Assesing suitability for driving
A combination of risk factors increases the probability of senior citizens displaying unusual driving behavior or becoming involved in accidents. However, in some countries, such as Germany, events such as this can lead to a driver being required to complete a driving suitability test. Tests like this are aimed primarily at ensuring that drivers meet the minimum physical and cognitive requirements for driving a motor vehicle safely.
Assessors at the driving license authorities evaluate these tests based on the opinions of experts such as doctors and psychologists who specialize in driving and traffic situations. The suitability requirements are tested and evaluated from a professional perspective before being compiled to make a report. This expert assessment provides an important basis for the driving license authority in question to determine the extent to which a driver represents a potential risk to other road users and decide whether or not the driver can keep their license.
Any administrative action taken is based on the facts at hand and their evaluation by the administrative authority in question. The word “facts” is used here in the legal sense, i.e. facts and circumstances that have actually been observed, rather than simply assumptions or speculation. Generally speaking, these take the form of unusual driving behavior or apparent errors while using the road, such as driving unusually slowly, unusual types of accidents, or odd behavior/observations when a driver is pulled over by traffic control officers. Concerns regarding a person’s suitability to drive can not be raised based on their age alone. It would also be just as inappropriate to make such a call based solely on knowledge acquired from the authorities regarding whether the driver in question wears a hearing aid, or the fact that they are a diabetic but follow their doctor’s orders and have good control over their metabolic state, for example.
OLDER DRIVERS OFTEN DO NOT SEE THEMSELVES AS A RISK FACTOR
Whether or not a fact is relevant to a person’s suitability to drive is determined using a carefully considered decision-making process, and can only be decided upon by the person responsible for applying the law – usually the qualified assessor employed by the driving license authority. Annex 4 of the German Driver’s License Regulations (FeV) lists medical conditions and factors that affect a person’s suitability to drive, as well as grounds for inclusion and exclusion in reaching a positive decision on driving suitability. The medical conditions listed in the FeV include visual and hearing impairments, limitations in movement, cardiovascular diseases, diabetes mellitus, kidney diseases, nervous system disorders (e.g. Parkinson’s disease, epilepsy), mental disorders, alcohol, narcotics, and other psychotropic substances and medications.
In concrete terms, it is the degree to which a driver’s performance is restricted, the type, severity, progression and treatment of their illness, and the strategies that can potentially be used to compensate for it that form the framework for the verdict, in addition to any other relevant risk factors. The facts relevant to the person’s suitability to drive are usually obtained from the police, the courts and district attorneys. However, private individuals and doctors who have treated the person in question can also report any doubts regarding the person’s suitability to drive to the driving license authorities.
A study of drivers aged 65 and over who had displayed unusual driving behavior showed that 85 percent of all cases led to the driver giving up their license or having it revoked. These drivers were also notable for being at the older end of the scale and suffering from multiple medical conditions. In cases where an accident had occurred, the driver in question was assigned the primary fault for the accident during the course of the police investigation, at least on a preliminary basis. The high number of drivers in this study who gave up their own license – around 70 percent – is also noteworthy. Only a small number of the cases included in the study had been reported by doctors, family, courtsor attorneys. Most of the cases where doubt had been cast on a person’s suitability to drive were reported by the police. The majority of these reports were submitted following a traffic accident. Furthermore, there were indications of some form of dementia in around one in five of the cases included in the study. It was not possible to dispel the doubts regarding the person’s ability to drive in any of these potential dementia cases.
AGE-BASED EXAMINATIONS IN DIFFERENT COUNTRIES
Like Belgium, France and Sweden, Germany is one of the countries that has thus far not required driver’s licenses for cars or motorcycles to be renewed, though this is now changing. The German Driver’s License Regulations now state that driver’s licenses issued afterJanuary 19, 2013, are valid for a period of 15 years, and older driver’s licenses must be replaced by January 19, 2033. Limited-term licenses whose extension is contingent upon health check-ups are issued for drivers of trucks and buses in license classes C1, C1E, C, CE, D1, D1E, D and DE, and also for drivers of taxis and rental cars used for passenger transport. In such cases, the driver’s license is limited to a maximum term of five years, and is only issued to drivers who can prove that they meet special requirements with regard to their physical and cognitive suitability for the job.
There are no standardized rules at the European level for either medical examinations or the intervals required between them once a driver’s license has been issued. In addition to this, some countries, such as Estonia, Finland, the UK and Ireland, check the effects of any medical condition that is subject to statutory disclosure – irrespective of the driver’s age – in order to determine its relevance to the person’s suitability to drive.
As a result of the situations outlined above, there are three different strategies with regard to the extension of driver’s licenses and to how medical conditions and typical age-related deterioration in performance are handled in the different countries:
1. The driver’s license is valid for a fixed length of time, with no restrictions based on a per-son’s calendar age. Accordingly, all holders oflicenses issued on January 19, 2013, or later are subject to a 15-year limitation on the validity of their official document (driver’s license for cars and motorcycles). The person’s legal permission to drive is also extended at the same time that their documentation thereof (their driver’s license) is renewed/extended. The EU member states that follow this model include Austria, Belgium, Germa-ny and Poland.
2. Driver’s licenses are extended subject to a medical examination by (at least) one doctor, starting from a set calendar age threshold:
- Starting age 50: Italy
- Starting age 60: Portugal, Czech Republic, Luxembourg
- Starting age 65: Greece, Slovakia
- Starting age 70: Cyprus, Denmark, Finland, Ireland, Malta, Netherlands
3. Driver’s licenses are extended – subject to a medical examination for all age groups (e.g. in Romania) – at periodic intervals, e.g. every ten years. The renewal period becomes more frequent as the driver’s calendar age increases, and it is directly linked to medical examinations. For example, the frequency may increase from the age of 40 (Hungary), 60 (Lithuania) or 65 (Estonia, Spain).
An evaluation of scientific tests on the effectiveness of various screenings used to determine suitability to drive in different countries showed that, in European studies, the tests tended to have more of a negative effect on road safety – for both the general population and the respective senior citizens themselves. The tests correlated partially with an increase in the number of traffic fatalities among senior citizens using unprotected forms of transport, as restrictive measures can lead to older people using the roads more as cyclists or pedestrians, leaving them with less protection than they would have from a car. In addition to this, age-related screening among senior citizens often generates fear of the examination, as it can lead to people having to stop driving at a younger age and thus suffering a loss of mobility.
THE APPROACHES TAKEN IN DIFFERENT EUROPEAN COUNTRIES FOCUS PRIMARILY ON ASSESSING A PERSON’SPHYSICAL AND COGNITIVE SUITABILITY
PROCEDURES IN SWITZERLAND, THE NETHERLANDS AND FRANCE
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.
In addition to this, there are some countries that rely on certified organizations and others where the process of determining suitability is rooted in the country’s general health system. In light of this, it is safe to assume that there is also significant variation in the rules that dictate how information and findings relevant to a diagnosis are consolidated into the final result. It does not seem clear to what extent the minimum requirements for these health check-ups as defined in Annex III of the European Driving License Directive are observed, especially since Point 5 of Annex III of this Directive permits the use of different regulations at the national level. Nevertheless, all EU member states are required to observe this EU directive and incorporate it into national law. However, the procedures currently being practiced should serve as a starting point for further harmonization, at least within EU member states.