En vieillisant on devient plus fou et plus sage

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En vieillisant on devient plus fou et plus sage

• La Rochefoucauld

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Carl Benz, 1896

• ..never more than 1,000,000 cars ..limited by
  numbers that could be trained as chauffeurs!

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Key points

• Older people most responsible road users
• Medical screening redundant, ageist and probably
  dangerous
• Driver licencing must not victimize older people
  but support
• Enabling appropriate assessment centres and
  guidelines
• Understand limitations of cognitive testing

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(No Transcript)
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1985
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Mobility vs Safety

• Mobility primary
• Safety secondary
• Peculiar attitudes to safety
• Nuclear catastrophe
• MoT/TüV/NCT
• Older driver screening

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Accident risk

• Lowest of the driving population

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What about the U-shaped curve?

• Older people drive less miles
• Drive on more risky roads
• Lower mileage intrinsically risky

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Smeeds Law Revisited..

• .a relative decrease over time in older drivers'
  accident involvement per driver license and per
  active driver from 1983 to 1999

Hakamies-Blomqvist, AAAP, 2005, 37, 675-80
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(No Transcript)
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UK/Irish Media

• 15 (negative)
• 4 (positive)
• 7 (balanced)

Feb 2005
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Medline

• 58 (risk)
• 15 (transportation)
• 27 (balanced)

Sept 2005
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Medication

• Positive impacts
• Anti-parkinsonian
• Antidepressants
• Anti-inflammatories
• Anti-dementia drugs?
• Negative impacts
• Less clearly demonstrated

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Less Crashes - More Deaths

• Fragility
• Children and air-bags
• Design of the environment
• Design of safety features

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Youth, speed, alcohol and
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Is dementia a problem?

• Crash risk similar in first two years 1994
• Overall crash risk similar 1996, 2000
• Less mileage
• Limitation
• 30 pass road test 1996

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Is dementia a problem?

• Major mobility consequences Taylor 2001
• AD neuropathology more common in dead older
  drivers
• Difficulty stopping patients
• Clinical problem

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Older driver screening

• Stop!
• No effect
• Illinois
• More deaths
• Australia
• Scandinavia

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Public Health
Older drivers the safest drivers on the road
Clinical
Doctors need assistance with assessment of older
people with illness
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Public Health
Clinical
Excellent practical guide for doctors in clinical
practice
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Assessment

• Move away from cognition
• Adopt functional/behavioural pathways
• Specialized centres
• FORUM (UK)
• New network (Sweden)

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Driver models

• Procedural, personality and behaviour
• Cognitive tests of limited value
• Hierarchical
• Strategic
• Tactical
• Operational
• Michon 1986
• Operationalized
• De Raedt 2000

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Off-road assessment

• Ability or disability-based?
• Enabling vs policing
• False assumptions about cost of on-road testing

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SDSA (and other tests!)

• .can be useful if used in a balanced fashion,
  taking into account the possibility of
  compensatory traffic behaviour.

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On-Road Test

• Gold/Brass standard
• 30 performance decrement in test car
• Needs standardizing
• Tester
• ADED, Greenwich University
• Test
• CARA, TRIP, Drivable..

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8 Major Policy Issues

• Support and funding to enable lifelong
  mobility
• Support for older people to continue driving
  safely
• Provision of suitable transportation options to
  the private car
• Safer, better designed vehicles for older people

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8 Major Policy Issues

• Development of safer roads and infrastructure
• Appropriate land-use practices
• Involvement of older people in policy development
• Educational campaigns to promote maximum mobility
  and safety for older persons

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Key Research Areas

• Improve vehicle design and crashworthiness.
• Improve assessment and rehabilitation of older
  drivers.
• Determine, demonstrate and promote societal
  benefits of improvements to enable safe mobility
• Provide transportation options in an efficient
  and cost-effective way.

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Key Research Areas

• Enhance land-use planning and sustainable
  communities
• Encourage domestic and international cooperation
  in the development of data and information
  sources

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Laccident, cest lautre

• Implement OECD
• Stop medical screening of older drivers
• Provide multi-disciplinary assessment and
  rehabilitation
• Support alternatives for graduated driving exit

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(No Transcript)
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If you design for the old, you include the
youngif you design for the young, you exclude
the old
Bernard Isaacs
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Was gefällt, bleibt in Gedächtnis
Friedrich II