Older Road Users

ACRS Policy Statement

All older road users, whether pedestrians, drivers, riders or passengers, share similar characteristics of declining functional capacities and increased fragility associated with ageing which place them at increased risk during mobility - risks which undeniably increase with increasing age. 

The ACRS recognises the need for research into the physical limitations of older road users, the mobility needs of this growing population sub-group, and for broader scoping research into how these factors may combine to affect the safety of all road users.   ACRS considers that applicable design standards need to be reviewed to accommodate the mobility limitations of older road users.

Discussion

Demographic changes associated with progression of the post-war generational cohort into old and older age over the next 20-30 years will have a significant effect on transportation in terms of independent mobility and the wider traffic environment.   In social planning terms, the "baby-boomer" generation represents a challenge of proportions which cannot be ignored, yet which will also be of relatively short duration.

Future generations of older drivers may not perpetuate patterns of ageing seen today, particularly in terms of the age of onset of physical health and mobility changes. People may live considerably longer, and expect to be mobile for considerably longer, but the ageing process may not follow the same pattern as that seen today because of better nutrition, improved access to health services, and the diagnosis and treatment for diseases at much earlier stages.

The current generation of older Australian drivers (ie those over 70 years of age) were born in the 1920s - at about the same time as the automobile. They have survived the Depression of the 1930s and World War II.   They have experienced arguably the most significant expansion of mobility and of technology in history. During their lifetimes, antibiotics came into use for the first time, work patterns changed from highly physical to noticeably sedentary, and diets have changed from home or farm-grown produce to mass-produced and packaged materials.   The pattern of diseases has changed, as have health practices and treatment technology.

Post-war "baby-boomers" now in their 50s, have experienced peace and plenty. They have had access to better and longer education than their parents, and are prepared to assert and defend their perceived rights.   Most have grown up with the car as part of the family, and learned to drive from either or both their parents and a driving school.   They learned road rules before gaining a provisional driving licence. They have grown up with, and indeed formed a large part of the increase in traffic density.   They expect the cars they drive to have a significant number of safety features, and are comfortable with rapid technological change. Their health problems are not due to poor nutrition in infancy or childhood, or from exposure to inhalation of noxious fumes (other than tobacco), but are more those of excess - diabetes and cardiovascular disease - both of which are currently undergoing major advances in diagnosis and treatment.

A more concerning illness in an ageing and mobile population is dementia. Almost always associated with increasing age, the disease characteristically includes lack of insight resulting in denial, is progressive, and is not fatal.   The transport consequences of this disease alone, across a larger than previous aged cohort, living into extended old age, and which is also markedly more mobile, cannot be over-estimated.

However, although the way we age physically may change, the process cannot be denied.   Ultimately everyone will confront the undeniable physical evidence of advancing age.   Ageing is a physiological process of slowing down and approaching mortality.   There are some clear indicators of such physiological changes in vision, and physical-functional capacity which can be measured, and may frequently be treated.   However, declining cognition is both more difficult to detect and to treat.   Increasing fragility of the skeleton, external and internal tissues cannot be reversed, and must be accepted as a given - making the "old" old very high risk participants in all forms of mobility.

In summary then, we have an ageing, educated and mobile population, still largely in denial of their approaching old age and its implications, technologically pushing back the barriers of ageing, who will nonetheless become frail older road users in need of support and protection in the foreseeable future. 

Thus three key research and practical, policy areas emerge:

1. Clear identification of road users who present an unacceptably high risk to themselves and other road users - via a physical/functional screening process
2. Identification of a range of Engineering solutions to separate and protect vulnerable pedestrians from vehicular traffic
3. Implementation of alternative transport solutions to meet the needs of non-drivers to access services and maintain a healthy, involved lifestyle.

These areas apply to all road users, regardless of age, but present an opportunity to address the specific needs of older road users, through the adoption of sound road safety measures which will benefit everyone.   As such they should form the basis of all transport policy.

