Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 148 No. 4546 (2018)

What is the profile of older drivers considered medically unfit to drive? A cross-sectional survey in Western Switzerland

  • Paul Sebo
  • Paul Vaucher
  • Dagmar M. Haller
  • Philippe Huber
  • Yolanda Mueller
  • Bernard Favrat
DOI
https://doi.org/10.4414/smw.2018.14684
Cite this as:
Swiss Med Wkly. 2018;148:w14684
Published
18.11.2018

Summary

OBJECTIVE

We aimed to assess how often and for what reasons general practitioners (GPs) consider older drivers medically unfit to drive.

METHODS

All GPs certified to carry out fitness-to-drive assessments in Geneva (medical assessors, n = 69), as well as a random sample of 500 GPs practising in Vaud, Neuchatel and Jura, were asked to complete a questionnaire about the mean number of assessments per week, the number of negative decisions in the previous year and the main reason for the most recent negative decision.

RESULTS

Completed questionnaires were returned by 268 respondents (45 medical assessors and 223 other GPs, participation rate: 47%). The mean proportion of drivers with a negative decision was 2.2% (standard deviation [SD] 3.3). The proportion was slightly lower among medical assessors (1.1%, SD 1.3) compared to other GPs (2.3%, SD 3.3, p <0.001). The main reasons for being considered medically unfit to drive were cognitive (64%) and visual acuity impairments (18%).

CONCLUSIONS

GPs in this survey reported considering approximately 2% of older drivers as medically unfit to drive, mainly because of cognitive and visual acuity impairments. Further research should identify how GPs decide if older drivers are fit or unfit, and assess the effectiveness of medical screening in reducing car crashes involving older drivers.

