“My 85-year-old father isn’t safe to drive any longer, but he absolutely refuses to stop.” It’s a common theme round the dinner table. And in the consulting room too, where exasperated families come hoping the GP can ‘do something’. But there isn’t much we can do. We can be firm with patients, we may be asked by the DVLA to perform a simple health check, and we can contact the DVLA if we feel that the public good justifies it, but we rarely have experience of our patients’ driving skills. “I would be happy to sit beside you driving” a GP told an elderly driver I know well. I have been her passenger. Clearly he never has. And discussing driving ability can be the end of the doctor-patient relationship. Tell a patient that they have a terminal illness and they will probably be distressed and frightened; tell them they shouldn’t be driving and the response is denial and anger.
The DVLA requires elderly drivers to fill in a long form before it will renew their licences, and may require an independent eye check. Unlike many public examinations which require an acceptable average mark over every element, your driving licence will be renewed if you scrape a pass on the visual test. No one checks that you can compensate for only-just-adequate vision through good reflexes, concentration, mental processing, and judgement. And what about hearing? And stiff necks? You need to be able to turn your head easily to look around you. And how many 85-year-olds have the physical strength to manage a powerful BMW in an emergency? Plus, you need road sense. Elderly drivers often choose inappropriate speeds, shooting onto roundabouts and crawling along motorways. Some interpret street signs and rights of way creatively, claiming that because the instructions are ‘misleading’ they are absolved from responsibility. Yet there is no assessment of road sense.
Ophthalmologists can be over-generous, for instance giving a 90-year-old permission to drive on condition that he stays at home after dark. The driver had to take his wife to hospital. It wasn’t till 10pm that she was settled and he felt free to start the familiar 20 minute drive home. Three hours later two police cars had to escort him to his front door.
It takes obstinacy and independence to be driving at 95. Not qualities which predispose drivers to trade in their car for Dial-A-Ride after more than half a century at the wheel. “I’ve never had an accident.” many say. But their cars clearly have. “I only drive locally and these days I go very slowly.” But over-80s have more accidents per mile than any other drivers.
How do the elderly come to realise that their driving days are over? A small, but dangerous, misjudgement may frighten them into exchanging the car for a taxi. Some find a face-saving way of giving up. My aunt lost, or ‘lost’, her car keys. Others accept proffered lifts because “it’s not a nice day to be driving”, and somehow it never is “nice enough to drive”. But with a worryingly high number, pleading, financial arguments, logic, elaboration of the risks of driving and information about the alternatives fall on deaf ears. If you feel that your life is not worth living without a car, even the argument that your driving could end someone else’s life carries no weight.
The baby-boomers will be coming up to 80 in the next decade or so. What should we be doing to remove from our roads a large and vociferous cohort of elderly drivers who are convinced they are safe drivers when they’re not? If their children disconnect the battery or let down the tyres the parent will just call the AA. Driving for many elderly people is not just a pleasure but a symbol of independence: “It’s my lifeline.” Arguing that using a car to go to the shops is just a convenience or a habit misses the point. It is a lifeline, but to a sense of self-worth. For many, relinquishing their licence is relinquishing living. No subsidised taxi scheme can compensate for that. How can we persuade our elderly relatives, friends and patients, and, in years to come, ourselves, that we can be independent and valued even when we no longer hold the car keys?
It is easier to be obliged by an inflexible rule to give up than to admit that you aren’t the person you were. So maybe no-one over the age of, say, 85, should be licensed to drive? Or should we have a more comprehensive assessment of all the faculties everyone needs to be a safe driver? In Spain, elderly drivers are required to play a videogame, steering an electronic car along a winding road. What a good screening test for reflexes and judgement! Why don’t we make a driving simulator test mandatory for all people applying for a renewal of their licence? Any other ideas?
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…