. However, it has to be analyzed firstly based on how can doctors identify those elderly drivers who are a danger to themselves and others? Secondly, as Ponds observed, once they are identified, how should clinicians balance the effects of removing a driving licence, which may greatly affect a patients lifestyle, against public safety and breach of confidentiality if the patient refuses to give up his or her licence voluntarily? (Ponds, 151) Medical decisions about illnesses that predispose to loss of consciousness are fairly clear-cut, but normal ageing processes and dementia can be much more difficult to identify and to assess; moreover, there seems little correlation between tests of mental performance and driving ability. Comparisons between practices in different countries may provide some answers, but the introduction of modified driving tests for elderly drivers with some evidence of mild impairment but who wish to retain their driving licence should be considered. Discussion reasons: The following reasons could be regarded as factors determining the causes for the issues in elderly driving. It is to be admitted that physical or biological factors along with social factors together play a significant task in making up the driving function of the elderly people. If Standardized testing process that helps in evaluating the license appears to slowly loose its hold, as some found that to be full of risks and formalities, the driving part by individual also carries with it errors. There seems to be some formalities to test the ability of elderly people in terms of their driving, such as the regular screening for age related diseases or driving ability among elderly drivers. Nevertheless, what happens generally is that screening tests have a threatening impact that people tend to give up driving instead of attending the tests. The importance of Cross-national comparisons is essential, between the self-report systems in the US. Since, the requirement of a certificate of health from the family doctor at an arbitrary age threshold and at each subsequent renewal in the Republic of Ireland, Switzerland, Denmark, and Greece; and regular retesting (with an increased frequency of testing after 69 years) in some US states. New Zealand combines elements of the last two approaches by requiring regular medical testing of people over 70 years and a driving test at two-yearly intervals after the age of 76, says (McFarland, 190) The routine use of psychometric tests alone to assess driving skills would probably be ineffective, and the lack of guidelines on clinical markers of driving performance in mild to moderate dementia should promote caution in attempting any purely medical assessment of fitness to drive in this population. Apart from that it has to be deemed with closer liaison between the medical profession and licensing authorities is urgently needed an one of the social factors to determine the driving skill of the elders and to promote further research and understanding of this topic. The effects of any opportunistic approach with mandatory reporting of drivers with dementia could perhaps be reviewed by comparison of licence suspensions before and after implementation of the law. Whatever the outcome of such comparisons might be, changing an established system may end up with difficulty: a survey of British drivers showed strong resistance to the concept of regular medical checks to retain driving licences. In addition to that, the demands of negotiating traffic may exceed the abilities of some drivers without an acute event (e.g., syncope) precipitating a crash. Twenty of the 69 crashes caused by older drivers happened at intersections and were due to driving errors; four drivers fell asleep at the wheel during short daytime trips. These are both causes of crashes in younger drivers as well, but the underlying causes for driving errors may be different (e.g., speeding, reckless driving). (Pfeiffer, 36) The pioneers of motor transport did not foresee that driving would become such a universal and accessible skill. Indeed one of them, Carl Benz, thought that the market for motor cars would be limited because no more than a million people would be trainable as chauffeurs. The rising proportion of elderly people who drive would also have surprised him. Point-prevalence figures of about 14 .4 million drivers over 65 years of age in the USA in 1983, and nearly 3 million over the age of 60 in the US in 1990, conceal this trend. Longitudinal data from the USA illustrate the startling growth in the proportion of elderly drivers in western countries: only 5.9% of drivers were over 60 in 1940, but this proportion has risen to 7.4% in 1952, and to 11.4% by 1960. If present trends continue, over a quarter of the driving population by the year 2000 and well over a third by 2050 will be people aged over 55 years. (Klamm, 87) This demographic change in driver age is important because the number of crashes and the severity of injuries by distance driven rise alarmingly after the age of 65, and come to resemble those for 15-25-year-old people. The elderly are also more likely to die in car accidents; if pedestrians are included, motor accidents in the elderly are the second most common cause for their admission to US emergency rooms and of accidental death. Although some commentators have suggested that the absolute risk of elderly drivers remains small, they tend to overlook the expected increase in the number of elderly drivers and the fact that crude accident