Issue 13 / 10 April 2012

A GRADUATED system of licensing older drivers may offer some benefits for GPs who often have to deal with difficult assessments of fitness to drive, according to Australian experts.

Dr James Griffin, a Queensland GP and Royal Australian College of General Practitioners spokesman on assessing drivers, said if older drivers had a graduated licensing system similar to that used for young drivers, it could take the pressure off GPs to make sometimes difficult assessments about driver fitness, so might warrant further investigation.

Dr Griffin said conditional licences would still necessary as they covered all ages and specific medical conditions.

Professor Ernest Somerville, a Sydney neurologist and chair of the Australian and New Zealand Association of Neurologists’ driving committee, agreed a graduated system might have some advantages for doctors.

However, Dr Griffin and Professor Somerville agreed that although a lot of emphasis was placed on the fitness of older people as drivers, it was the youngest drivers who were at a much greater risk of being involved in accidents.

They were commenting on two articles in the CMAJ on the relationship between older people and driving risk.

A commentary in defence of older drivers said that when senior drivers were compared with non-senior drivers who drove a similar number of kilometres, any overrepresentation in crash statistics disappeared completely. (1)

The commentary author said an increased number of deaths among older drivers was due to frailty, which increased the probability of dying, rather than the ability to drive safely.

However, an editorial in the same issue of CMAJ said graduated licences should be extended to senior drivers to prevent trauma, “rather than to await a series of incidents before taking action”. (2)

Under the graduated license system, an older person’s full driver’s licence would default automatically to a restricted licence at a given, consistent point in time.

“The optimal transition time would be debatable, but might be based on a specific age, retirement or other benchmarks”, the editorial said.

Older drivers could apply for exemptions if they could show good health certified by their physician.

“Placing the onus on patients to seek a medical exemption would likely be more effective than relying on others to start discussions about medical suspension”, the editorial said.

Professor Somerville said a 2001 report by the Urban Transport Institute of Victoria showed similar driver statistics as those provided in the CMAJ commentary. The VicRoads statistics showed that 16–19-year-old drivers were three times more likely to be involved in crashes than the 75+ years age group. (3)

“It is clear that the group of drivers who are at greatest risk are the very young”, Professor Somerville said.

Dr Griffin said the RACGP believed the ideal system for assessing fitness to drive was the establishment of medical review panels in all states, similar to a system that already exists in Victoria.

In Victoria, GPs could refer drivers to the panel, convened by the Victorian Institute of Forensic Medicine, if there was any dispute over a driver assessment.

“This system would make it clear that it is the driver licensing authority that is responsible for issuing drivers’ licences, not doctors”, Dr Griffin said.

Professor Somerville also called for all states to introduce a similar review panel system to that operating in Victoria.

Last month the National Transport Commission and Austroads released the revised national medical standards for driver licensing Assessing fitness to drive 2012. (4)

– Kath Ryan

1. CMAJ 2012; Online 2 April
2. CMAJ 2012; Online 2 April
3. Crash rates by age and sex of travellers 2001; Urban Transport Institute, Taggerty, Victoria
4. Assessing fitness to drive 2012

Posted 10 April 2012

6 thoughts on “Merit in graduated licences for seniors

  1. Philip Morris says:

    Safety on the road is paramount. Also, it is important to be fair to the older drivers and not take away their driving privileges prematurely or without substantial evidence they are a risk on the road. Having a drivers licence denied very often leads to a loss of independence, especially in towns and cities with limited public transport (and there are many of these!), with negative consequences for the older person and their carers. While some driving decisions are relatively straight forward (such as not driving for a period of time after seizures) many others are not so clear cut. I have seen patients with early Alzheimer dementia conditions denied their licence just because they are taking cholinesterase inhibitor medication. No regard was paid to the fact that driving is an over-learnt skill and is usually not affected early in the course of Alzheimer’s disease, nor was regard paid to the fact that the patient did very well on an ‘on the road’ driving assessment. Older drivers need to be treated individually about the capacity to continue driving. A ‘one size fits all’ response is unfair to our seniors who want to keep driving.

