Rethinking the road toll

When it comes to road fatalities, most people first think of drunk or ill-equipped young drivers. But the reality is quite different.

 By DARCY DUNCAN and SIMONE GOULD

 At the start of this year, the 2013 road toll was celebrated because it was Victoria’s lowest since 1924. But there was bad news hidden in those figures.

While deaths among young drivers aged 18-25 dropped by more than 40 per cent, deaths among drivers aged over 70 increased, with 59 fatalities last year. This was the highest of any demographic.

According to the Transport Accident Commission (TAC), in Victoria drivers 75 years and older have the highest risk per distance travelled of being killed in a crash of any age group.

The high death rate comes despite being involved in fewer crashes than other demographics. VicRoads research shows that when they are involved in an accident, they are more likely to suffer serious injury or death.

Victoria is the only state that has never has a requirement for medical and/or practical retesting after a certain age, but there is minimal support for introducing it.

Arthur Lee of Williamstown, 92, has been driving for more than 50 years. The former plumber still drives every day and hasn’t been involved in a crash for over 10 years.

His driving abilities have “stayed the same, no difference from years of driving”, he says.

Older drivers just have to “abide by speed limits and other roads rules” to ensure their safety, he says.

Neither Mr Lee nor his wife Jean, also 92, have considered giving away their licences and consider them a necessity.

“It would be stupid to give it up,” Mrs Lee says.

Both agree that retesting those over age 70 could be a good idea, to ensure drivers are physically and mentally still able to drive.

Anne Markwick, 75, first learned to drive in the 60s in Tanzania, where her husband, Keith, was working as a doctor.

Mrs Markwick has held a driver’s licence in three different countries: England, Tanzania and Australia.

The next time she’ll have to renew her licence will be in 2022, when she’s 83. Now, Mrs Markwick relies on her car to help take care of her six grandchildren, while her 77-year-old husband drives to work.

Poor driving is related to age, and she says she knows her limitations, she says.

“Just because you reach a certain age doesn’t mean that everything changes overnight,” Mrs Markwick says.

“The thing about age is that you know whether you can do it or not,” she said.

Her husband, who taught their 20-year-old granddaughter how to drive, doesn’t think that age should be “singled out”.

While Victoria does not require retesting, a shorter licence period applies. Only three-year licences are available to drivers once they reach 75 at (VicRoads’ discretion), instead of the usual 10-year term.

In December 2008, the NSW government introduced compulsory yearly medical tests for drivers older than 75 and, for those 85 years and older, the choice of either a driving test every two years, or a restricted licence where they can only go within a certain radius from their home.

While the impact of the rules was investigated and deemed to be working, in Victoria they were seen as ineffective.

“When we compared the crash rates here in Melbourne to those in Sydney where there is age-based testing, there was no significant difference in terms of the crash rate,” Ms Koppel says.

Currently the law in Victoria relies on self-reporting and assessment, with the responsibility for reporting medical conditions to VicRoads placed on the driver. Vic Roads can order medical assessments of drivers and rule someone unfit to drive. Referrals can come from a medical practitioner or police officer.

The result can be a licence issued with conditions, which as a restriction on driving at night or only in local areas, or certain car modifications might be required.

VicRoads has no plans to change the current system.

“Age-based assessment has been investigated many times and there is no evidence to suggest that age-based assessment leads to improved road safety outcomes,” a spokesperson says.

Studies conducted by the TAC have also found that introducing a system of retesting drivers would have little impact.

“There is no evidence to show that increased testing makes a difference to road trauma among older road users,” Mr Price says.

 At the present time no one is required to hand in their licence, he says, and “people can drive as long as they are safe to do so”. Most are good at self-regulating, he says.

 The TAC suggests family members review the information on Vic Roads’ website if they are concerned about a relative’s ability to drive.

 The RACV supports this approach.

 “Restrictions should not be placed on drivers on the basis of age alone – it is impairment, not age, that is the key issue in driving ability,” RACV spokeswoman Melinda Spiteri says.

The Monash University Accident Research Centre (MUARC) has also found age-based testing is not effective.

 It suggests the main reason more elderly drivers are sustaining injuries is because there are more of them on the road, MARC researcher Sjaan Koppel says.

 The proportion of people aged 65 years and older in Australia is predicted to increase from 14.4 per cent in 2013 to 24.2 per cent in 2051, according to the Australian Bureau of Statistics.

 MUARC is conducting a joint study with a Canadian Research Centre that has tested 928 elderly drivers while the MARC has tested 257 elderly drivers.

 The Candrive/Ozcandrive study began in 2010 and tracks drivers 70 years and over in Canada and drivers over 75 in New Zealand and Australia for five years.