1. Identification of "high-risk" road users

Once drivers over 70 years of age reach the predicted >25% of the driving population, it makes good sense to know that they have acceptable standards of vision, physical-functional control, and cognition to be able to safely drive a motor vehicle on a public road.

Clear and objective separation is required of the physiological limitations of ageing from the practical skills, habits and experience acquired over a lifetime of driving. 

Since there is currently no available "tool" to measure or collect standardised data on the health status of drivers, it is premature to claim that there is no place for such information in policy planning, or that such processes are not effective in reducing crash rates.   Only when a standard assessment tool has been developed and has been in use for some time can valid arguments be made or policy formed.

The existing negative perception of medical assessment processes for older drivers can be turned around, by focusing on the positive aspects, such as the diagnosis of developing conditions before they become licence-threatening. Annual assessment of fitness to drive can also positively reassure the capable driver, and provide information from which the competent driver can start planning to retire from driving.

Society in general clearly benefits from regular screening for treatable health conditions - this is clearly recognised for cancer of the breast or cervix - where all women over a certain age are screened bi-annually.   It also makes sense that such processes are conducted by trained health professionals.   Regardless of local (state) policy relating to when older drivers are screened for "fitness to drive", or who refers them for assessment, health professionals need appropriate tools to be able to achieve their task effectively. They need to be trained in the use of the screening tools. Pathways of care are needed from health professionals into the community, to ensure that those who lose their license are supported through the process and guided into appropriate transport options.

However, it must be recognised that such health screening cannot necessarily predict which drivers will, or even might, crash.   Road crashes are multiple-factor events.   Data on road crashes is typically collected by police officers at the scene, and focuses on whether or not any traffic violation occurred to cause the crash, rather than any pre-event health condition which may have contributed.

Medical practitioners are in a unique position to review the health status of their patients, but again, it may be misleading to assume that in future, all GPs will know their older patients as well as they do now.   With changing patterns of practice, more part-time practitioners, and multiple-doctor, multiple-site practices, it may not be possible for the same patient to see the same doctor on each occasion.

It is important that a standard screening process exists which does not rely heavily on the doctor-patient history, or on long-term knowledge of social and familial history.   An objective record of assessment acceptable to all practitioners can provide a more informed basis for decision-making, than anecdotal evidence or review by a familiar and trusted family doctor.

Evidence suggests that patients do respect information and advice from doctors, even when it is unwelcome. However, all health practitioners would benefit from raised awareness of the effects that ill-health and disease processes can have on the critical factors required for safe driving, including the effects of medications. 

Again, the current generation of 50+ drivers are typically better informed, more educated, more likely to ask questions before taking medication, and may require less medication than the previous generation due to improved health status.   This generation has grown up knowing and accepting mass screening, and are perhaps less likely to view it as a threat.

2. Road environment

Changing baselines for the visibility of signs, lighting and delineation from that of a fit young male to an ageing driver can benefit all road users through increased sight distances and warnings. 

Reduced speed limits may provide an "easy" engineering solution to what may become a difficult situation when 25%+ of all drivers are aged over 70. Reduced speed limits could decrease trauma and thus improve outcomes for all road users. Although the poorer outcomes of fragile participants cannot be changed, reduced speed of impact may help to change injuries sustained from "life-threatening" to survivable.

Rural drivers have special needs for mobility to access essential services. However they are also likely to be driving on roads carrying high-speed traffic - thereby putting themselves and other road users at increased risk. Typically rural areas have little or no access to alternative transport.   This is particularly difficult if the driver lives alone, or cares for an invalid partner, and where family support may not be available locally.    

Again, caution should be taken against assuming that the next generation of older rural inhabitants will necessarily reflect the attitudes of the current cohort.   Already the "young" aged (retirees from 55+) are selling up the family home and moving into inner city apartments and retirement villages with more transport options.   Whilst this may further add to the density of larger regional centres, it may also make the provision of alternative transport easier to manage.  

Finally, the current generation of ageing Australians is far more likely to demand to be involved in discussions and planning surrounding their mobility options.   It makes good political sense to ensure that their views are canvassed and encouraged.