It is half a century old, but the photograph of a teenage soldier sitting on his British Cromwell tank gives a shot of pride to the old man he has become. “It was a rather splendid tank,” says Alan Burridge, 75, of Woodstock. “Driving that gave me an incredible feeling of power.” That feeling, from driving race cars to the family sedan, was a natural part of Burridge’s life until last September, when his licence was suspended by Ontario’s Ministry of Transportation. Diagnosed in 2011 with early Alzheimer’s disease, Burridge was encouraged by his doctor to take a $550 on-road driving test from a private company to see how his incipient mental decline was affecting his driving skills. Burridge failed the test, got angry, took it a second time, and failed again. The final word on his driver’s licence, the plastic card that can be key to a person’s independence, arrived in a letter from the transportation ministry. “Although you may be disappointed,” the suspension letter read, “this decision has been reached to ensure both your own safety and that of other road users.” In a rapidly aging society, driving with dementia may become the new impaired driving. In the coming years, there will be a surge of senior drivers on Ontario’s roads suffering from dementia, the general term for those with cognitive impairments such as Alzheimer’s. Dementia affects the brain’s functioning, creating an inability to work out a complicated decision and, as it advances, a lack of awareness that a decision even needs to be made. The number of drivers with dementia in Ontario will more than double from about 45,000 today to nearly 100,000 in 2028, according to a Queen’s University study. “This is definitely a public-health issue, and the province has not done a lot,” says Robert Hopkins, who conducted the Queen’s study and is director of pychogeriatric research at Providence Care in Kingston. “We’re living longer and the number of drivers with dementia is going to increase substantially. It’s going to be a problem.” Ontario remains one of the safest places to drive, with the lowest road-mortality rate for people of all ages in North America, according to the Ministry of Transport’s latest statistics, from 2008. The ministry has a strong focus on drivers with dementia, says spokesperson Bob Nichols. “We continue to actively monitor, evaluate and support research in this very important area to help better determine the magnitude of the cognitively impaired driving problem,” Nichols says. But the Star has found a disturbing lack of awareness of the hazards ahead among doctors, government policy-makers and older drivers themselves. Critics say Ontario’s Ministry of Transport is failing to train family physicians to look for early signs of dementia that might affect driving. It gave doctors the legal responsibility for reporting medically unsafe drivers, but has never cautioned or fined a physician for failing to report. Nor, critics say, is the ministry focused enough on what researchers call the “holy grail” —a scientific test to help doctors spot at-risk patients without unfairly targeting others. DANGEROUS CURVE The dangerous curve coming up on our roads is a result of two inevitable trends: a massive population of aging baby boomers determined to stay behind the wheel, and the creeping onslaught of mental impairment for many as they age. In the past 20 years, the number of drivers over 65 doubled in Ontario, from 600,000 to 1,200,000. At the same time, the Alzheimer Society of Canada reports that more than 500,000 Canadians are living with dementia, with one new case being reported every five minutes. Within a generation, that will increase every year by 250,000 new cases — with a new diagnosis every two minutes. Many seniors have busy, productive lives, but there is no escaping the reality that the risk of dementia increases with age. It has a direct impact on driving — making those complex decisions, for example, when turning left at a busy intersection with pedestrians crossing and cars racing. “The vast majority of older drivers are safe,” says Dr. Shawn Marshall of the Ottawa Hospital Rehabilitation Centre, who is working on a major research project called Candrive to develop better testing for senior drivers. He warns against “crazy blanket comments that are ageist and unfair. “You don’t want people to be unfairly targeted and you don’t want safe drivers to be taken off the road,” he said. Because the driving population over 65 has increased so dramatically, the casualty rate for that age group — the number of serious and fatal collisions per 10,000 licensed drivers — in fact decreased by 40 per cent in 2008 compared to 1990. But that’s the rate — not the body count. The problem is that seniors are frailer, so when they get into accidents, the injury and death rate is high. Also, while young people tend to get into single-vehicle accidents — the drunk teenager who hits a tree — seniors tend to cause multiple-vehicle crashes. “People aged 70 or older have a higher accident rate per kilometre driven than any other age group except young male drivers,” concludes a new study released this month by Statistics Canada, adding that “seniors are more likely than younger people to be killed when they are involved in a collision.” The study found that 28 per cent of people over 65 who had been diagnosed with Alzheimer’s disease or some other form of dementia had a driver’s licence, and three-quarters of them had driven in the previous month. To make matters worse, drugs prescribed to many seniors can be an additional — and largely ignored —road hazard. Dr. Mark Rapoport, a geriatric psychiatrist at Toronto’s Sunnybrook Health Sciences Centre, led a study that found about 40,000 out of the roughly 210,000 people in Ontario identified as having dementia had active driving licences. Close to 9,000 of them were involved in crashes. When his team dug deeper into those accidents, they found that drivers on psychotropic medications— antidepressants, antipsychotics or benzodiazepines to deal with anxiety, agitation or sleep problems —had a collision risk 54 per cent higher than when they were not. “That’s alarming,” says Rapoport. “This is double whammy — they have dementia plus they have a behavioural disturbance.” One out of three drivers with dementia in his survey who crashed were taking psychotropic drugs. THE SCRAMBLE FOR A TEST The problem is that unlike suspected drunk drivers, for example, seniors involved in accidents are not routinely examined for cognitive impairment. Besides, there is no Breathalyzer-type test — no reliable, quick way to determine cognitive impairment that might impact driving. That makes it hard to pin down just how many fatal or serious accidents are caused by seniors with cognitive impairment. Close to 7,000 senior drivers were involved in fatal collisions or ones involving injuries in Ontario in 2008, the latest year for which statistics are available. Of those, only 166 were “coded” with a “medical or physical disability” according to the Ministry of Transport. But the real number could be