To the Editor: We read with interest the report by Hakamies-Blomqvist and colleagues comparing accident rates in Sweden and Finland. The methodology is excellent and consistent with the quality of research we have come to expect from their group. Their results confirm that current medical and vision screening do not reliably identify older drivers at risk. In Sweden, drivers are unlikely to lose their licenses subsequent to a physician's report, and there are no reasons to believe it would be otherwise in Finland. At present, the only screening operative in Finland seems to be the removal of drivers who do not persevere through all the bureaucratic red tape presented by Finnish licensing authorities to maintain their licenses after age 45. The authors list two important points: (1) driving privileges should not be revoked on the basis of diagnostic labels or age thresholds and (2) transportation issues must be addressed in the segment of the population at risk or deprived of driving privileges. The first point is, we hope, well established and widely supported. The second, is emerging slowly and needs further study and discussion. The impact of driving restrictions and alternatives on quality of life should be examined along with costs (financial and others) to individuals, families, and communities. Hakamies-Blomqvist and colleagues have shown that current medical screening is inadequate, and physicians need better tools and training to evaluate their patients' fitness to drive. Unfortunately, we are left with the impression that the authors do not recommend any screening for older drivers. Given the increase in accident rates, and particularly the increase in initiation of fatal motor-vehicle accidents by older adults, 3 there is a pressing need for the development and resting of screening tools in this population. (Author/publisher)
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