statistics do not take into account modified driving practices such as reduced mileage and avoidance of night driving. It should also be remembered that whereas most societies legislate against two of the most important factors in road accidents--speeding and alcohol (both associated with a third, inexperienced youth), the scrutiny of risk factors associated with motor crashes in the elderly is less intense. Is it desirable or feasible to identify those elderly people most at risk of driving accidents? (Hutton, 279) Evidences Involved: Many factors influence driver performance. Firstly the road condition and secondly the impact of whether, however both these factors work in a interdependent fashion. These tow factors probably disturbs the nature of driving and drivers. The weather can have a significant impact on the road conditions, just as the road conditions can have an impact on vehicle performance and driver behavior. When weather conditions are adverse, drivers begin to drive more defensively and cautiously, counter-balancing the road conditions. On the other hand, even the most careful drivers can be involved in a crash that is simply unavoidable due to bad weather road conditions. Over 125,000 crashes were reported by police in the state of Kentucky in 1998, observes (Odenheimer, 39) Approximately 34,000 of these crashes occurred with adverse road conditions, such as wet or icy. Therefore, there arises a need to quantitatively analyze how different driver groups perform in adverse road conditions. This data will help the researchers to determine factors that relate to traffic collisions. A better understanding of the research-based factors would assist in capturing the better countermeasures to reduce crashes caused by drivers who get disturbed by improper road conditions. The dramatic increase in the elderly population over the next 20 years demands further research on the elderly driver, observes (Odenheimer, 39) Examining Kentucky data (United States Census Bureau 1999), the population aged 65 and older in 1995 was 487,000. By 2025, the population aged 65 and older will increase to 917,000. The elderly will increase from being 12.6% of the total population to being 21.3% of the total population. This population growth far outpaces the growth of any other age group. (Friedland, 782) The Human factor: Human error is the most important cause of car accidents; and is the main factor (whether or not judgment is impaired for other reasons) in up to 71% of crashes. How does ageing affect the likelihood of driver error? Traffic offences might give some clues: drivers over 70 years of age tend to be convicted of sign, right-of-way, and turning offences rather than speeding, faulty equipment, and serious law violations. Reduced dynamic visual acuity and reaction time, and difficulties with divided attention tasks, are among functional deficits in later life that may contribute to reduced safety on the roads. Moreover, elderly people tend not to recognize age-related deficits in sensory abilities that are relevant to driving, and to underestimate driving dangers while overestimating their own driving skills. (Raffle, 92) However, although normal age-related changes can undeniably impair driving ability, age-related diseases might be a more important cause of motor accidents among the elderly. Dementia is a particular worry: it is common and may affect 10% of those aged over 65 and 20% of people over 85 years of age; most of those affected live in the community. A patient with dementia may have limited insight, early diagnosis is often difficult, and many cases are unknown to family practitioners. The cognitive and perceptual deficits of dementia include memory loss, reduced attention span, difficulties in visual perception, disordered scan-paths, impaired visuospatial discrimination, and reduction in visual fields; all of these factors may interfere with driving skills. (Waller, 615) Not surprisingly, continued driving in elderly people with dementia is the subject of increasing concern. Even in the 1960s a study of drivers in a retirement community showed a significantly increased risk of accidents in those afflicted by "senility" (presumably dementia), and 31% of drivers who were assessed were classed as "senile". (Walsh, 62) A 1998 report on driving practices in the elderly noted that cognitive function seemed to have little influence on whether elderly drivers stopped driving. Friedland and colleagues showed that patients with Alzheimer-type dementia were nearly five times more likely to have a car accident than were healthy age-matched controls. Nearly half the patients with dementia had had at least one crash before they stopped driving. (Evans, 186) Errors at crossroads, traffic signals, or while changing lanes accounted for most accidents. Lucas-Blaustein et al found that almost a third of a sample of patients with dementia reported a crash since onset of the illness and nearly half those who continued to drive got lost regularly. In the US, many patients with dementia continue to drive despite a striking deterioration in driving performance. Indeed, a deterioration of driving skills was one of the first signs of cementing illness in about 10% of patients, yet withdrawal from driving was usually initiated by a family member or a physician rather than the patient (Williams, 326). All the above references indicate physical factors leading to risk performance in driving. However over all analyses of accidents happening might not be considered