This paper identifies the main factors that can increase crash risk with age, as well of ways to help older drivers sustain a good level of safe mobility. Older people are a large and increasing proportion of the population. Their mobility is vital to maintain a full and independent life. However, as people get older, it is inevitable that general health and fitness will begin to deteriorate — and this is what causes concern that older drivers may be at an increased risk of being involved in an accident. There is therefore the need to help people maintain safe mobility as they get older. Road safety activities play a fundamental role in that by decreasing the risk of being involved in an accident. Ultimately, age related conditions can eventually mean that there is a point when an individual must give up driving. However, one fundamental philosophy which this paper adopts is that policies which prematurely remove an elderly person’s ability to drive can have negative consequences for their health and quality of life. These consequences can outweigh the reduction in crash risk to the driver and the rest of society. In short, any intervention must be proportionate to the risk, and a judgement must be made as to whether an individual intervention gets the balance right. Engineering measures such as road or vehicle design can prevent accidents and injuries to older road users, although they are not covered within the scope of this paper which considers primarily education, training and publicity measures. However, they are fundamental to helping drivers maintain a good level of safe mobility. Vehicle adaption is one way of modifying a vehicle to assist safe driving. In 2008, 190 drivers over the age of 60 years were killed in road accidents, 1,148 were seriously injured and 9,677 slightly injured. Although the casualty trend is decreasing, it is decreasing slower than for other ages. Reported statistics indicate that the risk of being involved in an accident increases after the age of 70, and up to that age drivers are no more likely to cause a crash than to be the victim of another road user’s mistake. However, drivers over 70 and especially over 80 years, drivers are more likely to be at fault when they crash. Underlying health conditions, and some types of medication taken to treat those problems, are a more common factor in accidents involving older drivers. Indeed, a proportion of older driver fatalities occur when a driver dies of natural causes while driving, and their vehicle immediately crashes. Older drivers are commonly involved in collisions at junctions, often because they misjudge the speed/distance of other vehicles or fail to see a hazard. Visual impairment may be a factor in this type of crash. Due to their more fragile health and physical condition, older drivers are more likely to suffer injuries when they crash. An important aspect of older driver policy is being able to accurately identify which drivers are significantly more likely to be involved in crashes, and ultimately to help them give up driving and adapt to life without a car. There are several cognitive and physical conditions which affect the ability to drive safely, and which, therefore, could act as indicators of increased risk. One important question is how best to test for these conditions, as it is crucial that interventions do not unfairly cause older drivers to lose their licence. As drivers age at different rates, age is almost certainly not a suitable indicator on its own. There is comprehensive guidance for medical practitioners about how to assess fitness to drive, but there is a need for more education for health professionals about using the guidance and what measures they can take to help their patients who are, or are becoming, unfit to drive. It is clear that many older drivers recognise that their driving ability has changed and consequently change when and where they drive (through self-regulation). However, not all older drivers do this, and there is little guidance for them or their relatives about it. A major deterrent to self-regulation or stopping driving is the lack, or perceived lack, of viable alternatives to the car. Exercise programmes can help to maintain health and driving ability as people get older. Driver education programmes specifically tailored for older drivers are another important method, although it can be hard to make sure that the programme reaches the right people. A key question is how and when drivers should be relicensed. In the UK this occurs at 70 years (and every three years thereafter) and requires only the driver to self-certify that they are fit to drive. Research does not suggest that a mandatory driving test would be effective. The main conclusions from this paper are (1) The evidence shows that the cessation of driving can have significant negative consequences on the health of older drivers. Driving cessation is recommended, if the case merits it, only after the safety of the driver cannot be secured through any other means. (2) RoSPA does not believe that there should be a maximum driving age beyond which drivers automatically lose their driving licence. Research does not indicate that there is an age at which all drivers become unable to drive safely. Setting an arbitrary age limit would inevitably be unfair to some drivers. (3) Information, education and publicity are needed to help to raise awareness of the effects of ageing, and of the possible effects of medicines on driving performance. (4) Assessment and training courses should be made available to older drivers, tailored to the needs of the individual. Some courses have already been developed and a case study from Norfolk is described. Positive advice on alternatives to driving should be incorporated into any materials and campaigns. (5) Transport planners should be catering for older road users who may be considering giving up driving. It is unlikely that people will consider giving up the freedom and convenience of driving their own car unless there are suitable, safe, clean, attractive, convenient and affordable alternatives. (6) Vehicle adaption is a method of optimising a vehicle for a driver, and tailoring it specifically to a driver?s requirement. Currently there are 14 mobility centres around the country that can offer advice on vehicle adaption http://www.mobility-centres.org.uk. (7) General fitness underpins many strands of injury prevention. Some evidence shows that exercise programmes can add value to other road safety interventions. (8) Driving cessation can be a controversial and emotional area, especially given the social importance of driving and the impact that giving it up can have upon health. Given this, it is important that the tools used to assess the impact of health conditions on driving standards are accurate. (9) Drivers should be encouraged to undergo a formal medical check before renewing their licence when they reach 70 years of age, and again each time their licence is renewed. (10) Research which helps develop better understanding of the link between self-regulation and crash risk, and how to help drivers to match the environments that they drive in to their condition would be a valuable contribution to this area. (11) Drivers can be encouraged to discuss health conditions and fitness to drive during consultations with health professionals, who may not always raise fitness to drive issues first. (12) Appropriate information and guidance for primary health care workers is important to assist them in assessing health conditions which may affect the way in which someone drives driving and to enable them to provide appropriate and sensitive advice. (13) Families who are concerned about the driving standards of elderly relatives may also currently struggle to find appropriate advice, and this need must be addressed. (Author/publisher)
Samenvatting