access_time published 07.10.2019
Aging and driving in Switzerland
Primary care Ethics
Aging and driving in Switzerland
It is time for Swiss practising physicians to discuss with the authorities whether the current laws on testing the driving skills of older drivers are ethical and do not discriminate against seniors who have good driving ability.
The age of the population is increasing in many countries. Switzerland has adopted a restrictive policy for the mandatory medical testing of seniors’ driving capacity. In the past a medical check was required for people aged 70, but since 2018 the age for testing has been increased to 75. Only accredited Swiss physicians, who have attended special courses and passed the examination, can perform the check. Of note, most European countries do not test by law senior drivers and these old persons can drive in Switzerland.
The Swiss constitution states that people should not be discriminated against because of sex, age, ethnics and religion. However, Swiss authorities discriminate against qualified practicing physicians who are older than 70 by forbidding them to test senior drivers. In contrast, lawyers, architects and other persons with important responsibilities who are older than 70 aren’t excluded from working tasks. This exception is unique to physicians and is unfair.
Swiss physicians who assess senior drivers must take a history. Curiously, it is not specified that they should ask about driving specifics, such as difficulty with turns, reversing, street signals, staying in lane, reversing, maintaining usual speeds and parking. Physicians must check for medications, visual problems (e.g., cataracts, glaucoma, macula, visual field defects), hearing loss, dementia, Parkinson’s disease, syncope, seizures, frequent falls and dizziness, relevant cardiac disorders (e.g., if the patient has an implanted cardiac defibrillator), hypoglycaemia, paralysis and/or significant neuropathy, significant mental or psychiatric impairment, impairing disorders (e.g., arthritis with impaired function of the cervical spine). Testing physicians must keep up with evolving driving technologies and transportation options.
Obviously, if the detected medical problems are amenable to an effective therapy, driving should be stopped till the problems are solved. However, this should not absolutely mean permanent withdrawal of the driving license. Withdrawal of the driving license should be ordered when the conditions are not amenable to treatment. It would be wise to check the recovery by means of a driving test with an expert.
Retirement from driving will be necessary for most of us when we age and loose functions. Seniors need counselling about driving. Heath and function for safe driving must be maximised, but not only on the basis of age. High-risk drivers must be identified and unsafe drivers must be reported to the authorities.
Older people are driving more than in the past and modern cars are safer than the old ones. Most seniors are wise drivers, with few risky driving behaviours. Old age is by no means a mandatory high-risk condition for unsafe driving .
Social media play a major role in discriminating against driving seniors. In reality, the most frequent and severe driving accidents involve young drivers with an antisocial driving style, all too often under the influence of toxic substances (e.g., alcohol or narcotics). Whereas these cases are rarely published, in a senior driver even a minor driving accident is widely reported. This fact creates the distorted feeling that seniors are “the dangerous drivers”. In reality, seniors are less likely to use toxic drugs. And even for drugs that impair driving (e.g., tranquilizers and psychotropic drugs), seniors don’t use these drugs more frequently than younger people. Nonetheless, high-risk drivers are not identified in the younger age group.
There is also a disturbing financial aspect. Use of recommended tool-boxes or evaluation by a medical specialist can be helpful, but cannot replace a practical driving test with an expert (reality against theory)  and it has been proven that there is no evidence-based gold standard test, including the Clinical Assessment of Driving Fitness , to determine driving fitness. Nonetheless, Swiss authorities have politically and financially supported authorised medical centres that have developed tool-boxes, teach and set examinations for the testing physicians. Authorised Swiss centres have a large interest in keeping their status, confirming their ruling position and restricting driving by seniors for the “safety” of driving. Driving tests are rarely performed and if requested the experts are from the authorised medical centres. If there is any (sometimes wrong) doubt about the driving fitness of seniors, the decision is deferred to these special medical centres. Their testing costs up to some thousands of francs and, as a matter of fact, generally seniors get an unfair evaluation and lose their driving license.
In conclusion, physicians should more consistently reflect patients’ greatest need and concern, but they cannot add to their outpatient workload without changing clinic schedules, coding and reimbursement . Driving retirement has societal and individual consequences. It is as worthy of clinical attention as medical diseases. Testing driving fitness requires training and remuneration should be commensurate to the complexity and time involved.
Many health professionals should appreciate how not driving can affect patients’ lives. Not driving means a reduction of freedom, opportunity and independence. It makes more difficult shopping, keeping social contacts and maintaining self-respect. It is time for Swiss practising physicians to discuss with the authorities whether the current laws are ethical and do not discriminate against seniors who have good driving ability. Also, Swiss authorities should explain why practicing qualified physicians who are older than 70 cannot perform these driving tests.
No financial support and no other potential conflict of interest relevant to this article was reported.
Giuseppe Cocco MD, EFESC
- Aronson L. Don’t Ruin My Life - Aging and Driving in the 21st Century. N Engl J Med. 2019;380(8):705–7. doi:https://doi.org/10.1056/NEJMp1613342.
- Pomidor A. Clinician' guide to assessing and counseling older drivers. 3rd ed. Washington, DC: National Highway Traffic Safety Administration. American Geriatrics Society, January 2016 (Report no. DOT HS812228).
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