Medical Fitness to Drive and a Voluntary State Reporting Law
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Mission • Identify traffic safety problems • Foster research that seeks solutions • Disseminate information and educational resources
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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
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 The Boomers are coming!
Workshop held Dec. 2007 • Consensus-based recommendations to guide license policy development developed • Released June 2008
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
Great Policy Example: Missouri’s House Bill 1536 • Voluntary Reporting • Clear Definition of Whom May Report • Reporter’s 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.
Missouri’s 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
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.
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
Evaluation of Missouri’s House Bill1536 • Conducted by: • Thomas Meuser‚ Ph.D.University of Missouri • David Carr, Ph.D.Washington University School of Medicine • Published Oct. 2008 • Available atAAAFoundation.org
Project Objectives • Document and describe the impact of MO’s 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
Reporting Process MO’sDepartment of Revenue (DOR) houses MO’s 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.
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?
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 (2.8:1 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
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%)
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)
The outcome? Few reported drivers traverse each step in the process, and just 3.5% of the total retained a valid license to drive. Missouri’s law works as a package to move most reported drivers into retirement. Crash data indicates that few continue driving after license revocation.
Summary of Findings • MO’s 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.
Summary of Findings (cont.) • MO’s 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).
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.
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.
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.