New research shows age may make you a better driver

As health systems around the world grapple with rising expectations, budgetary constraints and political meddling, we can sometimes forget the constant progress that is also occurring.

Indeed, there is also a danger of talking down the system. As discussed previously in this column, the flight of older people with acute illnesses (due to perceptions of trolley waits in the public system) towards a private system unprepared for such complexity is symptomatic of this.

One particular area of progress in Ireland with which I am delighted to have been associated is that of traffic medicine, which is focused on the interaction between medical conditions and fitness to drive. The ability to drive, particularly in a country with little by way of local public transport outside major urban centres, is critical to employment, social interaction and wellbeing.

Traffic medicine, a new specialism, tries to balance a therapeutic approach to rehabilitation and treatment to maintain transportation mobility while ensuring due safety for those affected by conditions which may affect driving ability.

Up to recently, Irish doctors and other health professionals had no effective guidelines or training in assessing medical fitness to drive, although at a practical level they gained pragmatic experience with the over-70s medical certification, an issue to which I will return later.

However, a European Union directive in 2009 on driving and diabetes, epilepsy and vision prompted the need for radical change in managing medical fitness to drive in Ireland. The Road Safety Authority (RSA) rose to the challenge and found a partner in the Royal College of Physicians in Ireland which had already set up a working group on the topic.

Working group

A National Office for Traffic Medicine was set up in 2011 between the two organisations. It hosts a working group comprising more than 30 medical specialties, associated disciplines, the Garda Síochána and the RSA, making it possibly the largest interdisciplinary health group in Ireland. Given the lack of useful guidelines, there was huge enthusiasm to develop a coherent programme of guideline development, education, research and communication.

We now have a system which is the equal of any in Europe and in some aspects more advanced. In addition to comprehensive guidelines which are revised annually on the basis of emerging research, there is an extensive education programme, with the first certificate in traffic medicine in Europe as well as a certificate in road safety aimed at the wider road safety community.

The success of the annual Mary Ward Essay Prize for Traffic Medicine for medical students (named after the first automobile fatality in the world in Birr, Co Offaly, in 1869) has stimulated interest in traffic medicine in medical schools and is due to be extended to other healthcare disciplines.

Developing further substantial Irish research in the field is important, and the RSA has instituted a bursary for traffic medicine research. The first awardee, the department of general practice in UCC, is due to present at the inaugural traffic medicine research day in March in Dublin, which will be attended by international experts.

Emerging evidence

The research activities of the national office have been notable, examining the impact of the educational programmes, the value of restricted licences and an overview of licensing of older drivers.

This latter issue is of importance because of consistent emerging evidence from around the world that not only do older drivers have a good safety record but also that medical screening programmes are associated with no reduction in in-car fatalities and increase in death and injury among vulnerable, older road users.

This counter-intuitive finding for those unacquainted with gerontology, who might only see the increased number of illnesses of later life, is explained by the better strategic and tactical thinking of older drivers, as well as premature withdrawal from driving when confronted by medical certification.

On this basis and given that there have been major improvements in the assessment procedures, the National Office for Traffic Medicine has recommended to the Road Safety Authority that medical screening for the over-70s should cease. The other improvements include a more comprehensive yes/no declaration of medical conditions when renewing a driving licence, comprehensive guidelines and education for doctors to pro-actively advise patients on driving, as well as a range leaflets on driving and medical conditions for the general public.

In the future, automated cars may reduce concerns over driving and medical fitness to drive, but until then we are fortunate to have so many professionals in Ireland dedicated to promoting mobility and safety for those of us affected by illness.