(R1) Ageing, mental illness and medical disease - Table 6
This workpackage considers both general and specific forms of driver impairment resulting from ageing, illness and disease. General impairment is investigated in terms of review, prospective surveys and epidemiological research methods to quantify the nature of the impairment and relation to accident risk as well as consideration of assessment protocols that are specific to certain categories of impairment.
Table 6. Summary Description of Research Workpackage for Ageing, Illness and Diseases.
Workpackage Title: Ageing, mental illness and medical disease
Objectives This WP deals with the IMMORTAL objectives related to impairment, accident risk and assessment methods based on ‘tolerance levels’ for drivers with chronic impairment resulting from age, illness or disease. Description of work / tasks Review Task R1.1: Literature review on relative accident risk and meta-analysis (month 7-13). Survey/Epidemiological Studies Task R1.2: Estimation of the culpability in accident risk amongst drivers with ageing, illness and disease conditions using an "induced exposure" estimation of risk involvement of several disorders in road accidents. (month 12-24).
Task R1.4: A prospective analysis of the Medical-Psychological assessment of fitness to drive and accident risk using medical-psychological assessment of drivers obtaining/renewing driving licence to predict licensing assessment and subsequent traffic violations and accidents (month 1-28). Experiments Task R1.5: Performance of drivers with clinical depression under various treatment regimes during a 6-week therapy with a Selective Serotonergic Reuptake Inhibitor (SSRI), a Tricyclic Antidepressant (TCA) or placebo treatment. (month 1-28). Task R1.6: Effects of diabetes on cognitive and driving performance using simulation experiment (driving simulator) and psychological examination of the effects of diabetes on cognitive and driving performance, and how these effects relate to other known effects such as fatigue and alcohol (BAC 0.5) (month 12-24).
Evaluations Task R1.7: Development of licensing assessment protocols for categories of impaired elderly driver to develop assessment protocols specific to categories of physical and cognitive impairment amongst elderly drivers (month 6-28).
Task R1.8: Driving assessment of persons with learning difficulties to develop a standardised test procedure (month 1-28). Management Task R1.9: Workpackage management and reporting (month 1-36). Deliverables D-R1.1: Literature review of impairment and accident risk associated with ageing, illness and disease. D-R1.2: Estimation of risk involvement of several medical disorders in road accidents. D-R1.4: Medical predictors at time of licensing for traffic violations and accidents. D-R1.5: Effects of depression and antidepressant therapy on driving performance. D-R1.6: Effects of diabetes on driving performance. D-R1.7: Protocol development for assessment of fitness-to-drive amongst categories of elderly driver. D-R1.8: Assessment of fitness-to-drive among patients with learning difficulties. D-R1.9: Ageing, illness and diseases: A synthesis of results. Milestones
(and criteria) Month 13: Completion of Deliverable D-R1.1
Month 24: Completion of Deliverables D-R1.2 and D-R1.6
Month 28: Completion of Deliverable D-R1.4, D-R1.5, D-R1.7 and D-R1.8
Month 30: Completion of Deliverable D-R1.9
(QA authorisation).
Interrelation with other workpackages and expected results Specific relation to other workpackages include: possible medicine effects from ageing, illness and diseases (R4); and licensing and countermeasure policy (P). The results of this workpackage will identify the type of impairment and accident involvement associated with types of chronic impairment from ageing, mental illness and disease. This will include recommendations for licensing assessment protocols based on form of impairment.
The available evidence suggests that the medical condition of drivers is an important factor when assessing fitness to drive and the ability to drive safely . However, it is also considered that medical conditions are not the most important factor in road accidents. In fact, most road traffic accidents have a multi-factorial cause: for many drivers, their medical condition is one on the factors involved.
It is important to consider that people with medical conditions need pharmacological treatment. In many cases the medical condition will remain for an extended period of time, in some cases for the rest of their life.
Special concern exists regarding ageing and the older driver. There is no age limit for holding a driving licence. Three specific aspects dealing with the older driver are of great relevance. First, the health of the driver: as they become older, the ability to drive safely could be reduced. Second, morbidity (and pharmacotherapy) increases with age, and medical factors adverse to safe driving may be multiplied and synergistic. Third, the assessment of drivers with dementia poses special problems especially with respect to the fact the average age of the driving population is rising.
