Cognitive Testing of Older Drivers

Senior DriverI am often asked about driver testing, particularly now that some older drivers are being given cognitive testing as part of the mandatory medical evaluation at and after age 80. This is called the SIMARD test and was developed at the University of Alberta in Edmonton. It allows the doctor or their medical staff to quickly and accurately identify people who are having cognitive difficulty that would compromise safe driving.

The first of four parts has the examiner slowly read a list of ten words to the subject. When all the words have been read, the person is asked to repeat as many of those words, in any order. Once completed, the task is done for a second time using the same word list.

Part two is a number conversion exercise. The subject is given a sheet of paper with a column of numbers and asked to write the numbers in words. An example of the task is seeing the number 5 and writing the word five.

The third challenge is to name as many items as possible that are sold in a supermarket within one minute. The maximum score is achieved by mentioning 30 distinct items.

Finally, we return to the word list in part one for the final test. The subject is asked to recall as many of the words read to them in part one as they are able to.

While this may seem trivial to you and me, it gives the medical examiner a proven yardstick to apply to their patients and fairly assess the driver. Many people are able to mask cognitive impairment during a routine medical visit and the SIMARD test helps the doctor be confident of their decision whether or not to recommend further testing and possible driving sanctions.

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Comments

There is some interesting commentary ...

This is a very complex subject, on a topic that's of interest to many.

Old Drivers

While I agree that over the age of 80 this should happen, I don't agree with the fact that they have to pay for it! Most people in their retirement don't have a lot of extra at the end of the day and now they have to shell out $80-$200 for a test, just to keep their drivers license?

C'mon! The system is broken! Let them have the test for free.! They still have to pay to have their license renewed anyways!!!

It's just Sad!!!

 

It ain't necessarily so.

To be clear, turning 80 doesn't force anybody to do anything more than have their physician complete a Motor Vehicle Medical Exam; if there are no concerns about their physical or psychological abilities, they will be able to renew their license just like that.

Furthermore, seniors (65+) are able to get their Class 5 Re-Exam for free, so provided this option is available to them then there's no cause for them to have to pay $80 - $200 for a test (though I believe the DriveABLE examination is closer to $300, should they choose to undergo that in response to concerns about cognitive ability).

And as for having to pay to have their license renewed, they get a great deal on that - $17 rather than $75 for a five-year renewal which is what the rest of us would have to pay.

Incidentally, if a senior opts to surrender their driving license, ICBC will cheerfully provide them with a BCID card instead.  And, there's no charge for this.

So maybe the system isn't as broken as you think?

Cognitive testing of Older Drivers

An interesting concept-

Testing short term memory for an ability in a long term memory skill-questionable at best, somewhat like asking your doctor for help with a mechanical problem with your car-ha!   

Second point--how the ability to talk fast is related to your ability to drive? Most of the con men I have met were very fast talkers--Makes them better drivers????

Third point--how removing lightly productive members of society and putting them in the position of being fully dependent --gains society in what way?? The members are belittled - the net cost to society goes up exponentially--the gain???????????? I feel that it is discrimination at its' very worst and few raise the eyebrows-let alone their voices.

Just a humble opinion

Independence vs safety is the real issue.

Third point--how removing lightly productive members of society and putting them in the position of being fully dependent --gains society in what way?? The members are belittled - the net cost to society goes up exponentially--the gain???????????? I feel that it is discrimination at its' very worst and few raise the eyebrows-let alone their voices.

I suspect that you're not understanding the issue, here.  Same goes for many. But there isn't any desire on the part of the licensing authorities (ICBC, in this jurisdiction, but this issue is almost universal in the developed world) to remove the driving privilege from old folks.  There is, however, a responsibility to ascertain whether drivers are entitled to their license - and this can change with the passage of time; if it were otherwise, then 5 year old children could apply for one.

As I would see it, the 'problem' is this: at some point in time, one of two things is going to happen to every driver:

  • They will die.
  • They will become incapable of operating a motor vehicle safely.

This applies to you, me, our site host, everybody reading this, it is universal.

Accepting that the death thing pretty much makes this discussion redundant, then it's going to be either a physical or pyschological ailment that renders a driver incapable or incompetent.