as had happened duo to a single factor, in fact the majority of causes could be considered as an approximate cause for this research. A Mott for man? Many European countries such as Germany, Sweden, and Austria routinely test vehicles as they age, but do not test elderly drivers. In the US, vehicles are checked annually after 3 years (the MoTT), but driving licence renewal after the age of 70 depends on a self-declaration of health (or illness). If disabilities are not reported, they may not be detected because the family doctor may not know some (such as dementia), and most general practitioners do not ask many of their elderly patients about driving habits. Striking under-declaration of conditions are well known in self-reporting systems. (Blaustein, 1087) The reporting of suspected medical unfitness to drive also raises important ethical issues about confidentiality. Most professional associations for physicians accept that the principle of confidentially is partly or wholly countered by a "common good" principle for the protection of third parties if direct advice to the patient is ignored. In the US, this conflict of interest is recognized by a compromise in which the physician only informs the licensing authority directly if he or she has failed to persuade the patient to inform the authority and had not been able to involve relatives in the decision. By contrast, 8 states in the USA require physicians to report to the local licensing authority all patients whose medical conditions might affect their ability to drive. (Reuben, 1135) Most patients with dementia who are reported to licensing authorities will almost certainly lose their driving licences. However, it should also be remembered that the use of a car is of great importance to elderly people: in one US study, 77% of elderly drivers rated their car as essential or very important to their way of life. Driving is probably both a right and a privilege: but 42% of the elderly think that driving is a right as opposed to 27% who think that it is a privilege. Compulsory removal of a driving licence represents a potential breach of civil rights. If we are to protect our patients as well as the public, we need to know whether we can predict which factors in dementia predict loss of driving capability and to be reassured that licensing authorities will not remove a driving licence without reasonable cause. (Retchin, 813) Fitness to drive The assessment of medical fitness to drive in age-related illnesses may be very difficult. Although many countries have quite clear-cut protocols for illnesses, which predispose to syncope or loss of consciousness, the premises on which they were based may have been weakened by larger community studies. Guidelines for less circumscribed and more heterogeneous neurodegenerative conditions such as dementia, subtypes of which may present with only modest cognitive loss and very slow progression, are even less certain, and were highlighted by a report in which almost a third of drivers with dementia had no evidence of impaired driving skills. Patients in whom there is clear-cut evidence of loss of driving skills or of gross behavioral or psychological dysfunction are easy to identify, but for the many subjects without gross deficit a decision about fitness to drive may be difficult to make on medical assessment alone. Self-declaration forms, as proposed for Parkinsons disease, are inappropriate in dementia and the usefulness of psychometric testing is uncertain. (Council on Scientific Affairs, 3216) A correlation between psychometric screening tests and driving ability has been described among elderly drivers of varied cognitive status, but no such correlation has been found among drivers with Alzheimers disease and dementia. Activity of daily living scales provide an index of practical function and may be a more useful guide; other tests, such as traffic sign recognition, merit further evaluation. Accounts from relatives of changes in a patients driving skill may be helpful, and an occupational therapy evaluation might help to form an impression of the patients overall abilities. In the absence of a clear clinical indicator, direct assessment of driving ability rather than a diagnostic label or an isolated mental test score should be the guide for continued driving in dementia. Cheap simulators based on personal computers are unlikely to represent a realistic alternative to test driving--as a normal test drive or an assessment of low speed, off-road driving tasks, preferably near the patients home and incorporating various levels of difficulty. Such tests could provide the basis for a graded approach to licensing, such as restricting driving to daytime or journeys below a certain distance, as occurs in New Zealand, rather than the stark choice of unrestricted driving or no driving, as in most countries. (OConnor, 1107) Conclusion [responses answers to objections Most elderly drivers without dementia accept that their doctors advice is very influential in making a decision to give up driving, and many patients with dementia will eventually respond to pressure from their families or physician. When it is necessary to send a medical report to a licensing authority without a patients consent, it would be extremely helpful for the physician to know that further assessment, as some form of driving test, would be arranged before a final decision was made. Confidence that driving licensing authorities had sensitive and realistic policies which favored assessment