I am writing in regard to the Council on Health Promotion article in the October issue of the BCMJ [The senior driver in BC: Reaching the 80-year milestone BCMJ 2013;55:380]. A driver’s licence is issued by the Office of the Superintendent of Motor Vehicles (OSMV), which is a branch of the Ministry of Justice. It is the responsibility of the OSMV to ensure that the person who holds a driver’s licence can drive safely.
The prevalence of dementia or cognitive impairment without dementia is 4% in 65-year-olds, and the prevalence of these conditions doubles every 4 years thereafter. According to DA Redelmeier and MB Stanbrook (CMAJ 2012;184:1123), “One in four Canadians over 65 with dementia retain a driving licence and about one in five continue to drive regularly.” They also state, “Of the 2209 Canadians who died in motor vehicle accidents in 2009, 389 were over age 65, a higher incidence than any other age group. For every death, an additional 35 individuals were injured.”
Many older people have no insight into their cognitive decline. I have often heard older drivers say, “How can you say it’s not safe for me to drive? I haven’t had an accident in 40 years.” It can be damaging to the doctor-patient relationship for the doctor to inform the older driver (or the OSMV) that the person should no longer drive.
In my opinion, the decision about whether an older person can continue to drive should not be the primary responsibility of the doctor. An occupational therapist can make the preliminary assessment, and the definitive test is a road test. As well, I believe that assessment of the older driver should start before age 80.
—Robert Shepherd, MD
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org