BMJ 2002;324:1154 ( 11 May ) Letters System of renewal of driving licences for elderly people needs overhauling EDITOR---As a general practitioner, I believe that the guidance from the Driver and Vehicle Licensing Agency (DVLA) is unclear about when an elderly person should be advised or instructed to cease driving. Conditions commoner in elderly people, but not unique to them, such as decreased visual acuity and myocardial infarction, have clear guidelines on how they restrict the licence to drive, but there is insufficient advice about slowed reaction times, decreased spatial awareness, or memory impairment. It may seem cruel to revoke the licence of elderly people when all they may do is drive to the post office or visit their spouse in hospital. Although younger drivers are responsible for, and involved in, a greater number of serious road traffic crashes, many elderly people with developing dementia or general frailty should simply not be on the roads. I have known of people unable to look after themselves and yet still drive, albeit with navigational advice. Family members may plead with me to speak to an elderly relative about stopping driving, but this may be after such suggestions from them were met with resistance or indignation. Currently, licence holders in the United Kingdom need to reapply for a driving licence on reaching the age of 70 and then every three years thereafter. This reapplication simply entails the completion of a form by the applicant with no medical examination or verification by the general practitioner or anyone else. This self declaration that "no medical disability is present"1 is insufficient as what should be a comprehensive assessment of a driver and his or her abilities. There needs to be an overhaul of licence renewal in this country, with far greater independent medical assessment. Medical records need to be verified and cross checked, and the current system should be abandoned. Currently, the DVLA advises that "progressive loss of memory, impairment in concentration and reaction time with possible loss of confidence, suggest consideration be given to cease driving." This is far too arbitrary and is in urgent need of reassessment. As one elderly patient remarked to me: "In this country if you can hold a pen you are allowed to keep driving." David Carvel, general practitioner. Biggar Medical Practice, Biggar ML12 6BE David.Carvel@biggar.lanpct.scot.nhs.uk 1. Drivers Medical Unit. At a glance guide to the current medical standards of fitness to drive. Swansea: DVLA, 2001. (Author/publisher)
Samenvatting