References

  1. Meuser TM, Carr DB, Ulfarsson GF. Motor-vehicle crash history and licensing outcomes for older drivers reported as medically impaired in Missouri. Accid Anal Prev. 2009;41(2):246–52. doi:.https://doi.org/10.1016/j.aap.2008.11.003
  2. Dobbs BM. Aging baby boomers--a blessing or challenge for driver licensing authorities. Traffic Inj Prev. 2008;9(4):379–86. doi:.https://doi.org/10.1080/15389580802045823
  3. Uwe-Ewert-Vortrag.pdf [Internet]. [cited 2018 Jan 27]. Available from: https://www.bast.de/DE/Verkehrssicherheit/Publikationen/Veranstaltungen/U-Ageing-2014/Downloads-Presentations/Uwe-Ewert-Vortrag.pdf?__blob=publicationFile&v=1
  4. Ewerta.pdf [Internet]. [cited 2018 Jan 27]. Available from: https://www.bast.de/DE/Verkehrssicherheit/Publikationen/Veranstaltungen/U-Ageing-2014/Downloads-Papers/Ewerta.pdf?__blob=publicationFile&v=2
  5. Lyman S, Ferguson SA, Braver ER, Williams AF. Older driver involvements in police reported crashes and fatal crashes: trends and projections. Inj Prev. 2002;8(2):116–20. doi:.https://doi.org/10.1136/ip.8.2.116
  6. HQIP-Guide-for-Clinical-Audit-Research-and-Service-Review-Revised. 2011.pdf [Internet]. [cited 2018 Jan 4]. Available from: https://www.hqip.org.uk/public/cms/253/625/19/190/HQIP-Guide-for-Clinical-Audit-Research-and-Service-Review-Revised%202011.pdf?realName=x5QijA.pdf
  7. Vaucher P, Cardoso I, Veldstra JL, Herzig D, Herzog M, Mangin P, et al. A neuropsychological instrument measuring age-related cerebral decline in older drivers: development, reliability, and validity of MedDrive. Front Hum Neurosci. 2014;8:772. doi:.https://doi.org/10.3389/fnhum.2014.00772
  8. Wagner JT, Müri RM, Nef T, Mosimann UP. Cognition and driving in older persons. Swiss Med Wkly. 2011;140:w13136.
  9. bfu_2.331.02_Rapport SINUS 2017 – Niveau de sécurité et accidents dans la circulation routière en 2016.pdf [Internet]. [cited 2018 Apr 22]. Available from: https://www.bfu.ch/sites/assets/Shop/bfu_2.331.02_Rapport%20SINUS%202017%20%E2%80%93%20Niveau%20de%20s%C3%A9curit%C3%A9%20et%20accidents%20dans%20la%20circulation%20routi%C3%A8re%20en%202016.pdf
  10. Ball K, Owsley C, Stalvey B, Roenker DL, Sloane ME, Graves M. Driving avoidance and functional impairment in older drivers. Accid Anal Prev. 1998;30(3):313–22. doi:.https://doi.org/10.1016/S0001-4575(97)00102-4
  11. Gilhotra JS, Mitchell P, Ivers R, Cumming RG. Impaired vision and other factors associated with driving cessation in the elderly: the Blue Mountains Eye Study. Clin Experiment Ophthalmol. 2001;29(3):104–7. doi:.https://doi.org/10.1046/j.1442-9071.2001.00411.x
  12. Rizzo M. Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving. JAMA. 2011;305(10):1018–26. doi:.https://doi.org/10.1001/jama.2011.252
  13. Redelmeier DA, Yarnell CJ, Thiruchelvam D, Tibshirani RJ. Physicians’ warnings for unfit drivers and the risk of trauma from road crashes. N Engl J Med. 2012;367(13):1228–36. doi:.https://doi.org/10.1056/NEJMsa1114310
  14. Hakamies-Blomqvist L, Wiklund M, Henriksson P. Predicting older drivers’ accident involvement--Smeed’s law revisited. Accid Anal Prev. 2005;37(4):675–80. doi:.https://doi.org/10.1016/j.aap.2005.03.009
  15. Siren A, Meng A. Cognitive screening of older drivers does not produce safety benefits. Accid Anal Prev. 2012;45:634–8. doi:.https://doi.org/10.1016/j.aap.2011.09.032
  16. Mitchell CGB. The licensing of older drivers in Europe--a case study. Traffic Inj Prev. 2008;9(4):360–6. doi:.https://doi.org/10.1080/15389580801895160
  17. Hakamies-Blomqvist L, Johansson K, Lundberg C. Medical screening of older drivers as a traffic safety measure--a comparative Finnish-Swedish evaluation study. J Am Geriatr Soc. 1996;44(6):650–3. doi:.https://doi.org/10.1111/j.1532-5415.1996.tb01826.x
  18. Siren A, Haustein S. Driving licences and medical screening in old age: Review of literature and European licensing policies. J Transp Health. 2015;2(1):68–78. doi:.https://doi.org/10.1016/j.jth.2014.09.003
  19. Siren A, Haustein S, Meng A, Bell D, Pokriefke E, Lang B, et al. Driver Licensing Legislation. CONSOL WP5.1 project. 2013. Available from: http://consolproject.eu/attachments/article/22/CONSOL%20Report_WP5.1-Legislation%20in%20driving%20licensing.pdf
  20. Vetsch M, Gantcheva N, Favrat B, Perron NJ. [Driving ability: how not to lose control?]. Rev Med Suisse. 2014;10(443):1746 –52. Article in French.
