Driving is something Albertans love doing and if that privilege is taken away it can be a devastating experience.
Taking away a senior’s licence has become a contentious issue and determining their ability to drive is also a challenge. It causes enough concern that Ponoka doctors did not want to comment on the issue as they felt it would negatively affect their business.
The issue was even raised on 630 CHED’s Rutherford Show. A test called the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a Modification of the DemTect (Simard MD) — developed by Dr. Bonnie Dobbs and Dr. Donald Schopflocher of the Medically At-Risk Driver Centre — is used by physicians to determine if a patient needs to be referred to DriveABLE for further testing.
DriveABLE is a private company that provides on-road and in-office testing for different clients. It has developed a visual test for patients who failed the Simard MD. Questions of the validity of the Simard MD test and DriveABLE have surfaced as advocates for seniors feel it causes them undue hardship. A test is an out-of-pocket expense of approximately $250.
James Nakoneshny, an advocate for seniors, feels the Simard MD test is unreliable. He questions the relationship of Simard MD to DriveABLE as Dr. Allen Dobbs, who developed DriveABLE, is Dr. Bonnie Dobbs’ husband.
“They know there’s a lot of money to be made,” said Nakoneshny. The authors state in the Journal of Primary Care and Community Health the Simard MD was developed to assist physicians “identify medically at-risk driver, but are hampered by the lack of a valid, easy to administer screening tool.”
Although it can used for any patient, the publication identifies there is going to be an increase in the next 30 years of the number of drivers with cognitive impairment “due to dementia or other age-associated pathologies.”
Nakoneshny’s concern is about the process.
“It’s not all bad, it’s not all gloom and doom. It’s how it’s being done and if you’re going to do it, do it for everyone then.”
Other tests available to patients: Dr. Michel Bédard, a researcher with the Canadian Institute of Health Research (CIHR) said the Simard MD test is not the only one available to physicians to administer to patients.
Researchers have not found what he calls the “Holy Grail” of tests.
“The Simard test is actually one test that has been marketed as achieving that goal. Actually our research group and others have demonstrated that it doesn’t have sufficient properties to be used in the way it’s proposed.”
“In this case there was only one study done with lots of limitations,” Bédard said.
“I think that’s one of the problems is that suddenly this thing is being promoted around.” He believes there are false positives and false negatives in the test and some people who are able to drive lose their licence and there are also those who are “not safe to drive and they continue to drive.”
There is also a large amount of people in what he calls a grey area and they must continue with other testing. This can be stressful and costly, he explained and he feels it is too early to tell whether the test is reliable.
Since most provinces require family physicians to determine if their patients are able to drive, which can cause issues.
“Many of them don’t want to do it because it jeopardizes the relationship with the patient. It’s a very difficult situation,” he said.
He suggests one of the better approaches is for a family doctor to refer patients to a specialized occupational therapist, especially one with driver training, who can conduct a full test of a person’s ability. For those grey areas he feels this is the best option.
“Until we find something that’s better.”
There are other cognitive tests available but Bédard feels they are as undetermined as the Simard MD test. DriveABLE poses another challenge because it is harder to test since it is a privately owned business.
“From a company point of view it’s reasonable but from a research point of view we can’t look at the data and see how good it is.”
The doctors face a challenge by being the ones who say a senior cannot drive and Bédard knows of some doctors who refuse to test their patient because of the conflict it can cause.
“We know that giving away the keys is one of the most traumatic type of situations in someone’s life. It’s affecting the patients. Some people increase in depression symptoms,” he stated.
“Then there’s the whole family aspect.”
Families must then determine who can drive the patient where they need to go. In a rural community this can affect the whole family.
“Putting physicians in this position, especially if you talk about a small town and if somebody may be someone’s physician for more than 30 or 40 years. It’s incredibly difficult,” said Bédard. He believes there is not enough support for those who cannot drive anymore and suggests evaluating all the pieces of the puzzle, including a physician’s relationship to their patient.
There is a flipside to this situation; “If people start to perceive that by going to their physician they’re going to lose their licence.” Physicians should be able to advocate for their patients without fear they will not return for checkups.
He believes the real issue is not one of age but of bad drivers and continuing research must be conducted to determine pros and cons of a test.
“As we identify the driver we also have to find ways to kind of remediate and possibly to help them remain on the road,” said Bédard.
“How do we continue to help them drive safely?” Alberta Transportation’s role with seniors licencing Trent Bancarz, spokesman for Alberta Transportation, said elderly drivers are not required to take the Simard MD or DriveABLE test but physicians are required to ensure their patients’ ability to drive.
Patients who reach the age of 75 in Alberta are required to undergo a medical exam before they renew their licence. They will take it again at 80 years old and every two years after.
“A physician is under no obligation to disclose if someone has a potential inability to drive,” stated Bancarz. He did say a physician is not under any legal obligation to notify Alberta Transportation of any issues unless they are specifically evaluating a patient on their driving ability and conducting a test.
“You’re legally obligated to report it, if it can affect your driving.”
Since the Department of Transportation does not conduct cognitive testing as a way of further evaluation, the Simard MD test is one of the tools doctors can use to assess a patient’s cognitive ability but Bancarz was unsure of others. He is also unsure if there is another test besides DriveABLE after being referred by a doctor.
Any decisions by the Registrar of Motor Vehicles to revoke a person’s licence can be appealed through the Alberta Transportation Safety Board.
“Basically there are avenues available to people,” Bancarz said.
Physicians can also recommend a driving road test for a patient besides Simard MD and DriveABLE. Alberta Transportation does not require a person to take the test and leaves it to the physician to determine whether the patient is fit. He did say individual circumstances might determine restrictions for a driver.
There are many cases of people being allowed to drive during the day but not at night, or in-town only but not on the highway, he stated.
Taking the Simard MD test is not mandatory for a patient but at some point a senior is going to have to undergo a test. The ultimate decision falls on the doctor, however. “It would be up to the doctor. I guess somebody could refuse and then the doctor could refuse to sign their form so that they can’t get their licence,” stated Bancarz.
The Simard MD test is used in parts of Canada, the United States and in other parts of the world such as New Zealand and Australia, and DriveABLE can be found in many parts of the world as well. More information on the Simard MD can be found at www.mard.ualberta. ca/en/SIMARDMD.aspx and more information on DriveABLE can be found at www.driveable. com.