1. MEDRIL workshop 2: The medical condition of the category B driving population Hotel Eurovillage, Brussels 25 November 2005 MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

2. MEDRIL Objectives 1.Survey of medical condition of the category B driving population 2.Design of a medical screening test for category B drivers / periodicity of testing 3.Analyse the benefits of practical (on-road) fitness-to-drive assessments for drivers with ‘borderline’ medical problems MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

3. Medical survey (and screening test form) Objective of survey: 10000 medical tests in Finland, Spain, Luxembourg & the Netherlands Using a standardised medical form To be carried out by the relevant doctor in each country (GP, specialist centre) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

4. Why Finland, Spain, Luxembourg & NL? = Testing at different ages, with different procedures and methods Spain: every 10 yrs until the age of 45, every 5 years until 70, every two years from 70 Luxembourg: every 10 yrs for 50-70 yrs old, 70+ = every 3 yrs, 80+ = every year Finland: eyetest at 45, medical exam every 5 yrs from 70+ (AND reporting requirement of GP) Netherlands: Testing from 70+, ever 5 years. Personal declaration plus medical certificate from GP. MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

5. MEDRIL test form (anonymous)

6. Content of MEDRIL test form 1.Personal data (age, sex, residence, education, living alone/with a partner) 2.Medical history / anamnesis (diseases, impairments, medication, alcohol consumption, health problems) 3.Medical test (visual acuity/field, blood pressure, strength, balance & reflexes, cognitive impairment, etc) Accompanied by guidelines for practitioners (target group, methods, thresholds…) Forms filled out at the same time as normal medical testing for category B drivers in country in question MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

7. Difficulties in achieving samples Difficult to convince GPs to take part. 10 minutes is a long time for a doctor! Problems related to payment of doctors Small number of drivers visiting individual GPs for medical testing Exception: Spain. ASECEMP = network of specialised medical testing centres for drivers MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

8. MEDRIL: final samples MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 Finland:260 (2000) drivers between 65-89 Spain:4026 (4000) drivers between 20 and 89 Luxembourg:345 (1000) drivers between 45 and 94 Netherlands:425 (3000) drivers between 65 and 94 (XXXX) = original objective

9. MEDRIL: final sample MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 n. = 5056

10. Tests for representativeness Samples were tested for representativeness of the category B population in each respective country (distribution of age and sex) Only Finland was found to be ~representative Other samples (ESP, NL, LUX) were statistically re- weighted (performed by Traffic Test, NL) Samples are now representative, in terms of age and sex distribution, of category B populations. MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

11. Results per country MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

12. Results: FINLAND

13. Results: SPAIN

14. Results: LUXEMBOURG

15. Results: NETHERLANDS

16. Results per medical condition MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

17. Abnormal visual acuity MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

18. Abnormal visual acuity (2) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

19. Visual acuity: comparative data Visual impairments in elderly European drivers study (A, B, D, ESP, NL): 5,3% of 75+ age category failed the 0.5 requirement (best corrected acuity in best eye). MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

20. Restricted visual field MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

21. Restricted visual field: comparative data Visual impairments in elderly European drivers study (A, B, D, ESP, NL): 2,7% of over 75 year olds unsuited; 2,4% questionnable MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

22. Problems with night vision (‘glare’) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

23. Problems with night vision (2) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

24. Glare / stray light: comparative data MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 Visual impairments in elderly European drivers study (A, B, D, ESP, NL): 29.5% of over 75 yr olds have stray light of 1.4+

25. High blood pressure MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

26. Cardio-vascular disease MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

27. Cardio-vascular: comparative data MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 Source: RIVM (NL)

28. Neurological problems MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

29. Neurological: comparative data Netherlands (Prevalence of diseases in the Netherlands, 1996): 6-10% of 80+ category suffer strokes Finland (Health 2000 data): 9,6% of men and 6,7% of women over 65 have suffered strokes MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

30. Mental health MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

31. Mental health: anti-depressants MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

32. Depression: comparative data MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 Source: Health 2000 report FINLAND 30-4445-5455-6465-7475-8485+ Male (%) 4,24,72,90,91,70 Female (%) 8,87,25,93,21,81,4 AWMF (Germany): 2-7% of the population require treatment as a result of severe depression.

33. Alcohol consumption / abuse MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

34. Alcohol consumption (3): do you consume 6 or more portions of alcohol daily or almost daily? MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 0%

35. Alcohol abuse: comparative data Approximately 12% of European adults consume alcohol at harmful levels, defined as 40g of alcohol or more per day for men and 20g of alcohol or more for women (10mg = 1 portion of alcohol) Source: PHEPA Project. European clinical guidelines on the management of alcohol problems in primary care. MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

36. Male / female alcohol consumption (NL) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

37. Medication MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

38. Medication: analgesics MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

39. Medication: sedatives MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

40. Medication: narcoleptics MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

41. Medication: hypnotics MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

42. Medicine: comparative data (LEHO) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 LEHO project (2003-2005)

43. Medicine: comparative data (2) Psycho-active medicines are consumed particularly in 50+ age category of women (IMMORTAL project, WP4.2), and men in early retirement (IMMORTAL, Danish study) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

44. Male / female consumption of psycho-active medicines MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

45. Sleeping disorders MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

46. Sleeping disorders: comparative data High prevalence among middle-aged men (4-5 %) – sleep apnoea Narcolepsy: prevalence 1 in 2000 Source: Institute of Transport Economics, Norway MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

47. Epilepsy MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

48. Epilepsy: comparative data “The prevalence of active epilepsy in the adult population is 4 to 10 in 1000 people (Hauser et al. 1996; Goodridge et al. 1983). For the European union we assumed a value of 6 in 1000. Of these patients, a substantial number hold a drivers licence (Sonnen 1995).” Source: Epilepsy working group of the EU Driving Licence Committee MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

49. Diabetes MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

50. Diabetes: comparative data Source: Prevalence of disease in the Netherlands, 2003 (types 1 and 2) MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

51. Strength, reflexes, balance MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

52. Mild cognitive impairment MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 *SPAIN: Serious dementia was found in one case (77 year old). Spain also had 1 moderate to serious case (72 yrs) and 2 moderate cases (71 and 76). NETHERLANDS: The Netherlands results show 4 cases of moderate dementia (70, 71, 74 and 86 years old) and no cases worse than that. FINLAND: no cases of moderate or serious dementia LUXEMBOURG: 1 case for both serious dementia and moderate-serious dementia were found in Luxembourg (77 and 81 years old respectively).

53. Comparative data: dementia MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006 Source: RIVM (NL), 1996

54. Criticism of mini-mental test Over-emphasis on memory-related tasks – relevance to driving ability? Lack of sensitivity: results may under- estimate the problem. Other tests may be more pertinent BUT test was carried out in a uniform manner from country to country so results are quite comparable. MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006

55. Conclusions 1.Small samples, representative data nevertheless 2.An idea of prevalence of certain health problems in the driving population 3.Most MEDRIL impairment data is supported by comparative data (mainly from general population) 4.Many conditions increase with age 5.BUT little idea of gravity of condition in each individual case, little idea of co-morbidity nor potential for progression (if relevant) or risk factor burden. 6.AND fitness to drive should not always depend on a medical diagnosis but rather on the functional consequences of the illness. MEDRIL MEDical testing for the DRIving Licence EU project 2003-2006