Medical Fitness to Drive

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Medical Fitness to Drive and a Voluntary State
Reporting Law
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AAA Foundation

• Established in 1947
• 501(c)(3) Not-For-Profit
• Research affiliate of AAA/CAA
• North American Focus

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Mission

• Identify traffic safety problems
• Foster research that seeks solutions
• Disseminate information and educational resources

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Funded through the generosity of

• and its members

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Senior Drivers Safety

• Good News
• Seniors are among the safest drivers on the road
• Many limit their driving to compensate for
  age-related health and functional changes
• Bad News
• Seniors are more likely to be seriously injured
  or killed when involved in a crash
• With advancing age comes changes in medical
  health and function that impact on the ability to
  drive safely
• While most seniors accept the need to hang up
  the keys, a minority may drive too long and pose
  a safety risk to self and others

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The Boomers are coming!

• Over next 20 years, number of senior drivers will
  nearly double
• These drivers will likely travel more miles than
  their predecessors.
• Majority will remain safe drivers
• Growing minority will need attention from state
  governments, health/ service professionals,
  family members, etc., to know when driving
  retirement is necessary

Population by Age Gender United States 2004
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• Workshop held Dec. 2007
• Consensus-based recommendations to guide license
  policy development developed
• Released June 2008

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Specific Workshop Recommendations

• Base final licensing decisions on functional and
  medical fitness to driver (MFD), not
  chronological age
• Develop and implement empirically defensible
  criteria and guidelines for functional abilities
  and MFD
• Enact standard reporting laws that provide civil
  immunity to clinicians and others who report
  people they think may be medically unfit to drive
• Establish and fund active Medical Advisory Boards

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Great Policy Example Missouris House Bill 1536

• Voluntary Reporting
• Clear Definition of Whom May Report
• Reporters Identity Held in Confidence
• Legal Immunity Protection
• Clear Procedures Forms
• Medical Advisory Board
• Consequences for Filing Inappropriate Report

across-the-board confidentiality of reporter,
legal immunity protection, non-specific with
respect to age, clear definition of who may
report (police, health, family, etc) and why, the
formation of a Medical Advisory Board, and
consequences for filing an inappropriate report.
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Missouris Voluntary Reporting Law

• MO Legislature passed HB-1536 in 1998
• Intended to promote reporting of medically
  impaired drivers by health professionals,
  particularly physicians
• Non-specific with respect to age
• Forms allow for reporting a range of health and
  drug/alcohol abuse conditions
• Similar to voluntary laws in 44 other states
• Never formally evaluated until now

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Medical Fitness to Drive (MFD)

• Can be an issue at any age but more likely as we
  get older.
• Studies indicate that certain age-related medical
  conditions may impair driving ability and thereby
  elevate crash risk.
• Reporting of MFD concerns is a voluntary process
  in most states, including Missouri.
• The first responsibility for addressing MFD
  concerns resides with the individual driver. Many
  states require drivers to notify the DMV of
  health conditions that may impair driving safety.
• Most states allow health professionals, law
  enforcement personnel, and others to report
  potentially unfit drivers for re-testing and
  possible license revocation. A few, such as
  California, mandate such reporting for people
  with dementia.

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Medically Fit Drivers

• Have sufficient vision, attention, memory (and
  other cognitive skills)
• Have motor function to manage the operational,
  tactical and strategic tasks of driving
• Meet the basic requirements for driver licensure
  as defined by state law

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• Evaluation of Missouris House Bill 1536
• Conducted by
• Thomas Meuser Ph.D.University of Missouri
• David Carr, Ph.D.Washington University School of
  Medicine
• Published Oct. 2008
• Available atAAAFoundation.org

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Project Objectives

• Document and describe the impact of MOs law for
  voluntary reporting of medically impaired drivers
• Capture data for all reported individuals, aged
  50, reported between 2001 2005
• Provide data to help MO improve the reporting
  system, as appropriate
• Provides a basis for future inter-state
  comparisons and national policymaking

