1. 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

2. 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

3. 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

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

5. 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

6. 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 % 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

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

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

9. 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

10. Fatalities in older car drivers crashesØ
Killed
All road fatalities
100 % A
Elderly driver safety in Switzerland, Ewert
10th/11th of November 2016

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

12. Fatalities in older car drivers crashesØ
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

13. Fatalities in older car drivers crashesØ
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

14. Fatalities in older car drivers crashesØ
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

15. Fatalities in older car drivers crashesØ
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

16. 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

17. 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

18. 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

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

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

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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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