At one time in human history, and probably not that long ago, physical ailments would have been sufficiently predominant amongst older folks in general as to render this problem moot.  But these days, in our society at least, people live longer.  And longer.  There is much greater potential, due to the mental issues with cognitive awareness, for a person to be able to get behind the wheel of their automobile and drive it, even though their brain is no longer able to govern and process this mental task load.

I'm not saying that the cognitive testing that's being used (as an alternative to a regularly structured Class 5 Road Test by an ICBC Driver Examiner) is perfect; but then, neither is the fundamental Class 7 N test that's required for a first time driver.

But the criteria, the rationale, for these tests are entirely different.  And if a senior has reached the point (unbeknownst to them) where they're no longer capable of processing the task of driving, then much better they be removed from being behind the wheel than make some cognitive error that results in death or injury; to themselves, to you, to me, or maybe to our children.

That's what this is about; that's what the net gain to society may be.

The Simard Test

I would like to add my two bits worth on this topic, as I am approaching 80.

Regarding the test:

Language:  Does the test have to be in English? Can it be in any language of choice? If not, why not? Are we required to be fluent in English in order to drive a car in our old age?  (Does the charter of rights apply here?)

I have a number of elderly friends who have never mastered English, and they are likely to stumble on the test for this reason.

Memory test on 10 words: I have always had a problem remembering words, particularly names. Sometimes to embarrasment. However, I have a propensity for remembering numbers with considerable ease, such as telephone numbers. Accordingly, I could potentially fail this part of the test. This condition has not prevented me from working successfully for 50 yrs, or driving my car without accidents. So, why not allow a choice of say words or numbers?  What is so definitive about words? What is wrong with using 10 numbers?

Listing 30 items purchasable from a super market, and under 1 minute:  let's take the case of my brother, approaching 80. He has never shopped for groceries in his life, let alone done any cooking at home. This doesn't suggest that he doesn't know what a tomato is, or a potato, but my guess is that, confronted with a 1 minute time factor, he would probably get as far as bread, eggs and bacon, and butter..sugar, tea and milk (which kind of summarizes his meals). So, what is so unique about this part of the test, or perhaps is this simply a very unfair test. My brother has worked all his life and driven without accidents.

I think the Simard test is palpably wrong. It emmanated from a university husband and wife team, as a nice side line business, and the university backdrop is taken by the provinces as being gospel, or perhaps it removes the onus from their shoulders when it comes to dealing with elderly drivers.  But don't get me wrong. Yes, as we get older, driving a car has significant liabilities for us seniors. And we need to stop driving when the time is right. For me, the Simard test is not a good way to weed out seniors, as exampled above. I am keeping my fingers crossed that my doctor will find me fit and capable to continue driving when I hit 80 and thus not have to take the Simard test.

I rest my case, and look forward to any replies or comments

SIMARD-MD is Faulty

I have just read your comments on the virtues of the Simard MD dementia test, and was surprised that you condone it. It is known by all of the experts to be faulty and those that contrived it, admit to only being at best 50% accurate. There is no known dementia test that is excepted as accurate enough to make definitive judgements, and the Simard is responsible for removing many licences of elder drivers unfairly.

ICBC Road Testing changes.

This post has nothing to do with the Simard test -  or any other cognitive testing (such as DriveABLE computer testing), but I think it's probably relevant when it comes to the alternatives available to seniors.

Incidentally, during my career I have conducted several thousand Road Tests; many as a supplementary Driver Examiner for ICBC, some as a Training Assessment Officer for private industry (Driving Instructor trainees and Class 4 trainees), some as a DriveABLE Examiner, others as a contract evaluator under the auspices of the then OSMV aka Road Safe BC.

Thanks to an initiative launched by (now retired) Blair Grant, ICBC Regional Manager (Licensing), a new Class 5 Senior's Road Test examination form is in use. And the format is the same old demerit points system as most of us who took a test in BC encountered, except that the number of demerits assigned for any error is only 5, there are no 10-pointers.

Easy to understand (far better than the Class 5/7 being used for new drivers, and those from none-reciprocal jurisdictions) but effective none the less in removing those who are no longer competent; whilst providing clear information on the areas where they need to improve, should they be inclined.

Just so you know.

 

Update?

Is this still the case?