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Reporting Process
MOsDepartment of Revenue (DOR) houses MOs
Driver License Bureau DOR Licensing Actions are
initiated pursuant to a determination of driver
unfitness and, in most cases, lead to a
12-month license revocation. Many pathways are
possible, and some individuals loop through
multiple DOR Actions over time. The database for
this project was keyed to the first recorded DOR
Action and follows the steps highlighted in
yellow.
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Research Questions

• Who files reports?
• Who is reported?
• Demographics
• Medical Status
• Unsafe Driving Behaviors
• What diagnoses or conditions are physicians
  reporting? Are certain conditions possibly under
  or over-reported?
• What happens to reported drivers as they move
  through the driver licensing system steps? Does
  reporting lead to license revocation or crash
  reduction?
• What are the retrospective and prospective crash
  patterns of those reported based on medical
  conditions of aging and licensing outcome?

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Sample Characteristics

• Reported Sample (2001-2005)
• N 4,100 (87 of cases age 50)
• Median Birth Year 1922
• 55 Male
• 38 Deceased
• 49 in 1 crash (as driver) 1993-2006
• 34 in 1 crash 2000-2006
• 31 in crash 0-6 months prior to report under
  HB-1536

• Control Sample (2.81 match)
• N 11,615
• Mean Birth Year 1922
• 55 Male
• 33 Deceased
• 27 in 1 crash (as driver) 1993-2007
• 12 in 1 crash 2000-2007
• NA

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Predictions Findings (1)

• Most reported drivers would be evaluated by a
  physician.
• FALSE (just 50)
• At least half would be referred for on-road
  testing.
• FALSE (24)
• At least one-quarter would pass the on-road test
  and retain a valid license to drive.
• FALSE (3.5)

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Predictions Findings (2)

• About one-quarter would have been in a crash as
  the driver.
• FALSE (49 with positive crash history)
• At least one-quarter would have had a citation.
• FALSE (8, for most this was the first action
  against their license)
• A substantial number would continue to drive
  despite license revocation.
• FALSE (98 of all crashes occurred before
  revocation)

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The outcome?
Few reported drivers traverse each step in the
process, and just 3.5 of the total retained a
valid license to drive. Missouris law works as a
package to move most reported drivers into
retirement. Crash data indicates that few
continue driving after license revocation.
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Annual Crashes Greater in Reported Drivers vs.
Controls
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Law Enforcement License Office Staff File Most
Reports
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Summary of Findings

• MOs voluntary reporting law works!
• Simply being reported caused 50 to move into
  driving retirement, either by choice or due to
  illness (or other factors).
• Reported drivers tended to be older,
  disproportionately male, and medically
  compromised (i.e., as evidenced by the prevalence
  of various health conditions and high mortality).
• Dementia was the most common condition, and may
  be considered as a top public health issue for
  older driver safety in MO.

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Summary of Findings (cont.)

• MOs DOR requires 1 in 5 reported drivers to take
  an on-road test with the State Highway Patrol.
  Many of these individuals never arrive for
  testing.
• 13 of those that take the Driving Skills test
  passed in three attempts
• Reports come from various sources, especially law
  enforcement (pursuant to a crash or on-road
  incident) and license office staff (pursuant to
  an observed ambulation problem and/or confusion
  at license renewal).

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Summary of Findings (cont.)

• Physicians submitted for 1 in 5 reports, and
  their rate of reporting increased from 2001-2005.
  
• There is room to enhance public safety by
  educating and empowering physicians, family
  members, health professionals, license office
  staff, and other non-police reporters.
• Physicians are asked to give their expert opinion
  on driver safety, yet often give mixed responses
  (i.e., listing the driver as safe or unsafe, yet
  still encouraging testing).
• Targeted education is needed to educate all
  stakeholders about the law and how to use it
  appropriately.

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• To view the Medical Fitness to Drive and a
  Voluntary State Reporting Law report, the North
  American License Policy Recommendations, or other
  information on senior mobility and traffic
  safety, please go to www.AAAFoundation.org or
  www.SeniorDrivers.org.

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• The AAA Foundation for Traffic Safety is a
  501(c)(3) public charity located in Washington,
  DC that is dedicated to saving lives and reducing
  injuries.
• It is supported by donations from AAA/CAA Clubs,
  AAA/CAA members, and other organizations
  associated with AAA/CAA.