Driving License Medicals at Medplus
Dec. 15, 2021
As we age the incidence of medical conditions that can affect the safety of driving increases. At Medplus we regularly access older people at the time of license renewal age 75, 80, and then every two years. However, we may need to review the ability to drive in other circumstances after a medical incident or physical injury.
Older age is not a contraindication to driving however the incidence of conditions such as dementia, stroke and cardiovascular disease does increase and can affect the ability to drive in some elderly. Other age-related factors that may impair driving include early-onset fatigue, slowed responses, visual problems, impaired cognitive function, and impaired mobility.
In New Zealand, the two main causes of fatal crashes in the elderly in 2008 were loss of control (40%) and driving too fast for the conditions (39%). Illness or disability was attributed as the cause of 6% fatal crashes and of those 1/3 were due to illness of no warning and 1/3 to impaired ability due to old age. Also of note, 80% of older drivers will continue to drive after their first accident and 40% of those will go on to have a second accident. The risk for accident/distance travelled is the same as that for age 20-24-year-olds who are a high-risk group.
Being able to drive is extremely important for many old people allowing them to keep them independent and mobile. However, it is not a right and it is up to us as GPs to find the balance between helping our elderly retain their quality of life but also be mindful of keeping them safe and others safe on the road.
After reading the above you can see why it is important when booking a driving license medical with a GP at Medplus you book with a GP that knows you well. It is also not a quick fit in at the end of a normal consult. It takes time to complete properly and do the appropriate clinical examinations required to be confident in completing the medical exam. As a result, we have come up with a process to help both you and our GPs do this properly and appropriately. If you are generally fit and well then at age 75 a normal 15-minute appointment with your regular GP would be appropriate. Once you reach 80 we will add a 15 min appointment with one of our practice nurses to do a cognitive test on you. We have also developed a patient questionnaire to fill in before your appointment and one for your family to fill in if we have any concerns about your ability to drive.
It is not however all doom and gloom as you get older. We can make recommendations to continue driving with conditions on your license such as driving an automatic vehicle only, no night driving, driving within 10 Km of home or after 9 am and before 3 pm. If we have concerns about your ability to drive we may recommend an OT assessment. This involves an off-road examination of vision, mobility, strength, and cognitive function and then a driving test if those are passed. If we feel you are unsafe to drive then we do have a legal obligation to advise the New Zealand Transport Agency in writing.
If you decide that you are not confident driving anymore or are declined a driving license for medical or physical reasons there are alternatives. Mobility scooters do not need a driving license and many local councils run training courses. Just contact the Road Safety Coordinator at your local council. You may be eligible for the total mobility taxi scheme where a person will receive a 50% discount on taxi fares. Again the local council or Age Concern can help you. There is free off-peak public transport between 9 am and 3 pm and after 6 pm weekdays and also weekends and public holidays. You can obtain mobility parking permits for yourself or to put in a family member's car. This scheme is run by CCS Disability Action and requires a GP to certify your application.
Hopefully, this article is useful in explaining the reasons behind our process. As a medical is done when you are well unfortunately it is not covered by your capitation subsidy from the government. At Medplus our cost is $75 and our practice nurse fee is $35.