In Switzerland, the age for an obligatory medical check-up was raised from 70 to 75 on January 1, 2019. Drivers aged 75 and over must undergo a medical examination by a doctor of their choosing every two years; depending on the structure in the respective canton, this doctor may also be their GP. The person in question requires confirmation from their doctor that they are suitable to drive. They receive a letter from their canton when they are due to go for their check-up. From this point onward, they have three months to take the examination and submit the report from their doctor. The authority then uses this information as the basis for their decision on whether the person is suitable to drive. If necessary, the authority can mandate that the person needs to undergo another medical examination or complete a driving test. Likewise, the canton’s authority can also limit driving permission for persons who are unable to meet the minimum medical requirements even when using compensation measures, rather than revoking their driving license completely. In such cases, the authority can set speed limits, specific regions or types of road, times of day (e.g. no driv-ing at night) or vehicle types that the driver must use or observe, or mandate that they can only use specially adapted/customized vehicles.
The minimum medical requirements used to determine whether someone is suitable to drive are defined in Annex 1 of the Swiss Road Permit Regulations (Verkehrszulassungsordnung). Among other things, these regulations contain provisions on a driver’s vision, neurological symptoms (no issues that impair consciousness or sense of balance), cardiovascular diseases (no risk of attacks, no significant anomalies in blood pressure), metabolic disorders (stable diabetes only), and organic brain dysfunctions (no dementia or similar symptoms). A failure to take the medical examination within the time frame provided can result in a person’s license being revoked and not returned until they can provide confirmation that they have passed the medical examination and are suitable to drive.
In the Netherlands, the age for an obligatory medical check-up was raised from 70 to 75 in 2014. There are several steps to the process for extending a driver’s license. Around four to five months before their license is due to expire, drivers must fill out a health declaration form (Gezondheidsverklaring). The form contains questions regarding restrictions to the driver’s mobility and vision, any existing medical conditions and any medication they take. Once this form has been submitted, the driver receives an email with an invitation to attend a medical check up with either their GP or a specialist, depending on their health status. Once the check-up is complete, the doctor produces a report, which is sent to the Centraal Bureau Rijvaardigheidsbewijzen (CBR). One of the CBR’s in-house doctors then assesses the information provided and evaluates the person’s suitability to drive. This doctor may decide that an additional, more extensive examination is required. In addition to approving or rejecting a person’s suitability to drive, the CBR can also issue a restricted approval. Restrictions may include a shorter term to the person’s driver’s license, a requirement that they use certain aids, such as glasses, or instructions that their vehicle must be converted in a certain way.
In France, there is no set threshold for when a medical check-up may be required. The reason given for this is that older drivers are involved in fewer accidents than drivers in other age groups. In addition to this, particular importance is placed on the mobility and autonomy of older people. The government also uses the lack of effectiveness of age-related tests as an argument for not making such tests mandatory. However, people must disclose any existing medical conditions they may have that are relevant to their suitability to drive, such as diabetes or epilepsy. If they fail to do so, they will be personally liable in the event of an accident. Their driver’s license may also be revoked or not renewed.
In accordance with Article 221-14 of the French Road Traffic Act, family members are permitted to provide the authorities with information regarding a person’s suitability to drive if they deem this to be necessary. Information on one’s medical conditions and reports by family members must be submitted to the prefecture, which can prescribe an assessment based on their inspection of the facts at hand. The doctor determines a person’s suitability to drive based on their physical, cognitive and sensory abilities, and can also carry out additional tests or seek advice from a specialist if necessary. Psychological evaluations must be conducted by a registered psychologist. The report remains valid for a maximum of two years, the driver’s license for a maximum of five; the exact terms are defined by the authority for the respective département.
The examples show that the different approaches taken in different European countries are linked to the driver’s calendar age, and focus mainly on assessing their suitability to drive based on their physical and cognitive performance. Not much consideration is given to assessing minimum the-oretical or practical driving skills in a way that would give older road users the tools they need to maintain their mobility. In addition to this, there are no uniform standards for periodical health check-ups. There are stark differences between some of the countries in terms of the methods used to determine suitability (self-reporting, examinations, certification), the content and scope of the health check-up, the qualifications of those who determine suitability, and their position in relation to the driver (Figure 21). If the task of approving a person’s suitability to drive is placed in the hands of their GP, this makes it difficult to maintain the principles of neutrality, independence and impartiality.