  2. RayT says:

    As a person who will turn 69 later this year I have vested interest in this issue.

    I am one of those fortunate people from a long lived family, who is physically youthful and in good health. I am also mentally alert and don’t even need glasses to drive legally, but wear them as I am used to having had 6/5 vision most of my life.

    I would certainly object to automatic restrictions, but can see the need for regular certification as a generality after age 70. There should be an independent panel GPs can refer to in dubious cases.

    I do live 18 Km from Adelaide in the hills and need my car(s) as public transport just takes too long.

  3. John Carlyle says:

    The observations of Philip Morris are accurate as his recent interest in the aging mind has led him to correct conclusions. I have been involved in assessing fitness to drive referrals from the Queensland Police Service and local medical practitioners and Hospitals for 30 years. The elderly individual capacity must be assessed patient by patient -all the objective studies here and overseas support this position. I have in the past re-issued a manual gears driving licence for a 95 year old [naturally with 6 monthly frequency of review]. If any patient falls into a grey area the most valuable further assessment is the formally qualified driving occupational therapist assessment in addition to the medical opinion. Driving school instructors assessments are useless and dangerous. There is no merit in academic hair brained schemes no matter how well intentioned they are. My decisions are all subject to judicial review and to date no Court has overturned a decision either to issue a licence or revoke a licence.

  4. bruni brewin says:

    Thank heavens for some sense. I too am 69 shortly and have been driving since before coming to Australia in 1965. I don’t wear glasses and go to workshops and meetings 45 mins. away by car but 3+ hours by public transport. I also have a colleague who has just passed a continuing oral and practical driving test at 85 yrs of age. A visit to your local GP would be advantageous as they have a record of your medication that would give an indication of how fit you are. Your demerit points would indicate if you are a problem on the road? Although, (tongue in cheek), there is a saying that older people don’t have accidents, but they cause other people to have them. Why? Because they tend to keep to the road rules, while the younger less patient population have problems with that and take risks to get past them.

  5. Bruce Hocking says:

    The suggestion that older drivers should be subjected to “graduated licenses”, somehow analogous to L and P plates, warrants sharp questioning. In Canada it is proposed that all seniors (age unspecified) are placed on a restricted licence unless good health is certified by a physician (1). This implies that doctors are good at screening older drivers regarding fitness to drive. Australian data shows this not to be so.

    Providentially a controlled study is possible between states such as NSW that require medical examinations at age 80 and over and states such as Victoria that do not. Langford etal have compared several aspects of fatal crashes between senior drivers in these states and found no significant differences (2).

    Mandatory licence restriction requiring medical examinations to obtain an exemption for all senior drivers will not contribute to improvement in road safety. But it will contribute to self-doubt, stigma and expense to seniors. It will also encourage self-righteousness by politicians and shock-jocks who demand these examinations.

    1. Redelmeier DA, Stanbrook MB. Graduated drivers’ licences for seniors: reclaiming one benefit of being young. CMAJ. 2012 Apr 2. [Epub ahead of print].
    2. Langford J, Bohensky M, Koppel S, Newstead S. Do age-based mandatory assessments reduce older drivers’ risk to other road users? Accid Anal Prev. 2008 Nov;40(6):1913-8.

  6. 55 Alive says:

    senior drivers are more likely to receive traffic citations and get into accidents than younger drivers b’cuz senior drivers are often viewed as a hazard on the roads. Statistics show a rise of fatalities, traffic violations and serious injuries caused by senior citizens that should not be driving.

    Road accidents caused by older drivers is growing every year and so do the challenges.

    In support of Driver Safety Program – let us bring awareness in senior citizen drivers about mature driver improvement courses – such as – to improve driving skills on road, refresh their driving knowledge and update them on latest traffic rules and regulation that help keep older drivers and their families safe behind the wheel.

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