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 [8]]. 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
Victoria