Assessing Fitness to Drive 2016
Assessing Fitness to Drive, a joint publication of Austroads and the National Transport Commission (NTC), details the medical standards for driver licensing for use by health professionals and driver licensing authorities.
The primary purpose of this publication is to increase road safety in Australia by assisting health professionals to:
The publication also aims to provide guidance to driver licensing authorities in making licensing decisions. With these aims in mind Assessing Fitness to Drive:
PDF is available for download below. You can also visit www.onlinepublications.austroads.com.au/items/AP-G56-17 for more information.
Assessing Fitness to Drive, a joint publication of Austroads and the National Transport Commission (NTC), details the medical standards for driver licensing for use by health professionals and driver licensing authorities.
The primary purpose of this publication is to increase road safety in Australia by assisting health professionals to:
- assess the fitness to drive of their patients in a consistent and appropriate manner based on current medical evidence
- promote the responsible behaviour of their patients, having regard to their medical fitness
- conduct medical examinations for the licensing of drivers as required by state and territory driver licensing authorities
- provide information to inform decisions on conditional licences, and
- recognize the extent and limits of their professional and legal obligations with respect to reporting fitness to drive.
The publication also aims to provide guidance to driver licensing authorities in making licensing decisions. With these aims in mind Assessing Fitness to Drive:
- outlines clear medical requirements for driver capability based on available evidence and expert medical opinion
- clearly differentiates between national minimum standards (approved by the Transport and Infrastructure Council) for drivers of commercial and private vehicles
- provides general guidelines for managing patients with respect to their fitness to drive
- outlines the legal obligations for health professionals, driver licensing authorities and drivers
- provides a reporting template to guide reporting to the driver licensing authority if required, and
- provides links to supporting and substantiating information
PDF is available for download below. You can also visit www.onlinepublications.austroads.com.au/items/AP-G56-17 for more information.
| ap-g56-17_assessing_fitness_to_drive_2016_amended_aug2017.pdf |
Association Between Sedentary Time and Mortality Across Levels of Frailty
Olga Theou, PhD⇑, Joanna M. Blodgett, MSc, Judith Godin, PhD, Kenneth Rockwood, MD
Division of Geriatric Medicine (Theou, Godin, Rockwood), Dalhousie University, Halifax, NS; MRC Unit for Lifelong Health and Ageing (Blodgett), University College London, London, UK
Correspondence to: Olga Theou, olga.theou@dal.ca
BACKGROUND: Sedentary behaviours are associated with adverse health outcomes in middle-aged and older adults, even among those who exercise. We examined whether the degree of frailty affects the association between sedentary behaviours and higher risk of mortality.
METHODS: In this prospective cohort study, we used data from 3141 community-dwelling adults 50 years of age or older from the 2003/04 and 2005/06 cohorts of the US National Health and Nutrition Examination Survey. Time engaged in sedentary behaviours was measured using uniaxial accelerometers, and frailty was based on a 46-item frailty index. Mortality data were linked up to 2011. We used Cox proportional hazard models to estimate the hazard ratio (HR) of sedentary behaviour.
RESULTS: We found that for people with low levels of frailty (frailty index score ≤ 0.1), sedentary time was not predictive of mortality, regardless of physical activity level (adjusted HR 0.90, 95% confidence interval [CI] 0.70–1.15). Among people who were vulnerable (0.1 < frailty index score ≤ 0.2) or frail (frailty index score > 0.2), sedentary time was associated with higher mortality only among those who were physically inactive (not meeting the criterion for moderate physical activity) (HR 1.16, 95% CI 1.02–1.33 for the group defined by 0.1 < frailty index score ≤ 0.2; HR 1.27, 95% CI 1.11–1.46 for the group defined by 0.2 < frailty index score ≤ 0.3; HR 1.34, 95% CI 1.19–1.50 for frailty index score > 0.3).
INTERPRETATION: The effect of sedentary behaviours on mortality varied by level of frailty. Adults with the highest frailty level experienced the greatest adverse impact. Low frailty levels (frailty index score ≤ 0.1) seemed to eliminate the increased risk of mortality associated with prolonged sitting, even among people who did not meet recommended physical activity guidelines.
Visit www.cmaj.ca/content/189/33/E1056.full to read the full published paper.
Olga Theou, PhD⇑, Joanna M. Blodgett, MSc, Judith Godin, PhD, Kenneth Rockwood, MD
Division of Geriatric Medicine (Theou, Godin, Rockwood), Dalhousie University, Halifax, NS; MRC Unit for Lifelong Health and Ageing (Blodgett), University College London, London, UK
Correspondence to: Olga Theou, olga.theou@dal.ca
BACKGROUND: Sedentary behaviours are associated with adverse health outcomes in middle-aged and older adults, even among those who exercise. We examined whether the degree of frailty affects the association between sedentary behaviours and higher risk of mortality.
