Elderly driver safety in Switzerland – current reality and future perspectives VII. International Conference on European Traffic Policies, 10th & 11th of November 2016, Barcelona Uwe Ewert, PhD MPH u.ewert@bfu.ch www.bfu.ch

Structure Traffic participation and accidents Traffic-related medical problems Current reality: mandatory medical examination Future perspectives: improved medical examination, self-assessment, additional measures Conclusion Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Number of elderly drivers will increase Number of elderly will increase by more than 50% until 2035 Percentage in the total population will increase from 18 to 26% Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Number of elderly drivers will increase Licence possession rates will increase Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Number of elderly drivers will increase Kilometers driven is and will be increasing Kilometers driven per day by those who do drive (Census by FOS) Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Traffic participation of the elderly People aged 65 and older will increase Driving licence possession will increase particularly in women and the very old Kilometrage of the elderly is increasing and will increase further but is currently much less than that of the adults: -55% when aged 65-79 -85% when aged 80+ There will be more elderly car drivers on the roads – in percent as well as in absolute numbers What about the accidents and injuries? Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Percent killed by age Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Percent seriously injured by age Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Development over time The number of fatalities and severely injured in crashes with older car drivers is Decreasing in absolute numbers Increasing in percent Relative importance is increasing Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatalities in older car drivers crashes Ø 2011-2014 Killed All road fatalities 100 % A Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatalities in older car drivers crashes Ø 2011-2014 Killed Elderly car driver involved in crash 16 % All road fatalities 100 % A Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatalities in older car drivers crashes Ø 2011-2014 Killed Elderly car driver involved in crash 16 % Elderly car driver at-fault 13 % All road fatalities 100 % A Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatalities in older car drivers crashes Ø 2011-2014 Killed Elderly car driver involved in crash 16 % Elderly car driver at-fault 13 % Killed: elderly at-fault car driver 8 % All road fatalities 100 % A Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatalities in older car drivers crashes Ø 2011-2014 Killed Elderly car driver involved in crash 16 % Elderly car driver at-fault 13 % Killed: elderly at-fault car driver 8 % Killed: other person 5 % All road fatalities 100 % A Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatalities in older car drivers crashes Ø 2011-2014 Killed Elderly car driver involved in crash 16 % Elderly car driver at-fault 13 % Killed: elderly at-fault car driver 8 % Killed: other person 5 % All road fatalities 100 % A Elderly car drivers cause about 13% of all fatalities. 8 percent are the elderly at-fault drivers themselves 5 percent are other victims Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Traffic-related medical problems of the elderly Visual-cognitive age-related changes Worsening of executive functioning Reduced flexibility (neck rotation, upper and lower extremities) Dementia Obstructive sleep apnea syndrome (OSAS) Diabetes (hypoglycemia) Cardiovascular diseases (syncopes - temporary unconsciousness) Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Traffic-related diseases/conditions of the elderly Many diseases can be treated at least symptomatically Visual-cognitive age-related changes - can be trained Worsening of executive functioning - can be trained Power and flexibility - can be trained Dementia – can hardly be treated, but general decrease of age-related incidence in several western countries Obstructive sleep apnea syndrome (OSAS) - Continuous positive airway pressure therapy (70% of patients) Diabetes (hypoglycemia) – medication, insulinotherapy Cardiovascular diseases (syncopes - temporary unconsciousness) – Canadian assessment system Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Current reality in Switzerland Mandatory screening system beginning at age 70 Repeated every two years Conducted by family practitioner Check whether medical minimum criteria are fulfilled Criteria only roughly defined Physician makes a recommendation Form is returned to road office Road office decides definitely Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Medical screening in Europe (source: ConSol) Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatality rate of pedestrians per mio inhabitants (source: IRTAD) Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Fatality rate of car occupants per mio inhabitants (source: IRTAD) Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Future perspectives Medical examination should be focussed on medical conditions with increased crash risk and substantial prevalence: - alcohol and drug dependence - cardiovascular disorders - dementia - epilepsy - sleep apnoea - cataract - depression Better education of physicians for the application of screening tests like the Mini Mental State Examination: - Avoid unnecessary tests - Consider the possibility of False Positive results Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Future perspectives Improvement of the medical examination: Less selection (licence withdrawal) More support with therapy, medication, adjuvants Evaluation of the new rules Self-assessment instruments: 2 different types Raising driver awareness Measuring maximum performance Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Self-assessment Voluntarily, own pace, less stress and anxiety Self-selection of persons doing the tests Potential biases - self-report bias - self-enhancement bias No systematic research on the effect of self-assessments on traffic safety Only complementary to other measures Swiss Council for Accident Prevention will develop ond implement a self-assessment tool. Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Additional measures Apart from the medical examination and self-assessements, the following additional measures exist: Adapted crash test dummies and crash tests to dealt with the frailty of the elderly Advanced driver assistance systems for the crashes typical for the elderly: - intersection assist - parking assist - emergency brake assist - Lane keeping and lande departure assist Acceptance of ADAS is higher among the elderly than the other drivers Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Additional measures Apart from the medical examination and self-assessements, the following additional measures exist: Several medications correlate with a higher crash risk - the risk of the disease alone is mostly higher than the risk of disease plus medication - most dangerous: sedative medication, hypnotics with long half-life - problem: no litigable threshold values Pictograms on medication packages (like in France) Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016

Conclusion Mobility is an important goal to keept the quality of life and the mental health of the elderly Equally so is the safety of all road users The delayed but especially the premature driving licence cessation should be avoided on a sound scientific basis Elderly driver safety in Switzerland, Ewert 10th/11th of November 2016