Helping older drivers prolong their ability to drive safely

Dr. Gary Naglie, Chief of Medicine and RRI scientist, Baycrest

The Toronto Star published a major investigative series in February that questioned whether enough is being done to identify elderly drivers who are no longer capable of driving safely on the roads. Ontario Transportation Minister Bob Chiarelli promised that new initiatives will be implemented to address this issue.

As a geriatrician, few topics that I discuss with my patients and their family members elicit as much emotion as the topic of driving safety. As a researcher, a main interest of mine is driving safety in older adult drivers. I am a member of Candrive, a national inter-disciplinary health research program that aims to improve the health, safety and quality of life of Canada’s older drivers.

With an aging population, there is a rapidly rising number of older drivers with dementia who may not be safe to drive. The challenge for medical professionals is to accurately distinguish which older drivers are unsafe. It has been estimated that the current number of drivers in Ontario with dementia is about 50,000 and that this will double to about 100,000 by 2028. Physicians are required by law to report their older patients who may be unsafe to drive, but no validated tools exist to assist physicians to identify unfit drivers. Although guidelines state that people with moderate and severe dementia are unsafe to drive, they indicate that some people with mild dementia may still be safe to drive. Establishing which people with mild dementia are safe to drive is not clear cut, as is the case with older drivers with other chronic illnesses. As pointed out in the Star articles, the Ontario Ministry of Transportation’s mandatory testing for drivers who reach age 80, and then every two years after that, does not include cognitive testing or on-road testing. Specialized driving tests for older drivers that include cognitive and on-road assessments are very expensive ($500 or more) and are not available in every community.

The Candrive research team is at the midway point of conducting a national five-year study of almost 1,000 drivers, aged 70 and older, with the objective of developing the first comprehensive science-based tool to help identify older drivers at risk for a crash. This study includes yearly in-depth assessments of sensory, physical and cognitive function, as well as driving habits and behaviours, using a GPS system to monitor actual driving. The results from this study will hopefully lead to the creation of an office-based assessment tool that will help physicians make more accurate decisions about the driving fitness of their patients.

But with all the focus on “weeding out” and “putting the brakes” on unfit drivers, what are we doing to help senior drivers extend their safe driving abilities longer in the lifespan?

Currently, physicians have little to offer their patients with mild cognitive impairment to improve their driving performance. To address this gap, I am working with a group of researchers at Baycrest (Drs. Brian Levine, Deirdre Dawson, Morris Freedman and Malcolm Bins), other researchers from across the city (Drs. Tom Schweizer, Sandra Black, David Tang-Wai, Nathan Herrmann and Corinne Fischer), and Candrive colleagues (Michel Bédard and Nicol Korner-Bitensky). We are launching a study to evaluate an intervention for seniors with mild cognitive impairment that aims to improve their ability to sustain attention and consequently their ability to drive. We hope the results from this study will show that we can prolong the time that older drivers with mild cognitive impairment can continue to drive safely.

Dr. Gary Naglie is Chief of Medicine at Baycrest, an affiliated scientist at Baycrest’s Rotman Research Institute, and a member of Candrive (www.candrive.ca)