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Medical aspects of fitness to drive – A guide for health practitioners

This guide is to assist health practitioners in assessing the fitness to drive of any individual. It also sets out the responsibilities and obligations of health practitioners.

9. Problems associated with increasing age

This section covers:

Summary table

The table below summarises the information outlined in this section. It does not describe any tests that may be necessary before some individuals can return to driving. Practitioners should ensure that they are familiar with the guidance outlined in the entire section rather than relying solely on the table.

Medical conditionClass 1 or class 6 licence and/or a D, F, R, T or W endorsement (see appendix 3)Class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement
Problems associated with increasing age Generally no licensing restrictions unless a medical condition(s) is present that may affect the individual's ability to drive safely.

If a medical condition is present, refer to the appropriate section of this guide, eg section 6 if a visual condition is present.
Same as private classes.
Conditional licensing may be appropriate for some individuals with some medical conditions, eg no night driving for individuals with night vision problems. Consideration should be given to the type of driving undertaken.

Factors for medical practitioners to consider

The aim of determining fitness to drive is to minimise the risk to the individual, and other road users, while maintaining appropriate independence and employment.

Medical practitioners should consider the following factors, in addition to the guidance outlined in this chapter, when assessing an individual for fitness to drive:

  • Presence of medical conditions - impact of medical condition(s) on the ability to drive safely. Carefully consider the impacts of multiple medical conditions and ageing factors.
  • Type of licence held and type of driving undertaken - commercial drivers spend up to an entire working week in their vehicle, and that vehicle can weigh greater than 25,000kg or carry many passengers. A crash involving such a vehicle could put many people at risk.
  • Medication - consider the effects of medications, and an individual's likely compliance with medications, on their ability to drive safely. Particular caution is required with the prescription of hypnosedatives in older people who drive, due to the possibility of exaggerated responses as a result of reduced clearance or enhanced sensitivity.
  • Individual's motor vehicle crash history (if known) - medical practitioners may need to recommend a longer period of refraining from driving if an individual has a history or pattern of crashes that may be associated with their condition. Where a medical practitioner is aware of a medically related crash, they must inform the Agency if the individual's medical condition remains unresolved and the individual is likely to continue to drive (refer to section 1.4).

Introduction

It is important that older people retain their independence, and driving is one factor that can facilitate this. Age by itself is not a bar to holding a driver licence and many people of advanced years continue to drive safely.

Although chronological age is not an indicator of an individual's physical well-being, the natural ageing process is accompanied by a significant increase in the incidence of medical conditions that can affect safe driving, eg dementia, stroke and heart disease. Some older drivers also take medications that can affect driving performance. The combination of these factors means that the regular assessment of the medical fitness to drive of older drivers is necessary.

With increasing age can come a number of factors that may impair safe driving, eg:

  • early onset of fatigue
  • slowed responses
  • visual problems
  • impaired cognitive function
  • impaired mobility
  • medical conditions that primarily affect older people, such as dementia.

Crash statistics show that, while older drivers in New Zealand are involved in relatively few crashes, in terms of crashes per kilometre driven, they are second only behind young drivers in terms of crash risk (the likelihood of having a crash). Based on Police crash reports for the period 2003-2007, age-related factors were estimated to contribute to 347 medical-related crashes. This is about 20 percent of medical-related crashes during this period.

General advice

Driving can be an integral part of an older person's life and independence. Where a medical practitioner considers that an older driver may need to refrain from driving in the near future, medical practitioners may wish to counsel the older driver on this earlier than when refraining from driving is required, to allow the older driver to start thinking about alternative transport arrangements. This is particularly important for conditions that may impair the older driver's memory, as some older drivers may continue to drive when they have been advised not to, simply because they do not remember the medical practitioner's advice. Where an older driver may need to give up driving, medical practitioners should consider involving supportive family members and other support networks of the individual.

The presence of borderline mental or physical limitations may necessitate more frequent screening in individual cases. A medical practitioner can write to the Chief Medical Adviser to recommend that the Agency impose a licence condition for more frequent medical assessment for older drivers with conditions that are likely to substantially deteriorate between medical examination requirements.

Medical practitioners should advise older drivers about the enhanced effects of alcohol on the ageing brain. The extra dangers of fatigue for the older driver should also be drawn to their attention.

When there is evidence of the onset of a deterioration of skills or cognitive ability, medical practitioners may wish to advise individuals that they should consider, as much as possible:

  • reducing the amount of driving undertaken
  • avoiding peak traffic periods
  • avoiding busy roads
  • avoiding night driving.

Occupational therapist assessment

Where there may be medical factors that could affect an older driver's ability to drive safely, it may be appropriate for the older driver to have a driving assessment by an occupational therapist with specialist skills in driver assessment. These specialists are available in most centres and offer a thorough, independent, objective assessment of driving ability that is a valuable adjunct in determining fitness to drive.

Occupational therapists assist people with disabilities, including age-related disability, to be independent in the activity of driving where technical and financial resources allow. Occupational therapists may also advise individuals with disabilities that result in them being unsafe to cease driving. Occupational therapists’ driving assessments cover a wide range of skills required for safe operation of a vehicle, including:

  • biomechanical problems - these are evaluated and recommendations are made for the acquisition of suitable vehicles and appropriate vehicle modifications, with consideration given to lifestyle and mobility devices such as wheelchairs
  • cognitive skills, including concentration, decision making, eye-hand coordination and impulsivity - to ensure ability to cope with the demands of driving and traffic situations.

Details of occupational therapists’ driving assessment services can be obtained from Enable New Zealand on 0800 171 981 or from the New Zealand Association of Occupational Therapists on 04 473 6510.

Medical assessment of the older driver

Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or a D, F, R, T or W endorsement

The assessment of the older driver should take particular note of the following:

  • 1. Medical history
    • history of previous or existing medical problems, with particular attention to episodes of dizziness, vertigo, angina, visual disturbances, transient ischaemic attacks and similar episodes
    • questions about any recent motor vehicle crashes or near misses
    • current medications.
  • 2. Mental function
    • orientation in time and space, recent memory, coordination, congruity of behaviour and responses, inattention, confusion, ability to communicate (see section 2.8).
  • 3. Vision
    • for details of testing, see section 6
    • general visual acuity and visual fields should meet the required standards.
  • 4. Cardiovascular system
    • presence of poorly controlled hypertension
    • presence of arrhythmias
    • evidence of significant ischaemic heart disease.
  • 5. Central nervious system
    • Parkinsonism
    • post-stroke effects
    • transient ischaemic attacks.
  • 6. Locomotor system
    • general mobility and strength, especially in relation to arthritis and other degenerative conditions.

Also consider the presence of other conditions, such as malignant disease or significant respiratory problems, in relation to the individual's overall fitness to drive. Where some level of doubt exists, it will be prudent to arrange for further assessment, eg a practical driving test or an occupational therapist assessment. In certain cases, it may be possible to impose conditions on a driver licence in order to meet a patient's specific limitations, eg no night driving may be a licence condition for those with night blindness.

Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement

When driving should cease

This will depend on the nature of any medical condition(s) and any age-related factors.

The medical standards are stricter than for private driving. Also consider whether an annual assessment is warranted. Particular thought should be given to:

  • type of work being undertaken
  • hours of driving required
  • type of vehicle being driven (including the nature of controls, transmission, etc). 
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