Identifying the impaired older driver.

• Functional age is normally measured in terms of an older person's ability to manage daily living skills such as personal care, cleaning, washing, managing the household, etc.

• Driving test for elderly drivers should include an assessment of motor function (coordination and speed of reflexes), visual perception speed and processing, cognitive functioning and mental state. This a much better assessment than just using chronological age, how old they are.

• The major risk for crashes in the elderly are undiagnosed dementia and neurological conditions, those with multiple unmanaged co-morbidities and multiple adverse drug reactions. Together with hearing loss, loss of muscle strength and flexibility, slowed reflexes, these can cause slower reaction times, impaired visual perception and scanning, and impaired perceptions on the road.

• Safe driving cognitive performance requires-

  ·       Fast speed of information processing.

  ·       Quick reflexes.

  ·       Accurate visual vigilance.

  ·     Visuospatial orientation which is usually impaired in the early stages of dementia.

  ·       Being able to maintain sustained attention and concentration without distraction.

  ·       Simultaneous attention of more than 2 stimuli.

  ·       Divided attention when needing to look to the left or to the right, behind or in front.

  ·       Rapid change focus of concentration.

  ·       Impaired judgement reduces the driver's ability to make appropriate decisions in complex traffic situations.

  ·       Difficulty in coping with sudden changes or a new environment.

  ·       Preserved short-term memory to remember speed limits and traffic signs.

  ·       Judgement.

• Those older people at risk of impaired driving include-

  ·       Serious walking and balance disorders.

  ·       Flexed posture, marked slowing of movement.

  ·       Impaired righting reflexes.

  ·    Restricted neck movements impeding lateral rotation to check for blind spots.

  ·       Slowed information processing.

  ·       Poor vision.

  ·       Poor hearing.

  ·       Vague and repetitive.

  ·       Cognitive impairment.

  ·       Poor memory.

  ·       Poor attention.

  ·       Poor insight.

  ·       Poor judgement.

  ·       Poor comprehension.

  ·       Slowed reaction times.

  ·       Poor coordination.

  ·       Poor problem solving.

  ·       Easily distracted.

  ·       Muscle weakness.

  ·       Taking multiple medications.

• THE TRIGGERS FOR MEDICAL ASSESSMENTS OF OLDER DRIVERS

   ·      Struggling at home alone.

          Reports from family or friends that driving behaviour is erratic and unsafe.

  ·      Evidence of frequent “dents”, “dings”, “bumps”, “scratches’ or more serious damage to the car.

  ·       Risky and dangerous driving behaviours such as speeding, near misses, not giving way, veering out of lane

  ·       Getting easily agitated or aggressive.

  ·       Getting lost on familiar routes.

  ·       Reacting very slowly to dangerous traffic situations.

  ·       Frequently forgetting where the car was parked.

  ·       Driving with head below the steering wheel level so they can’t really see properly around them.

  ·       Taking forever to get into and out of the car.

  ·       Mistaking the accelerator for the brake pedal.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.