of driving skills rather than diagnostic labels would greatly reduce doctors worries about possible breaches of confidentiality. It must also not be forgotten like Carr observes removal of their driving licence may be insufficient for the small minority of patients who are resistant to persuasion, oblivious to the removal of their licence, and unfit to drive: their vehicle may need to be disabled (Carr, 62). So the majority of responsibility depends on the individual who should drive depending upon their cooperation of health and the standardized tests should come under a regular practice and check with all the cases of elders. References Carr D, Madden D, Cohen HJ, Jackson TW. The use of traffic identification signs to identify drivers with dementia. J Am Geriatr Soc 1991, 39: A62. This book highlights the reality of fatality statistics for older drivers.       Council on Scientific Affairs, Automobile-related injuries, JAMA 1983; 249: 3216-22, This book deals with Older drivers involved in fatal crashes and fatally injured older pedestrians       Evans L. Older driver involvement in fatal and severe traffic crashes. J Gerontol 1988; 43: S186-93, This book deals with elderly drivers do pose a threat that younger drivers do not. While younger drivers can be careless, elderly drivers can be clueless.       Evans L. Traffic safety and the driver, New York: van Nostrand Rheinhold, 1991, This book deals with elderly people do drive because they have higher rates of fatal crashes than all but the youngest drivers, especially per mile driven, the institute reports.       Fife D, Barancik JI, Chatterjee BF. Northeastern Ohio trauma study: eleven injury rates of age, sex and cause. Am J Publ Health 1984; 74: 473 78, Deals with the debate over elderly drivers will increase in intensity in the coming years.       Friedland RP, Koss E, Kumar A, et al. Motor vehicle crashes in dementia of the Alzheimer type. Arm Neurol 1988; 24: 782-86.       Hutton J. Eye movements and fixations m the evaluation of Alzheimers disease. In: ONeill D, ed. Carers, professionals and Alzheimers disease. London: John Libbey, 1991: 279-87. This book supports mandatory testing for seniors that goes beyond answering multiple-choice questions       Klamm ER. Auto insurance: needs and problems of drivers 55 and over. In: Malfetti JL, ed. Drivers 55 +: needs and problems of older drivers: survey results and recommendations. Falls Church, VA: AAA Foundation for Road Safety, 1985: 87-95.       Lucas-Blaustein M, Filipp L, Dungan C, Tune L. Driving in patients with dementia. J Am Geriatr Soc 1988, 36: 1087-91.       McFarland RA, Tune GS, Welford AT. On the driving of automobiles by older people. J Gerontol 1964;19: 190-97.       OConnor DW, Pollitt PA, Hyde JB, Brook CPB, Reiss BB, Roth M. Do general practitioners miss dementia in elderly patients? Br Med J 1988; 297: 1107-10. In this book we as a society have to adopt rules for the safety of our citizenry       Odenheimer GL. Cognitive dysfunction and driving ability, J Am Geriatr Soc 1991; 39: A9. This book Deals with law established a minimum vision driving requirement and allowed DMV officials to require a behind-the-wheel test based.       ONeill D, Neubauer K, Boyle M, Gerrard J, Surmon D, Wilcock GK. Dementia and driving. J R Soc Med (in press).       Pfeiffer Rl, Afifi AA, Chance JM. Prevalence of Alzheimers disease in a retirement community. Am J Epidemiol 1987; 125: 420 36. Deals with Car Hire Firms Turn Away Older Drivers; Companies Are Warned That They Need to Change Their Policies or Risk Alienating the Increasing Power of the Grey Pound.       Ponds RW, Brouwer WH, van Wolffelaar PC. Age differences in divided attention in a simulated caving task. J Gerontol 1988; 43: P151-56, This book deals with Checking the seniors as well as junior drivers is a very good practice       Raffle A, ed. Medical aspects of fitness to drive. London: HM Stationery Office, 1985: 92-93, Deals with the medical aspects of elderly drivers and recommends different strategies to counter it.       Retchin SR, Cox J, Fox M, Irwin L. Performance-based measurements among elderly drivers and non-drivers. JAm Geriatr Soc 1988; 36: 813-19, Book deals with Measurement instruments among elderly drivers.       Reuben DB, Stillman RA, Traines M. The aging driver: medicine, policy and ethics. J Am Geriatr Soc 1988; 36: 1135-42, It deals with Medical policies and implications for elderly drivers.       Waller JA. Cardiovascular disease, aging, and traffic accidents. J Chronic Dis 1967; 20: 615-20, Deals with diseases and aging effects in accidents by elderly drivers.       Walsh JB. Previously unrecognised treatable illness in an Irish elderly population. J Irish Med Assoc 1980; 73: 62-67.       Williams AF, Carsten O. Driver age and crash involvement Am J Publ Health 1989; 79: 326-27, Deals with statistics and figures related to accidents involving elderly drivers in different states. Hoffman, Lesa; McDonald, Joan M.; Atchley, Paul; Dubinsky, Richard. “The Role of Predicting Driving Impairment in Older Adults”. Psychology and Aging. 20(4), December 2005, 610-622. Dittman, Melissa. “In the Driver’s Seat” American Psychological Association: Monitor on Psychology. Page 39 Volume 34, No. 1 January 2003 Reger, Mark. Press Release “PSYCHOLOGISTS SEARCH FOR SCREENING METHOD TO HELP DECIDE WHEN EARLY-ALZHEIMER’S PATIENTS SHOULD STOP DRIVING.” American Psychological Association. January 25, 2004. Available Online at: www.apa.org/releases/alzheimersdriver.html Read More