much higher, since it is investigating police officers who do the coding at the scene of an accident — and diagnosing dementia is not that easy. That dilemma surfaced dramatically 12 years ago when 84-year-old Pilar Hicks killed Etobicoke’s Beth Kidnie, driving over the mother of three, who was out for an evening walk. Hicks dragged Kidnie under her car until she arrived home. The body became dislodged at the end of Hicks’s driveway, where it lay until discovered by a passerby. The inquest into the tragedy heard that Hicks may have been cognitively impaired at the time of the accident, but authorities couldn’t be sure. But there was no doubt Hicks had dementia by the time the inquest got underway two years later, and she was not required to testify on compassionate grounds. The inquest had a sharp focus on drivers with dementia, including a recommendation that the transportation ministry find out just how many such drivers were on the roads. The ministry says it followed up on this recommendation by supporting and evaluating several studies, including the Candrive initiative. Dr. Malcolm Man-Son-Hing, a geriatrician and scientist working with Dr. Marshall at the Ottawa Hospital Research Institute on the five-year project, says they hope it will lead to the first science-based tool to diagnose drivers with dementia. Now at the halfway mark, Candrive is following nearly 1,000 drivers aged 70 and over, using a GPS system that monitors their driving. “At this point, we are concerned about governments that are prematurely creating policy,” Man-Son-Hing says. “There are huge variations among doctors who report and do not report. It is completely unfair to the patients. We believe there should be a scientific basis for these decisions.” Until the Candrive study is finished, says Michel Bédard of Lakehead University, a Canada research chair in aging and health, we should not rely on existing on-road tests or in-office tools for doctors. “We don’t have the right tool yet but everyone is trying to find it — it’s the Holy Grail.” Meanwhile, governments are making policy decisions without hard science, he says. But Allen Dobbs, who runs an Alberta-based company called DriveABLE (its office near London recommended Burridge lose his licence), says his firm already has solid scientific research and is licensing offices across North America. DriveABLE administers two tests. The first is a computer touch-screen one involving driving-related questions. The second is the on-road test — the one Alan Burridge failed twice — which examines individuals’ reactions and decisions while they drive. “We are saving lives,” contends Dobbs, an adjunct professor of medicine at the University of Alberta, where he is also a professor emeritus of psychology. “Science is incremental,” Dobbs notes. “Why would you say that because you might have something better in four years that you wouldn’t use what is available now?” In Ontario, the ministry requires that companies such as DriveABLE send occupational therapists on the road test — widely considered to offer a better assessment of skills — when drivers are being evaluated. Dobb’s wife, Bonnie, a professor in the department of family medicine and director of the Medically At-risk Driver Centre at the University of Alberta, developed a checklist for doctors to help them decide their patient’s driving future. Called SIMARD MD, the test is free to doctors on the university’s website. Bédard has criticized the SIMARD test, saying it is not reliable and sends patients for tests who do not need to go. But Dobbs counters that the tool’s track record is excellent, especially when combined with a road test from her husband’s company. The tool recommends testing at her husband’s company for patients who fail or fall into a grey area. “DriveABLE is the gold standard,” she says. THE PUSH BACK In the meantime, physicians face stiff push-back from seniors when it comes to giving up that driver’s licence that may have become an essential part of their lives, one many assumed was permanent. “It’s very rare I have patients who say, ‘Oh you’re right doctor, I don’t think I’d be safe to drive,’ says Marshall. Most of us have a very inflated opinion of our abilities.” We certainly cling to that license for as long as we can. Three-quarters of Canadians over 65 remain licensed drivers according, to the most recent Statistics Canada survey, and most continue well into their later years. More than 200,000 drivers on the road across Canada today are over 85. In Ontario, close to two-thirds of men over 85 are still driving. Even among the over-90 set, more than one in three Canadian men had driven a vehicle in the previous month. Many of them might be quite capable drivers, since medical experts stress that health and mental differences vary more among seniors than other age groups. But here is the dilemma: it is precisely senior drivers who might fail to realize how much of a danger they pose to themselves and others, because the very condition that could make them risky on the road — dementia — robs them of their ability to spot their disability. “Along with cognitive impairment comes loss of insight,” says Stephanie Melvin, deputy superintendent at British Columbia’s Ministry of Transportation. “People aren’t noticing that they’re cutting corners, veering into other lanes, or going the wrong way down the street.” For understandable reasons, people cherish that piece of plastic they may have had since they were teenagers. This is the first generation of seniors who have grown up behind the wheel, and we all tend to see that licence as a right, not a privilege. Woodstock’s Burridge was fuming when he lost his licence. “I’ve driven tanks and race cars,” he said. “I’ve been driving for decades and now they say I can’t drive?” After he left the British Army in 1957, Burridge delighted in the rapid acceleration of the Aston Martin, much like the early James Bond. Later, when he moved from England to Ontario, he’d take a friend’s supercharged Lotus for laps around the Drummondville racetrack. He was a mechanical engineer who understood these machines and their power. Last year, when his doctor asked him to take DriveABLE’s on-road test, he was accompanied by an occupational therapist and a driving instructor who he felt critiqued him on minor points and exaggerated the concern he expressed about driving a test car he was not accustomed to. They allowed him to take the $550 test a second time, for free, but he still failed. “I’ve lost my independence,” he says. That is going to be the case for more and more senior drivers. As medical and safety experts point out, the difference between the alcohol-impaired driver and the medically impaired one is that there is a chance the drunk driver may sober up. “There is an element of choice with drunk driving,” says B.C.’s Stephanie Melvin. “But we’re all going to age. We all have those ‘where did I leave my keys?’ moments and it’s going to be difficult for families to deal with an aging relative who drives.”
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