Conditions Required To Implement Measures For Maintaining Individual Mobility And Improving Road Safety
As indicated at the start of this chapter, the changes to the demographic pyramid and the fact that the percentage of younger people with driving licenses has increased mean that, in the long term, there are likely to be more senior citizens than ever behind the wheel on Germany’s roads. One of the main challenges this presents is coming up with a way to help senior citizens retain their in-dependent mobility while also minimizing the potential risks posed by older drivers. Experts recommend adopting a multipronged approach in order to prevent the apparent contradictions between these goals from becoming an issue. In addition to monitoring, advisory and certification measures (enforcement/education/examination), such an approach would also include design solutions (engineering; use of driver assistance systems) and integrative mobility concepts. Before we discuss these potential solutions, it is worth taking a top-down perspective of the factors and characteristics that place limitations on older drivers.
To start with, we need to differentiate between biological age and calendar age. While a person’s biological age represents a diagnosis of their physical condition, their calendar age is based on their date of birth. There is no direct linear correlation between the two; the way different bodies age is too heterogeneous and affected by too many different factors. From the age of 35, arteriosclerotic processes start to affect the human vascular system, potentially impairing the performance of key organs. This natural change in the body determines a person’s biological age, causing them to age faster or more slowly irrespective of their calendar age.
Due to the discrepancies between biological and calendar age, the different phases of aging are not defined according to the calendar, but are instead based on the abilities that the aging person still possesses in terms of various function and aspects of life. As a result of this, ever since the 1980s gerontologists have been more interested in a person’s functional age, aiming to view aging as a developmental process with biological, social and cognitive components. The ICF system (International Classification of Functioning, Disability and Health) published by the World Health Organization (WHO) assesses overarching functions, abilities and resources, including factors relating to a person’s personality, attitudes and habits. This offers a wider perspective for drawing conclusions on how a person manages their limitations.
Limitations imposed by health conditions reduce mental and cognitive functionality, especially in people dealing with dementia, and losses relating to medical conditions dominate the functional age of those who suffer from them. The gradual deterioration of sensory, cognitive and motor abilities and the associated limitations they potentially place on a person’s mobility behavior often make it harder for older people to come to terms with these changes, to accept them, and thus to start considering the best ways to compensate for them. The aforementioned “better than average” effect plays a role here, but shame, placing a high subjective importance on owning a driver’s license, and local mobility restrictions stemming from a lack of sufficient alternatives can also warp a person’s judgment with regard to their own abilities. Nevertheless, a realistic assessment of one’s overall situation is necessary in order to use the road responsibly. In principle, the success of training-based approaches and educational programs and the usage of alternative mobility concepts and technical aids, such as driver assistance systems, is defined by whether or not participants recognize and accept the usefulness of such services, and whether they are fundamentally prepared to move away from their old way of doing things.
PRACTICAL EVALUATIONS OFFER A WAY FORWARD
So how can the state of play with older drivers be incorporated into traffic policy and strategy perspectives and the actions required in order to improve road safety? First and foremost, it is important to note that older car drivers are not a special risk group per se when compared to younger motorists. Most senior citizens are able to compensate for their age-related sensory, cognitive and motor deficits by using their experience and adopting a defensive driving style.
However, there are signs that the number of unreported cases of older drivers who have either partially or completely lost the ability to drive safely is rising steadily. In light of such developments, we need to come up with solutions that are standardized and fair while also being proportionate and transparent. This was also the general tenor among Work Group III (“Senior citizens as road users”) at the 55th conference of the German Council on Jurisdiction in Traffic, which was held in Goslar at the start of 2017. The work group argued that older drivers need to be given the tools to take responsibility for themselves and make sure that they check in good time whether they need to adapt to changes that might affect their ability to drive safely – and if so, how.