My grandma is turning 80 and she is asking me to find out what she will need to do. 

Could you let me know the steps. 

It seems like you are saying she needs to go to her doctor and ask for a medical exam to prove she is fit to drive.

That should be all that is needed unless the medical exam isn't great, in that case she needs to pass a Simard test?

The DMER

This article is simply an explanation of one test that doctors in BC use to help determine the cognitive ability of their patients in connection with an examination of their ability to drive a motor vehicle.

That examination, a Driver's Medical Examination Report (DMER), is sent to licensed BC drivers by RoadSafetyBC at age 80 and every two years after that unless there is an identified need for it to occur more often.

Based upon the DMER and other information such as traffic ticket history, collision history or unsolicitied driver fitness reports, RoadSafetyBC may choose to refer a driver to ICBC for an Enhanced Road Assessment or simply take action to limit or prohibit the person's ability to drive.

Driver Medical Examinations

Driver Medical Examinations are unconstitutional. According to BC's Human Rights Code..."no person over 19 years, may be discriminated against on the basis of age, in life, work or the delivery of services." If this were not enough, ICBC's own statistics show that seniors are the safest group of drivers on the road. The report "Proportion of Fatalities by Age Group and Contributing Factors -2015/2017": in the 16-45 Age Group, speeding and/or impairment were factors in 90% of fatalities, while distracted driving was a factor in 65% of fatalities. In the 65-plus Age Group the factors were just 5% and 25% respectively.

Furthermore, there is already in place a system to identify potentially dangerous drivers...the Demerit Point System. It applies to all motorists so there is no need to additionally target seniors.

These "examinations" have been criticized by many as having little to zero credibility in determining a person's ability to drive safely. Asking someone to identify a horse, rhinoceros and a camel, or count backwards from 100 by sevens is comical, not scientific. Time to end this abuse of seniors.

Unconstitutional? That's absurd.

There is no discrimination in requiring potential drivers (or potential gun owners, for that matter) to show that they are fit to be licensed.

Think about this, and what you're implying:

According to BC's Human Rights Code..."no person over 19 years, may be discriminated against on the basis of age, in life, work or the delivery of services." 

Because according to your logic, anybody who has reached their 19th birthday can simply drive. Why would you have to get a license? That would be discriminatory! Besides, getting that license shouldn't be necessary. My dad was driving his dad's grocery truck around Carlisle back in 1935, when he was 14 years old, and he did fine ...

Except ... in modern society, we've determined that drivers should in fact be licensed, and this automatically allows for preconditions. Things like checking eyesight, or whether you are prone to blackouts, or capable of cognitive thought.

And expecting to rely on police action (i.e. demerits) to rectify problems is absurd! Did you even read this week's column on Improving Everything Except Drivers? The police aren't remotely interested in being a part of getting bad drivers off the road.

But increasingly, and in tandem with the longevity that we enjoy these days, we are finding more and more seniors behind the wheel who are no longer cognitively able to operate a motor vehicle. So they have to lose their driver's licenses, to protect the rest of us. And our kids.

DMEs

Nobody is suggesting that a licence is not required. There is no discrimination when the law applies to everyone. However, once a person acquires that licence, it is discriminatory to target a particular age group for an invasive test that is supposed to determine mental acuity. Using the stats from ICBC, it could  be argued that the 16-45 age group - where 90% of fatalities involve speeding and/or impairment - should be subject to annual medical exams to get the recreational drug users off the road.

Others have pointed out the dubious efficacy of the Simard test. Counting backwards from 100 by sevens (try it) or remembering a string of unrelated words 20 minutes later has no relevance to driving ability. There is also the question of the fee. I was charged $135, but I know of some who paid $150 and another who was charged $225! With some 70,000 DMEs carried out each year, that represents more than $10 Million coming out of seniors' limited resources every year. 

I would be more than willing to undergo a legitimate driving test every 2 years after 80...and be judged accordingly. These tests are unconstitutional, invasive, costly and unnecessary.

You just aren't getting this, are you?

Let's consider some of your statements here.

There is no discrimination when the law applies to everyone.