  21. Seeger R. Verkehrsmedizin in der Grundversorger-Praxis [Traffic medicine in basic medical practice]. Ther Umsch. 2011;68(5):235–41. Article in German. doi:.https://doi.org/10.1024/0040-5930/a000157
  22. Büla C, Eyer S, von Gunten A, Favrat B, Monod S. [Driving and cognitive impairment: how best to anticipate?]. Rev Med Suisse. 2011;7(316):2184–9. Article in French.
  23. Favrat B, Pasche C. [Aptitude to drive: what road to take?]. Rev Med Suisse. 2012;8(325):176–7. Article in French.
  24. Krämer G, Bonetti C, Mathis J, Meyer K, Seeck M, Seeger R, et al. Epilepsie und Führerschein / Epilepsie et permis de conduire. Swiss Med Forum. 2015;15:157–60. Article in German and French. doi: and doi:https://doi.org/10.4414/smf.2015.02170
  25. Lehmann R, Fischer-Taeschler D, Iselin HU, Pavan M, Pralong F, Seeger R, et al. Richtlinien bezüglich Fahreignung bei Diabetes mellitus / Directives concernant l’aptitude à conduire lors de diabète sucré. Swiss Med Forum. 2011;11:273–5. Article in German and French. doi: and doi:.https://doi.org/10.4414/smf.2011.07489
  26. Mathis J, Seeger R, Kehrer P, Wirtz G. Fahreignung bei Schläfrigkeit. Empfehlungen für Ärzte bei der Betreuung von Patienten mit vermehrter Schläfrigkeit / Capacité à conduire un véhicule et somnolence. Recommandations pour les médecins lors de la prise en charge des patients souffrant de somnolence. Swiss Med Forum. 2007;7:328–32. Article in German and French. doi: and doi:.https://doi.org/10.4414/smf.2007.06161
  27. Mérour A, Favrat B, Borruat F-X, Pasche C. [Requirements on vision for driving: to see more clearly]. Rev Med Suisse. 2014;10(452):2252–4, 2256–7. Article in French.
  28. Serra A-L, von Gunten A, Mosimann U, Favrat B. [Driving ability, mental illness and psychotropic medication in the elderly]. Rev Med Suisse. 2014;10(428):981–5. Article in French.
  29. Diabete_et_Conduite.pdf [Internet]. [cited 2016 Jan 28]. Available from: https://cabinetzimmermann.ch/images/med-infos/Diabete/Diabete_et_Conduite.pdf
  30. Sebo P, Haller DM, Favrat B, Huber P, Mueller Y, Vaucher P. Adherence to guidelines when evaluating fitness-to-drive in the elderly: a practice review of Swiss physicians. Swiss Med Wkly. 2018;148:w14632.
  31. Statistique_mdicale_2016_de_la_FMH1.pdf [Internet]. [cited 2017 Jun 24]. Available from: https://contens30.fmh.ch/fmh/_files/pdf18/Statistique_mdicale_2016_de_la_FMH1.pdf
  32. Lovas J, Fereshtehnejad S-M, Cermakova P, Lundberg C, Johansson B, Johansson K, et al. Assessment and Reporting of Driving Fitness in Patients with Dementia in Clinical Practice: Data from SveDem, the Swedish Dementia Registry. J Alzheimers Dis. 2016;53(2):631–8. doi:.https://doi.org/10.3233/JAD-160254
  33. Ryan M, McFadden R, Gilvarry E, Loane R, Whelan D, O’Neill D. Awareness of Medical Fitness to Drive Guidelines among Occupational Physicians and Psychiatrists. Ir Med J. 2017;110(10):653.
  34. Schmittdiel J, Grumbach K, Selby JV, Quesenberry CP, Jr. Effect of physician and patient gender concordance on patient satisfaction and preventive care practices. J Gen Intern Med. 2000;15(11):761–9. doi:.https://doi.org/10.1046/j.1525-1497.2000.91156.x
  35. Lurie N, Slater J, McGovern P, Ekstrum J, Quam L, Margolis K. Preventive care for women. Does the sex of the physician matter? N Engl J Med. 1993;329(7):478–82. doi:.https://doi.org/10.1056/NEJM199308123290707
  36. Meuser TM, Carr DB, Unger EA, Ulfarsson GF. Family reports of medically impaired drivers in Missouri: cognitive concerns and licensing outcomes. Accid Anal Prev. 2015;74:17–23. doi:.https://doi.org/10.1016/j.aap.2014.10.002
  37. Sims J, Rouse-Watson S, Schattner P, Beveridge A, Jones KM. To Drive or Not to Drive: Assessment Dilemmas for GPs. Int J Family Med. 2012;2012:417512. doi:.https://doi.org/10.1155/2012/417512
  38. Jamt REG, Gjerde H, Normann PT, Bogstrand ST. Roadside survey on alcohol and drug use among drivers in the Arctic county of Finnmark (Norway). Traffic Inj Prev. 2017;18(7):681–7. doi:.https://doi.org/10.1080/15389588.2017.1283027
  39. Wadd S, Papadopoulos C. Drinking behaviour and alcohol-related harm amongst older adults: analysis of existing UK datasets. BMC Res Notes. 2014;7(1):741. doi:.https://doi.org/10.1186/1756-0500-7-741
  40. Yan T, Xu H, Ettner SL, Barnes AJ, Moore AA. At-risk drinking and outpatient healthcare expenditures in older adults. J Am Geriatr Soc. 2014;62(2):325–8. doi:.https://doi.org/10.1111/jgs.12636

Most read articles by the same author(s)

<< < 1 2