The aim is to gather data to develop a screening test to help GPs and other health professionals identify at-risk drivers. The drivers have annual medical tests and in-car devices are installed to accurately record driving patterns, road awareness and the decisions made while driving.

Findings from the first year of the Candrive/Ozcandrive study show that “low-mileage” older drivers have a greater risk of being in a crash.

These older people often drive less because they have functional impairments or are unwell, making them less fit to drive.

They also drive more on local roads, where there are more conflict points (places where accidents are more likely) than on freeways.

This is because older drivers encounter more difficult driving conditions, like intersections, where they have to make decisions about gaps. This is supported in The Victorian Older Drivers’ Handbook, published by Vic Roads, which says a “failure to select a safe gap in traffic is a major contributing factor” in why elderly drivers are involved in crashes and potentially fatal accidents.

 The aim of the study is to better understand the actions of elderly drivers and see what steps can be taken to prevent them making bad driving decisions.

 “We’re really focused on safe mobility, trying to keep people driving for as long as it’s safe to do so,” Ms Koppel says.

“[Mobility] helps them stay connected in the community, it helps them get to the places they need to get to for medical services or medication,” she says.

Some drivers who have functional and cognitive impairments, like dementia, might not adapt their driving to suit the changes that happen as they age, Ms Koppel says.

“They’re the ones that we need to identify … rather than subjecting all older drivers to scrutiny,” she says.

The Royal Automobile Club of Victoria (RACV) has a program called Years Ahead, which has been operating since 1997 and has provided a service to more than 120,000 people.

The program is aimed at giving older drivers an education on how to handle themselves on the roads.

Its role is to provide driving and road safety tips as well as information about choosing a safe vehicle. Car safety is an important issue, with studies showing many elderly drivers have old cars – perhaps bought at retirement and kept for a prolonged period – that do not have the latest in safety equipment, such as ABS breaking, electronic stability control and a full selection of airbags.

Another reasin for a high level of serious injury and death is physical frailty. Half of the deaths of those aged 70 years and older would not occur if they were as robust as younger drivers.

TAC spokesman Nick Price says older drivers are “over-represented in serious injury and fatal crashes” and he attributes this to “frailty, reduced bone strength and fracture tolerance”.

The Monash Accident Research Centre says further research should allow the identification of ways to “reduce crash and fatality statistics due to improved vehicle design and performance, vehicle technological solutions, older driver training and educational programs, and improved highway design”.

The Victorian State Government recently launched an $8 million world-first Enhanced Crash Investigation Study, which will examine in detail hundreds of serious injury crashes.

The purpose is to better understand what causes these injuries and how they can be better prevented.

In 2010, consultant pharmacist who has previously worked with the TAC, Dr Jenny Gowan, suggested S-plates for older drivers.

“I got so much opposition,” Dr Gowan says.

“It was just amazing that people did not see it as a positive initiative, they saw it as an infringement and a stigma.”

The basis of the suggestion was that older drivers should have a zero blood alcohol restriction, like P-platers. Dr Gowan still believes this should be introduced.

Dr Gowan has done about 8500 home medicine reviews and often sees older people to review their medication, which can include substances that have the potential to impair their driving.

She says keeping older drivers safe on the road is about getting people to make the decision about whether or not they are fit to drive, but this doesn’t always work.

“Unfortunately many older drivers don’t recognise their loss of driving skills, and well-meaning relatives will just reject it,” she says.

Under the current system, the onus is on the driver, not doctors, to report any medical condition or illness to VicRoads.

This can be problematic particularly with conditions like dementia where memory and judgment is impaired.

According to Alzheimers Australia, Victoria is facing a dementia epidemic.

They project that the number of people living with dementia in Victoria will increase by 229 per cent by 2050.

When someone is diagnosed with dementia, they have to report this to VicRoads but they won’t necessarily have to stop driving. Instead their licence may become conditional and they may need to have regular medical reviews and driving tests.

But a survey of family carers, friends and people with dementia conducted by Alzheimer’s Australia shows that over 30 per cent are unaware they need to report the medical condition to VicRoads.

The survey also showed that stopping driving can have a big impact on the driver as well as their family.

Only a small number of participants had a positive experience after stopping driving. For others it led to socialising less, anger, confusion and depression.

With the number of Victorians over 75 predicted to increase by 42 per cent by 2022, older driver mobility and road safety are going to become increasingly important issues.

Organisations are focusing not on taking healthy and capable elderly drivers off the road, but making the safety and health issues clearer.

By combining government initiatives and advertisement the high rate of road fatalities begin to fall.