METHODS: In this prospective cohort study, we used data from 3141 community-dwelling adults 50 years of age or older from the 2003/04 and 2005/06 cohorts of the US National Health and Nutrition Examination Survey. Time engaged in sedentary behaviours was measured using uniaxial accelerometers, and frailty was based on a 46-item frailty index. Mortality data were linked up to 2011. We used Cox proportional hazard models to estimate the hazard ratio (HR) of sedentary behaviour.
RESULTS: We found that for people with low levels of frailty (frailty index score ≤ 0.1), sedentary time was not predictive of mortality, regardless of physical activity level (adjusted HR 0.90, 95% confidence interval [CI] 0.70–1.15). Among people who were vulnerable (0.1 < frailty index score ≤ 0.2) or frail (frailty index score > 0.2), sedentary time was associated with higher mortality only among those who were physically inactive (not meeting the criterion for moderate physical activity) (HR 1.16, 95% CI 1.02–1.33 for the group defined by 0.1 < frailty index score ≤ 0.2; HR 1.27, 95% CI 1.11–1.46 for the group defined by 0.2 < frailty index score ≤ 0.3; HR 1.34, 95% CI 1.19–1.50 for frailty index score > 0.3).
INTERPRETATION: The effect of sedentary behaviours on mortality varied by level of frailty. Adults with the highest frailty level experienced the greatest adverse impact. Low frailty levels (frailty index score ≤ 0.1) seemed to eliminate the increased risk of mortality associated with prolonged sitting, even among people who did not meet recommended physical activity guidelines.
Visit www.cmaj.ca/content/189/33/E1056.full to read the full published paper.
Transitioning Baby Boomers
Graphic Source: http://2010.census.gov/2010census/data/
Decreasing functional abilities related to normal aging and prescription medication use can adversely impact cognition, visual and auditory acuity, and mobility of Americans 65 years and older.1-3 These factors have been casually associated with an increased risk of being involved in a motor vehicle crash (MVC). Moreover, frailty increases the risk of death and severity of injury for older adults involved in MVCs.
In 2010, NHTSA reported that 5,484 people age 65 and older were killed and 189,000 were injured in MVCs. These data represent 17 percent of all fatalities and 8 percent of all people injured.4 Compounding this scenario further are the constant changes in automotive technology and new driving regulations, which may present to an older driver as confusing and come about without the benefit of informal or formal training and evaluation.1-3 Addressing health determinants is vital to assuring that the overall disease burden and health status of a community are not compromised further as a result of transportation polices and design decisions.
Applying the concepts of environmental justice to vulnerable populations, such as the older driver, ensures that safety parameters are integrated in a comprehensive transportation policy to provide important health impacts. Even when accounting for the uncertainty and inconsistencies of publicly available data (i.e. secondary reporting, data entry errors, missing data) this level of analysis by a trained public health expert working in collaboration with transportation engineers and other professionals, provides better information in which to make design choices.
Figure 1 illustrates the projected age distribution of American men and women in 2010 (dark green), 2030 (teal blue) and 2050 (light purple). The dark green bars represent the current baby boomer generation (aged 46 to 60); corresponding to the fastest growing segment of the U.S. population.5 By 2030, this group will transition into the later stages of life defined as 65 years and older.5 To meet the needs of an increasing older population, it will be imperative that local and federal governments are prepared to make changes in applicable policies and proper resource allocation.
References
1. Elderly drivers no more dangerous than 20-somethings (August 25, 2012). Retrieved From:
http://www.worldbulletin.net/?a&ArticleID=94408
2. Supporting Older Americans (August 29, 2012). Retrieved From:
http://economix.blogs.nytimes.com/2010/06/14/supporting-older-americans/
3. Nearly Half of Senior Drivers Worry about No Longer Driving, AAA Survey Reveals (August 28, 2012). Retrieved From: http://newsroom.aaa.com/2012/04/nearly-half-of-senior-drivers-worry-about-no-longer-driving-aaa-survey-reveals/
4. NHTSA Senior Driver Fact Sheet (August 28, 2012) Retrieved From: http://www.nhtsa.gov/Senior-Drivers
5. US Census Population Distribution (August 29, 2012). Retrieved From: http://2010.census.gov/2010census/data/
In 2010, NHTSA reported that 5,484 people age 65 and older were killed and 189,000 were injured in MVCs. These data represent 17 percent of all fatalities and 8 percent of all people injured.4 Compounding this scenario further are the constant changes in automotive technology and new driving regulations, which may present to an older driver as confusing and come about without the benefit of informal or formal training and evaluation.1-3 Addressing health determinants is vital to assuring that the overall disease burden and health status of a community are not compromised further as a result of transportation polices and design decisions.
