Say yes to medical certificates for older drivers

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    The requirement for a medical certificate for drivers over the age of 80 will be abolished if the government acts on a decision by the Storting.

    Whether the requirement for a medical certificate for drivers over the age of 80 should be retained or scrapped has been the subject of considerable, often heated, debate in recent years. Matters came to a head following a discussion in the Storting where it was decided to abolish the requirement for the mandatory medical certificate. The discussion in the Storting forms the basis for Anette Bringedal Houge's analysis of the parliamentary debate in this issue of the Journal of the Norwegian Medical Association (1). The qualitative analysis is based on the content of the arguments presented in the Storting.

    The article makes for discouraging reading in some ways. As the author notes, many of the arguments in the parliamentary debate were based on personal experiences, anecdotes from the politicians' own social circle and selective use of reports and report findings (1). She suggests that the traffic safety aspect was downplayed for fear of claims of age discrimination. Furthermore, she notes that the Storting's decision appears to be a reaction to the use of cognitive testing in this context.

    Traffic safety thus seems to be of secondary importance, making it detached from the core issue, which should be: how can we continue the good work on traffic safety that led to a marked and gratifying reduction in traffic accidents and fatalities after the peak year of 1970 (2)? What cost-effective measures can we introduce to identify drivers who are at a high risk of traffic accidents? Medical conditions that impact on driving safety primarily occur at an advanced age (3). This mainly relates to eye diseases and dementia, but also conditions such as stroke, polyneuropathy and musculoskeletal diseases.

    The common misconception that cognitive testing must be performed before the medical certificate can be issued may partly explain the strong opposition to the medical certificate requirement. However, the recommendation is for patients to be tested on suspicion of cognitive symptoms. If cognitive testing were to be used as a screening method, the naysayers could well have a point as this could mean an unacceptably high number of false positive test results.

    A medical certificate for older drivers is a way of limiting the number of motorists who increase the risk of small as well as serious road traffic accidents

    One argument that is often made is that the driver must be the one to make the decision to stop driving when he/she no longer feels fit to do so. This brings us to one of the main challenges in the most important category of diseases in this context, namely dementia. A key symptom of dementia is the inability of patients to recognise their own health condition, known in medical jargon as anosognosia (4). This often leads to such patients failing to seek medical advice – especially since they do not consider themselves a risk on the roads (5). New figures from the Norwegian National Centre for Ageing and Health show that dementia numbers will increase from the current 100 000 to around 200 000 in just 20 years (6) – which is a large rise in the number of potentially dangerous drivers.

    Based on the findings of an impact assessment in which the Norwegian Public Roads Administration pointed to a likely increase in traffic safety risk if the medical certificate requirement were to be abolished, the then Minister of Transport and Communications, Knut Arild Hareide, did not want to phase out the scheme in 2021 (7). He left it to the new government to decide how the Storting's decision should be followed up. It is now hoped that GPs' arguments for retaining the medical certificate requirement will be taken into account (8). Such a requirement would help identify older drivers with symptoms that do not always prompt them to seek medical advice. Discontinuing the scheme could lead to many of the most vulnerable members of society being deprived of the opportunity to receive help and support.

    A medical certificate for older drivers is a way of limiting the number of motorists who increase the risk of small as well as serious road traffic accidents. It is a cause for concern that the knowledge we have in this area, as presented in Bringedal Houge's analysis, is being overlooked.

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