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Keep Older Drivers on the Road

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Mandatory medical screening of older drivers – which has been imposed in some European countries and is proposed in the UK – is not evidence-based

and may have dangerous consequences, a gerontologist has said.

“Age-related medical screening should be abolished,” said Professor Desmond O’Neill, consultant physician in geriatric and stroke medicine at Trinity College, Dublin, Ireland, recently in the British Medical Journal. [BMJ 2012;345 DOI: 10.1136/bmj.e6371]

Older drivers not only have an enviable crash record, but they also raise traffic safety among other generations, explained O’Neill.

“The risk of serious injury to children is halved if driven by grandparents rather than parents,” he said, “yet the belief that older drivers pose a disproportionate risk to other road users refuses to die.”

His suggestion that medical screening for older drivers be abolished does not imply professional neglect of their medical fitness to drive, he added.

O’Neill said a recent report from a UK parliamentary charity that “overstates the risk of older drivers and recommends training for them” was disappointing and an unnecessary measure of “dubious value.”

According to him, several practitioners are confusing increased risk of death because of fragility with crash risk. In addition,

they may lack sufficient gerontological training to understand that the positive aspects of aging, such as wisdom and strategic thinking, help in adaptation and compensation to the “vicissitudes of later life.”

Previous studies on medical screening showed a hazardous shift from protected to unprotected road user, explained O’Neill.

When the Danish government added a cognitive screening test to the medical screening test for older drivers, it did not reduce the rate of older   people dying in car crashes

but significantly increased the risk these people had of being injured as pedestrians.

We need flexible transportation options responsive to the needs of older people and car safety features designed with the elderly in mind, he said.

The emergence of better guidelines for doctors dealing with opportunistic screening among older patients in the clinical setting is of enormous value.

 Rather than mass screening,

“we should focus on evidence based innovations, such as restricted licensing and rehabilitation, for people with age-related illness.”