For the senior driver, the 80th birthday represents an arbitrary line in the sand. At this point, the Office of the Superintendent of Motor Vehicles (OSMV) steps into a senior’s life and requests a medical exam. From this point forward, a Driver’s Medical Exam Report must be completed every 2 years and sent to the OSMV to confirm the senior’s fitness to maintain a driver’s licence. If a family physician isn’t available to perform the examination, a walk-in clinic physician can do so. Just under 2% of seniors reaching this age milestone will have identified health problems that could affect their driving ability, in which case a referral to the DriveABLE program will most likely occur.
DriveABLE, operated under the direction of the OSMV, is used to evaluate cognitive skills that might affect driving ability, such as memory, attention, reaction time, and judgment. Such cognitive testing can prove stressful for a senior driver. The DriveABLE testing process requires the use of a computer, and some seniors may be unfamiliar with the technology and feel intimidated by this requirement. As well, some of the memory test questions can be regarded as unfair. For example, should all senior drivers be able to list off thirty items sold in a grocery store? On a more positive note, following discussions with the OSMV, a companion can now accompany the senior to the testing session to offer support with the process.
The weeks spent waiting for the results of the DriveABLE test can also be stressful. Loss of a licence creates a feeling of lost independence, and will inevitably lead to major lifestyle adjustments.
The Council of Senior Citizens Organizations of BC (COSCO, www.coscobc.ca) is an umbrella organization for a number of retirement agencies, with 106 000 members. The organization provides pamphlets outlining positive objectives for seniors, including how to remain active, engaged, and independent. One of COSCO’s advocacy areas is senior drivers. The organization’s main intent is to keep capable senior drivers on the road while recognizing that some restrictions may need to be applied to certain drivers. They would like to see seniors be able to continue driving for longer based on testing and ability. COSCO notes the importance of seniors remaining socially connected—even if night driving becomes limited, it is important for seniors to pursue outings and maintain mobility during the day. COSCO also notes that taking multiple medications could have bearing on cognitive function for some seniors.
In a recent interview with COSCO representatives, concerns were raised about age discrimination—specifically the public perception that seniors, solely because of their age, aren’t able to cope with the responsibility of driving. Seniors have remarked that some physicians, mainly younger ones, seem uncomfortable dealing with them. A physician should never call a senior “dearie,” or “sweetie;” as at any age, it’s considered rude. To help improve physician rela-tionships with seniors, COSCO would like to see a greater focus on senior care in the medical school curriculum.
Another complicated factor of the driver’s medical examination is its possible negative effect on the doctor-patient relationship. When a health problem that could limit driving ability is identified during the exam, the physician must not only inform the patient—he or she has a legal duty, both to the patient and the public, to bring it to the attention of the OSMV. The patient, however, may regard this as a betrayal of their relationship. The situation can become personal, leading the patient to seek care elsewhere, both for driver’s testing and future medical care. This could lead the patient to a walk-in clinic, where health issues are more likely to remain unidentified because of limited options for longitudinal care. Many family physicians have reported such occurrences.
Our present BC driving evaluation approach has arisen from good intentions and consistent cooperation, uninterrupted by politics or policy changes. The OSMV has worked with the BCMA’s Emergency Medical Services Commit-tee since the 1960s to produce the British Columbia Driver Fitness Handbook for Medical Professionals. This publication, developed through extensive consultations with medical specialist organizations, helps physicians identify drivers at medical risk. It has been updated on an ongoing basis, as have the driver’s medical evaluation forms.
We will continue to work with COSCO, the OSMV, and other organizations to improve the evaluation process for determining seniors’ fitness to drive, with the goal of ensuring a safer driving experience for both seniors and the public in BC.
—David F. Smith, MD
Emergency Medical Services Committee
This article is the opinion of the Council on Health Promotion and has not been peer reviewed by the BCMJ Editorial Board.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org