In order to ensure that older drivers start to be more realistic in their assessment of their own abilities, the work group proposed the introduction of a qualified practical evaluation. The aim of such evaluations, according to the group, would not be to stop older people from driving, but rather to demonstrate the options available to them in order to help them stay safe and mobile. This would take the pressure off family members to raise any doubts about a person’s suitability to drive, and the qualified feedback would enable senior citizens to implement measures that would help them retain their driving abilities.
ACCEPTING ACCOMPANIMENTWHEN DRIVING ISKEY TO SUCCESS
As a voluntary tool for improving the accuracy of drivers’ self-assessments, the practical evaluation starts with a data collection component, the aim of which is to observe a person’s driving behavior and record and evaluate any mistakes they make based on standardized categories. In the second part of the evaluation, the results are explained to the driver and combined with suggestions and advice that can help them improve and maintain their driving abilities. As partners that offer a comprehensive range of services, Germany’s “Technische Prüfstellen” (technical testing centers) and driving suitability certification centers would be the perfect choice for such tasks, as they are already required to adhere to the principles of neutrality, independence and impartiality and possess a certified quality management system. The role of the in-vehicle assessor could thus be played by either a traffic psychologist or an officially certified expert or examiner.
In addition to this, as an extension of the existing regulatory framework, a driving instructor could take on educational tasks such as preparing drivers for the practical evaluation or providing theoretical and/or practical refresher courses. The in-vehicle assessor would explain to the older driver where their strengths and weaknesses lie and give them tips on improving their driving behavior. In cases that represent potential risks, such as an accumulation of several mistakes, repeated gross violations of the rules of the road, and obvious repeated difficulties with driving maneuvers that are typically problematic among older drivers – such as turning, reversing, U-turns, entering and exiting traffic, maintaining a safe distance from other vehicles, and navigating junctions and rights of way – it would be advisable to seek further clarification as to the causes of this behavior. This task could be handled by psychological or medical experts who work for the driving suitability certification authorities and specialize in traffic-related cases.
OBLIGATORY TESTS FOR OLDER DRIVERS
But what can we do if the number of accidents involving older drivers continues to rise, and on-demand testing and voluntary practical evaluations prove unable to stop this trend? How do we respond if, so to speak, people refuse to take responsibility for themselves? If that happens, we will need to rethink where we strike the balance between personal responsibility and government regulation. In such circumstances, implementing obligatory tests for older drivers would seem both professionally prudent and a proportionate response to the issue. This report proposes 75 as the minimum age for such tests. For drivers who have completed voluntary practical evaluations, this threshold for the mandatory test could be pushed back gradually, up to a maximum of five years. This would make 80 the entry age for the mandatory test.
Linking the entry age to voluntary measures in this way would make the voluntary measures more appealing. These could also be expanded to include training programs to improve the driving skills of senior citizens, such as road safety training courses to help them navigate hazardous situations better, or informational and educational services. One example of this in Germany is the “Mobil 65+” program developed at the University of Leipzig. It teaches senior citizens about how the way their senses work changes as they get older and about the effects and side-effects of medications. It also covers exercises to improve physical mobility in the neck and shoulders for example, and relaxation exercises to increase resistance to stress. Another such training program is the “People & cars – Safety is a frame of mind” initiative (“Mensch & Auto – Sicherheit ist Einstellungssache”) run by the German Senior Citizens’ League (DSL). This initiative teaches senior citizens about how medication can affect their ability to drive safely, how toset their seats, seatbelts and mirrors correctly, and how to use driver assistance systems.
UNUSUAL BEHAVIOR MUST ALWAYS BE INVESTIGATED
The mandatory test could include both an examination of the person’s driving behavior and a requirement for them to produce a certificate of health before the practical examination begins. This initial health check-up should provide guidance statements on the driver’s cognitive functions (“no signs of dementia”), multimorbidity, health-related risk factors, and an eye test. If the doctor performing this check-up notices anything unusual, a certified and more in-depth examination would be required. The degree to which a driver’s performance is restricted and the type, severity and progression of their health-related limitations and conditions need to be weighed up on a case-by-case basis by means of a full medical appraisal. This should also determine the options for and limitations of individual compensation strategies and, where applicable, provide information on any other associated risk factors. Such an appraisal requires the extensive expertise of the specialists at the driving suitability certification authorities.