Applying the concepts of environmental justice to vulnerable populations, such as the older driver, ensures that safety parameters are integrated in a comprehensive transportation policy to provide important health impacts. Even when accounting for the uncertainty and inconsistencies of publicly available data (i.e. secondary reporting, data entry errors, missing data) this level of analysis by a trained public health expert working in collaboration with transportation engineers and other professionals, provides better information in which to make design choices.
Figure 1 illustrates the projected age distribution of American men and women in 2010 (dark green), 2030 (teal blue) and 2050 (light purple). The dark green bars represent the current baby boomer generation (aged 46 to 60); corresponding to the fastest growing segment of the U.S. population.5 By 2030, this group will transition into the later stages of life defined as 65 years and older.5 To meet the needs of an increasing older population, it will be imperative that local and federal governments are prepared to make changes in applicable policies and proper resource allocation.
References
1. Elderly drivers no more dangerous than 20-somethings (August 25, 2012). Retrieved From:
http://www.worldbulletin.net/?a&ArticleID=94408
2. Supporting Older Americans (August 29, 2012). Retrieved From:
http://economix.blogs.nytimes.com/2010/06/14/supporting-older-americans/
3. Nearly Half of Senior Drivers Worry about No Longer Driving, AAA Survey Reveals (August 28, 2012). Retrieved From: http://newsroom.aaa.com/2012/04/nearly-half-of-senior-drivers-worry-about-no-longer-driving-aaa-survey-reveals/
4. NHTSA Senior Driver Fact Sheet (August 28, 2012) Retrieved From: http://www.nhtsa.gov/Senior-Drivers
5. US Census Population Distribution (August 29, 2012). Retrieved From: http://2010.census.gov/2010census/data/
| driving_safety_and_the_elderly.pdf |
| elderly_and_infrastructure_fact_sheet.pdf |
| modeling_elder_drivers.pdf |
| nhtsa_2010_older_driver_fact_sheet.pdf |
| retting_ite_older_driver_safety_august_2013.pdf |
Improving the Road Safety of Older People
Final Report
"This Report has been developed to present the findings of a six month study undertaken within Northern Ireland on improving the road safety of older people and arises out of a commitment given in Northern Ireland’s Road Safety Strategy to 2020. Older people are one of the most at risk road user groups in Northern Ireland (NI): over one in ten of those injured on the road is aged 60+. Only with a full understanding of causation factors and contributory issues can the task of minimising risks to this road user group be moved forward.
Drivers
Pedestrians
Risk and Age
Self-Regulation
Drivers
- Older road users are more susceptible to being involved in a collision at junctions, specifically T junctions, particularly drivers making right turns.
- Collisions involving older drivers are less likely to involve speeding or drink/drugs.
- Older drivers consider themselves to be more experienced than other drivers and consequently safer; other road users have the opposite opinion.
- Older people are confident that they can self regulate their driving to reduce the risks and will know themselves when they should stop driving completely. It appears from feedback received during this study that there is a belief that some older drivers retain their licence for identification purposes; whilst still allowing them to drive as often or as little as they wish.
- Only 33% of older drivers are aware that they are able to have an assessment to determine if their car requires adaptation; 36% are aware that adaptation centres are available across NI.
Pedestrians
- Older pedestrians account for 14% of all pedestrian casualties and as such appear to be more at risk than older drivers (10%) and passengers (10%).
- Older pedestrians are significantly more at risk in the hours of darkness and are more likely to cross unsafely, both at and away from formal crossing facilities. Older pedestrians consider crossing facilities to be unsuitable for their needs and they believe that controlled facilities do not allow enough crossing time. Only 57% of older people feel safe as a pedestrian.
- The perceived lack of enforcement by the Police is a concern for older people, especially pedestrians.
Risk and Age
- The currently available data for older drivers in NI and elsewhere suggests that 70 years old is the correct age to intervene as it appears that the driver risk exceeds that of the typical driver at this point.
- The currently available data for older pedestrians in NI suggests the risk begins to increase around the age of 65. The older passenger data does not give a clear picture of when the risk to an older passenger becomes a concern.
Self-Regulation
- Older drivers and pedestrians, especially those over 70 years of age plan their journeys based on weather, the time of day, busy roads and hours of daylight. The collision data suggests that older road users travel at different times of the day to other users and are more at risk in the late afternoon.
- Older people in both urban and rural areas feel that public transport is not adequate for their needs."
| final_report_-_improving_the_road_safety_of_older_people_210912__2_.pdf |
| 1208_sameru_newsletter_aug_2012_rev_11_1.pdf |