Within the framework of the European Union, ANNEX III of the Council Directive on the Driving Licence (CD 91/439/EEC) describes minimum standards of physical and mental fitness for driving a power-driven vehicle. The following aspects are described: sight, hearing, locomotive disability, cardiovascular diseases, diabetes mellitus, neurological diseases, mental disorders, alcohol, drugs and medicinal products, renal disorders, and miscellaneous provisions. In practice, this means that various types of illnesses and diseases, including the effects of medical treatment, can affect fitness to drive.
One of the aspects dealing with medical conditions and driving, is that we have limited knowledge on their role on fitness to drive and accident risk: this is logical as we are dealing with many illnesses and disorders. Furthermore, although differences between people always exist, these increase with age: therefore the older driver, medical condition and fitness to drive is a complex matter. Finally, many drivers are very healthy people, while others have several disorders at the same time: such multi-morbidity (for example, heart problems and bad vision, etc) is a complex matter.
It is conceivable that many medical-pharmacotherapy conditions could impair the ability to drive to some extent. However, we do not have clear evidence for many of these conditions to base a decision that the level of impairment is unsafe in reference to standard criteria. For this reason, CD 91/439/EEC faces problems in the implementation of guidelines for impairment.
IMMORTAL will attempt to deal with the existing problems related to ageing, illness and diseases, and driving. This will be achieved by providing relevant information on the role of ageing, illness and diseases on accident risk, evaluation of fitness to drive and ageing/medical conditions, implement European knowledge and experts' opinions about existing questions, and propose guidelines.
This WP is co-ordinated by UVA. In practice, various types of illnesses and diseases, including the effects of medical treatment, can affect fitness to drive. In this context, a double approach for the WP 1 has been taken:
When possible, a broad approach will be taken: i.e. all possible illness and diseases (Task R1.1 to R1.4).
In other cases, because it is impossible to deal with all the diseases, specific target populations have been selected as priorities for traffic safety. These include the elderly, those with learning difficulties, those with depression, diabetics and finally, dementia disorders (Task R1.5 to R1.7).
Review
Task R1.1 Literature review on relative accident risk and meta-analysis by TOI.
Survey/Epidemiological studies
Task R1.2 Estimation of the culpability in accident risk amongst drivers with ageing, illness and disease conditions by TOI using an "induced exposure" estimation of risk involvement of several disorders in road accidents.
Task R1.4 A prospective analysis of the Medical-Psychological assessment of fitness to drive and accident risk by UVA using medical-psychological assessment of drivers obtaining/renewing driving licence to predict licensing assessment and subsequent traffic violations and accidents.
Experiments
Task R1.5 Performance of drivers with clinical depression under various treatment regimes by UM-BBI to assess actual driving performance of depressed outpatients during a 6-week therapy with a Selective Serotonergic Reuptake Inhibitor (SSRI), a Tricyclic Antidepressant (TCA) or placebo treatment.
Task R1.6 Effects of diabetes on cognitive and driving performance by CDV using simulation experiment (driving simulator) and psychological examination of the effects of diabetes on cognitive and driving performance, and how these effects relate to other known effects such as fatigue and alcohol (BAC 0.5).
Evaluations
Task R1.7 Development of licensing assessment protocols for categories of impaired elderly drivers by UNIV LEEDS (with assistance from TRL) to develop assessment protocols specific to categories of physical and cognitive impairment amongst elderly drivers.
Task R1.8 Driving assessment for persons with learning difficulties by SINTEF to develop a standardised test procedure for drivers with learning difficulties.
Management
Task R1.9 Work package management and quality assurance. The work package leader (UVA) will manage the tasks in co-operation with the task leaders and assure the quality of the work. UVA will be responsible for the co-operation between all partners involved in R1 and for the joint synthesis report The results of the various studies will be linked and recommendations for further action will be proposed in the report, including suggestions for 'tolerance levels' applicable to licensing assessment.
