Occupational Therapist’s brief comments on recent media coverage related to elderly drivers and “Fitness to drive”.

15 July 2011

In recent weeks, the Queensland media has been awash with news articles related to Ali France, a young mum injured by an elderly driver  in a motor vehicle accident.  The plight of Ms France has been taken up by Southport MP Peter Lawlor[1], as well as several commentators in the media. In recent months, there have been several additional news reports related to elderly drivers colliding with fences, diners in restaurants, and other stories related to a driver with mental health stuggles killing 2 young twins[2]  In review of the publications of late, is is clear that the general public, medical professionals, MPs and even journalists do not understand the current situation in QLD.  Additionally, the QLD Police appear to struggle with implementing “show cause” policies within an acceptable period of time.

In light of this, I have summarised a few salient points below.  Although I am somewhat bias towards the skills and assistance that my profession can provide, the points remain true!

Each of the different points focuses on a slightly different angle:

1.      A revision of Jet’s law will likely improve reporting of medical conditions that may impact on fitness to drive.  Currently, Driver licence holders have a mandatory requirement to report any long term or permanent medical condition that may affect their ability to drive safely.  Many drivers are unaware of this legislation that applies even if they have a temporary condition.  Doctors, GPs and Health Professionals in QLD have the ability to report patients to QLD transport if they feel that the patient will not do it themselves, however this is rarely exercised as it often has a negative impact on the practitioner-patient relationship.

The Australian Medical Association, individual GPs, private psychiatrists, Alzheimer’s Australia and the Occupational Therapy Association , to name a few, have time and time again suggested that it is essential that the Queensland Transport and DMR better manage and supervise this process, as opposed to all control being expected by the very busy practitioner.  For example, in VIC, NSW, SA and WA, the Driving Licencing Authority (DLA ) maintains supervisory control, and can request second opinion or a OT driving assessment if they consider the GPs report, or lack of reporting to be insufficient.  This also applies if in the case where a “show cause” type request is made.  In the case of a OT driving assessment being recommended, the DLA funds this assessment to acquire a thorough and evidence based decision.  In Queensland, several subsequent transport ministers over many years, as well as departmental staff have appeared to have their head stuck in the mud regarding this issue, and have not recommended or implemented any valuable systemic changes, despite the wide body of evidence and opinion recommending otherwise.

2.      GPs do have other options, and do not have to make all the decisions without gathering all the medical facts.   GPs should consider requesting a second opinion from one of several sources, so that they do not have to be seen as the “bad guy”, and allow retention of all-important doctor-patient relationship.  Options include:

a.   Make a specific appointment to review the capacity to drive, not just tag it onto the last minute of the normal health and medication review

b.    Refer for a Occupational Therapy driving assessment

c.   Refer for a Specialist or Geriatrician consultation for second opinion

d.   Optometrist or Opthamologist consultation for eye or vision problems

e.   Psychiatrist for mental health conditions

3.    With many insidious medical conditions such as strokes, gradual cognitive decline with aging, Alzheimer’s and mental health conditions, patients display limited insight into their own fitness to drive and gradual decline.  Despite what many folk protest, local[3] and international research has repeatedly proven the fact that “self-assessment” is not accurate.  Regular testing after a certain age is not discriminatory; nor is it a bid to strip people of their independence.  Regular medical reviews specifically looking at driving capacity (at least yearly for non-specific decline and 6-monthly for Alzheimer’s or mental health conditions), with follow up OT Assessments where necessary, or when the GP is unable to declare otherwise.

4.    Many commentators in the media, as well as the general public opinion is recommending a driving test once a particular age is reached.  Although a helpful suggestion, this non-specific approach would most likely not yield any viable results, and would be significantly expensive for taxpayers to support.  As any health professional will tell you, it is not about age, but about impairment.  A driving driving test and test of road law by a driving instructor although helpful,  will be unsuccessful in assisting those who are on the borderline of fitness to drive as it does not address the specific impairment or medical fitness, Many drivers responds very well to driver retraining or licence modifications, which a driving test is unable to recommend.  Furthermore, with respect, in most cases a driving instructor does not know, or may overlook the impact of complex medical aspects such as: multiple medications, pain, concentration capacity, physical tolerances, cognitive impairment or psychosis; on driving capacity.  In this case it is what you don’t know that will hurt you.  An Occupational Therapy assessment, in conjunction with a medical consultation to review the results of the driving assessment is the most thorough, most evidenced from a medical point of focus and best practice in the assessment of drivers with a medical condition.

5.      In the private sector, an OT Driving Assessment is an expensive process that may cost anywhere between $300 and $600.  Only small rebates are allowed by medicare, private health insurers or the DVA.  Public assessments are available in Brisbane only, with long waiting lists.  Many GPs have commented that they would make more referrals, however they do not wish to encumber their patients, many who are on the pension, with high costs.  As noted previously many other states, the DLA assists with the cost of the assessment, meaning no large out of pocket costs for licence holders.  This is an area where QLD is once again, behind the ball compared to other states, especially for regional licence holders.

6.      OTs provide practical advice, not just about driving only.  OTs provide advice on improving driving behaviours, developing better routines, advising on necessary restrictions such as night driving or highway driving, and can authorise vehicle modifications such as spinner knobs or hand controls (which in QLD are illegal to fit without health professional certification).  OTs can also provide GPs with support and education to improve their assessment of clients in the short times that they have available, by advising on best practice and valid examination techniques.

7.      OTs provide all important and necessary counselling and practical strategies regarding ceasing driving, when to stop, how to continue an active community life without a vehicle.

8.      OTs can assist with family conversations and know how to assist families to constructively commence assisting their loved one to hand over the keys when or if this uncertain and challenging time presents itself.

[1]See http://www.goldcoast.com.au/article/2011/06/15/323881_gold-coast-news.html
[2]See: http://www.abc.net.au/news/stories/2011/03/16/3165165.htm?site=sunshine and http://www.sunshinecoastdaily.com.au/story/2011/03/15/inquest-paper-trail-fails-hornby-twins/

[3] See http://www.qut.edu.au/research/news-and-events/news-event.jsp?news-event-id=35986 and http://dx.doi.org/10.1037/a0023835

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