The story was a media sensation — a young, single mother killed by a driver who ran a red light in Toronto’s west end, leaving behind her two children, including a seven-week-old baby boy.

The woman behind the wheel was 83 years old. 

In the days that followed in January 2010, the issue of elderly driving seemed to be on everyone’s radar, if only briefly. Questions abounded about whether someone that age should have been driving in the first place.

Multimedia Driving: The golden years Capital News Online talks to seniors about the twists and turns of driving after 65.

Ontario Premier Dalton McGuinty made a public appeal to seniors, telling them, “There does come a point in time when it is no longer safe for you to drive a car…You have to be honest with yourself in that regard.”

But determining when people should hang up their keys isn’t that simple. Most people know being honest with themselves is actually quite difficult. In most provinces, determining when a senior should stop driving is left up to a person’s physician. Many will tell you that making such a significant and life-altering choice for someone else is extremely delicate. 

Ottawa researchers are in the process of creating what they hope will be the most objective tool that differentiates seniors who should be driving from those who shouldn’t. Their research is also raising important questions about how society deals with a growing population of older drivers. 

The doctor’s dilemma

“I’ve heard patients say they would rather be dead than lose their license,” says Dr. Malcom Man-Son-Hing, a geriatrics physician at the Ottawa Hospital and a researcher at the University of Ottawa. “That’s their initial reaction. With time, of course, the harsh negative response gets a bit muted, but their reflex action is ‘You might as well shoot me doctor.’”

It’s the most difficult subject a geriatrics physician can bring up with a patient, says Hing.

With seven provinces requiring physicians to report to ministries of transportation any patient they believe is unfit to drive, it’s a conversation that is happening around the country.

"I’ve heard patients say that they would rather be dead than lose their license."

“It is easier to tell patients they have a dementia like Alzheimer’s than to tell them they can’t drive,” says Hing. “It really can destroy physician-patient relationships. Oftentimes, if a physician has known a patient for years, they are reluctant to bring up the issue because it can cause friction between them and their longtime patient.”

But because no medical screening tool exists that is scientifically grounded in the actual driving patterns of seniors, says Hing, he has often doubted whether he made the right decision when reporting someone to the ministry. He says the absence of such a tool has also led to a wide variation in practice from physician to physician.

 “There are some family physicians who are quite laissez-faire about letting their older patients drive, and there are some who think you have to be pretty strict about it,” he says.  “So whether you have a license has often depended on who your family physician was.”

The search for objectivity

Nine years ago, to deal with what he saw as one of the “most pressing clinical questions facing geriatricians,” Hing teamed up with other researchers to create CanDrive, the Canadian Driving Research Initiative for Vehicular Safety.

In 2009 Hing and fellow University of Ottawa researcher Dr. Shawn Marshall began what is arguably the most comprehensive study on elderly driving habits in the world. With funding from the Canadian Institutes of Health Research, Hing and Marshall recruited more than 900 elderly drivers in cities across the country and equipped their cars with GPS devices. The team’s research partners in Australia have also recruited 250 drivers there and in New Zealand.

For five years, Hing and Marshall will collect data in the hope of better understanding the driving habits of seniors. The aim is to develop what they call a “fair” and “objective” tool to assess the abilities of older drivers. 

“Physicians, when you survey them, will tell you ‘Yes, we need a tool because we don’t know who to report,’” Marshall says. “But this is about keeping drivers on the road, not forcing them off. We want to objectively determine the ones at risk from the ones who are not.”

Dr. Shawn Marchall is working to create an objective screening tool for older drivers.

Marshall says some of the safest drivers on the road are senior drivers.

A year-and-half into the study, Marshall says the team has already collected more data on elderly driving patterns than anyone, anywhere, has before.

“We’ve collected millions of kilometers worth of data,” he says.

The GPS monitoring tells Marshall and Hing how much time a driver spends on the road. One of the most important things they are looking for are drivers who end up getting into at-fault collisions.

But it is the off-road testing of participants that is equally as important to the study. Hing and Marshall will eventually take the data collected from the GPS and map it to the physical health of the participants to determine how health conditions affect driving patterns.

“As you get older, you tend to develop maniacal conditions and many of these maniacal conditions affect your driving ability,” says Hing. “For example, these conditions are Parkinson’s, arthritis, eye sight problems, dementia. All these things will affect your driving ability.”

Once a year during the five-year study, participants are assessed on both their physical health and cognitive functions, but also on their attitudes towards driving.

“So, over five years, certain people will inevitably crash, and we can look at the characteristic of those who crashed versus those who didn’t,” says Hing.

This information, they hope, will help develop a tool that determines which characteristics — be it physical, mental, cognitive or attitudinal — are the best predictors for crash risk. Doctors then can make a sound judgment on whether their patients should or should not be driving.

Knowing a driver's exposure rates, in other words, how often they drive, is what makes the study unique, say the researchers. A driver with any number of conditions might already be self-regulating by limiting their driving, and determining their true risk factor wouldn’t be possible without knowing how much they are actually driving.

“That’s really been the fault with other studies,” says Marshall.

The data from the GPS will also tell the team which drivers, with any set of specific characteristics, are speeding the most, running the most red lights and making the most illegal turns. 

