Unfit drivers FAQ
Medical conditions that will force drivers to hang up their keys
February 13, 2008
Heart conditions, dementia and alcohol abuse are obvious indicators that a driver should surrender the car keys. But few may be aware that sleep apnea and arthritis are also in certain cases grounds to declare a driver "unfit."
The Canadian Medical Association offers doctors a guidebook flagging certain behaviours and conditions to watch for in patients who want to drive. The guidebook is extensive and covers a range of issues from aging to metabolic disorders to psychiatric illness. But the very vastness of what qualifies a person to be unfit to drive has prompted some doctors to call for tighter guidelines.
In response to a 2008 study that found few Ontario doctors were reporting medically unfit drivers, the College of Family Physicians of Canada said doctors needed more support. The body said doctors need more instruction on what defines a reportable condition and how to deal with upset patients.
How widespread is the problem?
A study released in February 2008 by the Toronto-based Institute for Clinical Evaluative Sciences cites research that suggests unfit drivers kill more than 5,000 pedestrians around the globe every year. The ICES study examined data pertaining to drivers admitted to Toronto's Sunnybrook Health Sciences Centre between 1996 and 2001 following a life-threatening auto or motorcycle accident. Victims were assessed for alcohol abuse, cardiac conditions and neurological disorders — all of which are reportable conditions. The study found that 37 per cent of the drivers had a reportable condition and unfit drivers spent a total of 8,440 days in hospital at a cost of $3 million.
Similarly, a three-year study by University of Toronto researchers found that nearly one-third of older people continued to drive after being diagnosed with mild to moderate forms of dementia. The study, involving more than 700 older drivers, was published in September 2006 in the Canadian Medical Association Journal.
How do reporting requirements vary across the country?
Doctors in all of the provinces and territories have a duty to report patients who they assess as unfit to drive to the motor vehicle licensing authority, according to the CMA handbook for physicians. This obligation contravenes standard physician-patient confidentiality.
The duty is mandatory in all provinces and territories except Alberta, Nova Scotia and Quebec.
What conditions are doctors monitoring?
The list as outlined by the Canadian Medical Association is extensive but includes the following:
- Alcohol abuse and dependence.
- Sleep disorders including obstructive sleep apnea and narcolepsy.
- Psychiatric disorders such as acute psychosis, schizophrenia, personality disorders, depression, bipolar disorder, anxiety disorders, and psychotic episodes.
- Loss of visual functions such as depth perception and contrast sensitivity.
- Certain cardiovascular diseases.
- Patients who have suffered a stroke or brain injury.
- Patients with Cushing's disease with muscle weakness.
- Gross obesity.
- Musculoskeletal diseases.
Who has final say over whether or not I can drive?
Once a doctor has deemed a person unfit to drive, the licensing authority will render a final decision on whether that person should continue to be eligible to drive.
How long does a doctor's assessment stand for?
It varies for each condition. For example, in the case of a stroke, doctors generally advise patients not to drive for a month. Patients can begin driving when given appropriate treatment and assessed for motor, cognitive, perceptual and vision deficits. In the case of patients given antidepressants or antipsychotics, a doctor may initially recommend careful screening for drowsiness or hypotension.
At what age should I stop driving?
There is no set age that determines when a person should stop driving. Instead, drivers should consider how any medical conditions or impairments have affected their driving skills. The Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE) offers a list of questions to drivers and their families to determine whether they should continue driving.
Questions to the driver include:
- Have you noticed a change in your driving skills?
- Do others honk or show signs of irritation?
- Have you lost confidence in your driving ability, leading you to drive less often?
- Have others criticized your driving or refused to drive with you?
Family members wondering whether an elderly person should continue driving might want to consider whether they feel comfortable when that person is driving, as well as whether the person has exhibited abnormal behaviour behind the wheel or had recent accidents or traffic tickets.
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