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Assessing fitness to drive in the elderly and those with medical conditions: guidelines should specify methods and evidence
  1. L Rachid Salmi1,2,3,
  2. Sandy Leproust4,
  3. Catherine Helmer1,2,
  4. Emmanuel Lagarde1,2
  1. 1Université de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
  2. 2INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
  3. 3CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux, France
  4. 4Kappa Santé, Paris, France
  1. Correspondence to Professor L Rachid Salmi, ISPED, Université de Bordeaux, 146 rue Léo-Saignat, Bordeaux, Cedex F33076, France; rachid.salmi{at}isped.u-bordeaux2.fr

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Introduction

On 29 November 2002, five firemen attending a minor collision on the side of a bridge on highway A7, near the town of Loriol in south-eastern France, were hit by a car driven by an 81-year-old man. Three firemen died immediately and two others were thrown over the bridge into the river.1 The investigation concluded that the driver was physically and mentally healthy and that he admitted he was driving at over 150 km (90 miles) per hour.2 However, some members of the media suggested that the collision could have been avoided if systematic assessment of fitness to drive was mandatory for all older people.3 As a result, the French Ministry of Health asked the Academy of Medicine to set up a taskforce to define medical contra-indications to driving, and procedures for screening patients with specific conditions.4 The taskforce mostly consisted of clinical and occupational medicine physicians (see the appendix in the report by Dômont5). Although criteria for the relevance of screening6 and the usefulness of such programmes had previously been questioned,7 the process seemed to lack the public health perspective expected when a screening programme was being considered. In this Policy Forum, we assess, using criteria for assessing screening for driving fitness in older persons, whether the evidence shows that major guidelines for physicians result in improved road safety, and whether their potential benefits actually outweigh the disadvantages for the elderly and those with specific conditions, especially in terms of loss of mobility and its consequences.

Assessing the usefulness of early detection

All screening programmes are based on a single hypothesis8: the early detection of disease with potentially severe consequences improves prognosis by facilitating timely treatment. Screening can only be effective, however, if: (1) the preclinical phase is long; (2) treatment is more effective early than late; …

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