ON-ROAD STUDY IN BIELEFELD
In an on-road study conducted and managed by the Bethel Evangelical Hospital in the German city of Bielefeld between 2017 and 2019, a sample of older drivers who responded to a newspaper ad-vertisement were subjected to extensive neurological and traffic psychology tests. The study also collected data on health factors such as pre-existing conditions and medication taken, as well as the participants’ histories and previous experiences of road use (annual mileage, accidents, etc.).
A total of 89 participants (33 women and 56 men) aged between 63 and 94 (average age: 77) were included in the study. Following a psychological evaluation of their driving behavior, which was completed by 85 of the participants, they were grouped into four categories based on standardized protocols that accounted for how they used the road; these four categories were also assigned to two overarching groups (fit or unfit, with the number of participants in each group noted in brackets).
|Fully fit to drive without further driving lessons (41)
|Not yet fully fit to drive; driving lessons recommended (24)
|Fully fit to drive with further driving lessons (16)
|Not fit to drive (4)
Almost half of the sample group (41) passed the driving behavior evaluation without any concerns or observations of unusual behavior, and received positive feedback to this effect. 16 of the participants demonstrated repeated errors that were not severe enough to be deemed critical (e.g. changing lane without endangering others) and received a recommendation that they should take driving lessons in order to give them more training and eliminate the unsafe elements of their driving behavior. 24 of the participants demonstrated some major errors with regard to both vehicle operation and adaptation to the prevailing traffic situation. These behavioral traits were not exclusively caused by cognitive limitations such as slower reaction times; some were the result of the driver’s personality and attitudes. For example, some of the participants allowed themselves “a little leeway” with regard to the timing of a red light, or regarded the rules for cross-walks as being open to interpretation.
REVOKING APERSON’S LICENSE SHOULD ALWAYS BETHE LAST RESORT
While around half of the participants demonstrated mistakes in their road use, the traffic psychologist and the driving instructor were both of the opinion that these mistakes could be eliminated if the drivers were to take driving lessons that would give them training in specific maneuvers (e.g. turning and changing lanes). Only four of the participants demonstrated such severe erratic behavior in their driving that they were strongly recommended to stop driving altogether. Drivers generally only qualified for this group if the driving instructor had to intervene several times during the evaluation (e.g. by braking or taking over the steering of the vehicle), i.e. the test would have resulted in an accident if the instructor had not intervened.
The statistical analysis showed significant differences between the age groups in terms of the quality of their road use: 78.6 percent of the participants classed as “unfit” were aged over 75, and only 21.4 percent of those declared currently unfit to drive were under the age of 75. The results of the computer test were also reflected in the drivers’ performance during actual road use: there was a strong correlation between the over-75s group and mistakes with regard to “risk-related self-control” (e.g. maintaining an appropriate speed), while the younger participants in the study showed no particular tendency towards such mistakes, and for the most part displayed an unimpaired ability to drive safely. However, the navigation of junctions (making turns, recognizing hazards), which accident statistics have already shown to be a common problem, often proved a particularly critical issue for both age groups during road use.
In summary, it is now possible to identify the individual strengths and weaknesses of older drivers. In addition to extensive findings on risk and safety factors, there exist a number of valid concepts for in-depth diagnosis that can be supported with the practical evaluation and driving behavior observation methods. Before taking severe steps such as revoking driver’s licenses or testing people’s suitability to drive, we should first offer them voluntary services based on individual consultation, such as on-road training, cognitive performance training and further medical examinations. There are already a number of tried-and-tested measures in this field that have been proven to have a positive effect. In order to make their use more widespread – on both a voluntary and an on-demand basis – we need to provide more incentives. Maintaining mobility should be the top priority. Obligatory measures should be introduced from the age of 75 based on the relevant evidence, and should focus on establishing minimum standards for driving motor vehicles safely.