In the meantime, physicians are forced to use other tools to assess the abilities of senior drivers, and these practices have raised concern.

Deffective assessments?

In British Columbia, and to a lesser extent in Alberta, doctors often use touch screen tests to assess the cognitive functions of senior drivers.

Carol Libman, a consultant with CARP, a national advocacy organization for aging Canadians, says tools like this are unfair, and often don’t reflect the person’s ability to drive.

"This is very risky stuff. People depend on driving and isolation can be very scary."

“I constantly get calls from people in B.C. telling me they took the test and felt intimidated. This a generation that is not used to touch screens, and people freeze up,” says Libman. “People tell me they were confused as to what to do…have you ever been to an airport and seen seniors in a line using a touch screen? They often don’t know what to do.”

Libman says poor test results often have more to do with a generation unfamiliar with new technology and less to do with how safe someone is on the road.

The big concern, says Libman, is that if a doctor doubts a senior’s ability to drive, these tests are often turned to immediately. If someone fails, the results must be reported to the ministry, which often results in the loss of a license.

“This is very risky stuff,” says Libman. “People depend on driving and isolation can be very scary.”

Ideally, the research being done by the Ottawa team will give physicians and ministries a clearer idea of which drivers should be allowed to drive under restricted circumstances.

For example, the data might very well show that there are drivers who only get into crashes at night. 

“This can give the ministry guidelines to determine that maybe people with those characteristics should have conditional licenses that allow them to only drive during the day,” says Hing.  “Or the same thing could be said about a group that shows they are involved in more crashes on four-lane roads. The ministry could be guided to suggest they should be restricted to two lanes.”

Hing says the way ministries of transportation determine who should have a conditional license in large part mirrors how physicians choose who shouldn’t be driving.

“It’s haphazard, and there’s no real scientific approach to determining the conditional licenses for many people,” he says. “The ministry just uses their own gut feeling on what is the best approach for a particular person. And that’s very strange, an administrator in a government office deciding what kind of conditional license someone should have.”

If the tool does its job correctly, though, it will properly identify drivers who shouldn’t be on the road, says Marshall.

“Ideally, you’re hoping to identify some things that might be remedial that could be fixed with reeducation…Or maybe the next step is they need a conditional license,” he says.

“But what we know is that in the 10 years before you die, you will give up your license. And while we really want to keep you on the road as long as possible, we do need to prepare people that they might not drive any longer.”

Hanging up the keys

After Madeline Larue lost some of her vision, her license was revoked. Now it's up to her daughter, Pauline Lance, to help her get around.

Madeline Larue was forced to stop driving five years ago when she started losing vision in her right eye.

The 79-year-old now relies mostly on her children to get her around, whether it’s to a doctor’s appointment or a routine shopping trip.

“I have to wait until they're done working. If I have to go in daytime, I have to wait until nighttime or sit until the weekends,” Madeleine says. “It’s hard.”

Madeline says she doesn’t see her family as much as she used to and can no longer go on small trips.

“It would be awful to have to do what she has to do,” Madeline's daughter, Pauline Lance, says. “She depends on people all the time. I just drive where I want to go now and if that ever came to a stop it would be awful.”

Pauline, a public servant, says she often finds herself taking time off work to help her mother. Her life is now partially organized around where her mother needs to go.

Madeline and Pauline’s situation will become more and more common with the first wave of baby boomers entering their senior years.

Experts already worry about the dependency some seniors have on family members, and the strains that can go along with this. Isolation, which is often synonymous with depression, is one of these strains.

While public transportation is an option to get seniors from point A to point B, not all are comfortable with the system or can access it.

Madeline, for example, hasn’t used the bus in years.

“I used to take the bus before I was driving, but now it’s all turned around,” she says. “I’d have to get used to the bus routes again.”

For seniors in suburban and rural areas, they may not even have the option to use these bus routes. Public transportation is often too far from people's homes, the buses come infrequently, or not at all.

In 2010, the Canadian Medical Association Journal called for a national dialogue on some of the most pressing issues facing elderly drivers.

“Just as planning for job retirement is the social norm, we should be planning for driving retirement by creating programs to help seniors drive safely as long as possible and when they can't, to help them get around," wrote the editors.

Amongst other things, the editorial called for subsidized shuttle van services in suburban and rural areas and tax incentives for those who carpool the elderly.

Carol Libman, the CARP advocacy consultant, says if there was better, more accessible public transportation, particularly in suburban and rural areas, many elderly drivers would put down their keys voluntarily.

CARP continues to advocate for elderly drivers and promotes discussion on issues facing seniors in a section of their website called CARPool.

But experts say little has changed since the CMAJ editorial came out year and half ago. The issues about elderly drivers have not significantly made their way into national dialogue and have failed to penetrate the halls of legislatures across the country.

Hing says he hopes the research he and Dr. Marshall are doing will help get these issues on the minds of Canadians.

“It’s only when an older person gets into a crash that it makes the front page and then the discussion comes into play for a couple of days," says Hing. "Then it simply goes away.”

Driving: the golden years

Seniors take CapNews for a ride, sharing their driving experiences.