Good. Because that's the situation here in BC. Nobody is allowed to obtain a license until they're at least 16 years old, and nobody is required to undergo a medical test until they've reached the age of 80*. And so long as their physician doesn't identify any physical or mental issues that are of concern, then they will be able to keep on keeping on doing what they're doing, including driving.

* Unless there is some particular concern about their driving ability, caused by a stroke, an elipeptic event, the loss of a limb, etc.

However, once a person acquires that licence, it is discriminatory to target a particular age.

Hold it a moment, there. Certainly, 'regular' drivers don't have to undergo a medical test of any kind until 80, but for commercial drivers this comes up frequently. As an example, I had to go through this process when I applied for my Class 3 license. In 1973, when I was 18. And this type of stringent requirement continues throughout their lives so long as they hold a commercial license. So any senior who wants to pretend that they're being targeted uniquely, on the basis of their age, is simply wrong.

Using the stats from ICBC, it could  be argued that the 16-45 age group - where 90% of fatalities involve speeding and/or impairment - should be subject to annual medical exams to get the recreational drug users off the road.

Irrelevant, and probably unconsitutional. Plus which, expecting every driver out there - including teachers, doctors, lawyers, politicians, website hosts, etc - to take an annual medical to prove ... what? That there are currently no traces of medication or alcohol in their system? How pointless is that? Besides, those same statistics these days provide strong indications that mobile phone use is now the leading trigger of fatal collisions. Needless to say, they don't have a medical measurement figured out for that, yet.

I would be more than willing to undergo a legitimate driving test every 2 years after 80...and be judged accordingly.

Good grief. What on earth would be the point in requiring drivers to demonstrate that the same fundamental skills (parking, turning, lane changing, etc) that they possessed several decades ago haven't somehow miraculously deserted them? If someone has been driving for sixty odd years, hasn't acquired a history of tickets and crashes, and has now managed to drive to the license office, then probably they 'know how to drive'.

But also, consider the arrogance of your position. When, at any time, do any of us undergoing a test of something (whether it involves educational knowledge, or ability to do a job of work, etc) get to stipulate the nature and content of the test? But apparently that's what you feel you're entitled to do!

----------------------------------------------

The licensing authorities - and it's not just ICBC / RSBC, this is a universal issue in the developed world, everywhere on the planet - have a responsibility to try and make the roads safer for everyone. And increasingly, the crash rate per kilometers driven is no longer confined to the youngest, most inexperienced drivers: the seniors are now competing (for want of a better word) with those in the 18 ~ 22 year old group for the number of crashes, and consequent injuries and damage being caused.

ICBC have tried in various ways to address this. At one time, turning 80 actually did trigger a requirement for a new Road Test (during which the Driver Examiners were expected to show a certain amount of 'discretion' about the errors observed, so long as the driver appeared to be driving safely). At one point, a whole new Road Test Results sheet was created for seniors re-taking the Class 5 test; it allowed up to 65 demerits (instead of 45) with no 10-demerit categories, only 5-demerit ones.  They did their utmost to make it easy for senior drivers to hold on to their license.

But, this wasn't addressing the problem. Also, I think it may well have been deemed unconstitutional under Rights & Freedoms, so fair enough.

So that's why RSBC (using ICBC as their tool) has introduced the Enhanced Road Assessment, in order to make the most obective judgment of whether a senior driver is still able to function safely in the driving environment. To the best of my knowledge, there's no charge for this.

So the smartest thing that seniors, as a group, can do is to lobby the BC Health Ministry for reduced cost (or free) medical assessments, in order to avoid the sometimes high costs being levied by General Practioners and Medical Clinics conducting a relatively simple driver medical exam for RSBC.

I've reached the targeted age

I've reached the targeted age group and have no problems with testing.

Don't have any stats to provide but I have a feeling that when you consider the klicks the older generation 80+ generally drive I'm sure the accident rate is not that great for kilometers driven.

One person I know recently sold his car and quit driving aften closing the garage door and then proceeded to reverse through the door. Put it into reverse instead of drive. Always backed in which is the safest way so that he was pulling forward onto the street. His thought was if he did it once good chance he would do it again.

The 'targeted age' is not a thing.

Let's put this into perspective. Because the first time I had to complete a Commercial Driver medical examination was 1973. When I was 18, and needed my Class 3 to drive a cement mixer. So actually, what are the requirements?

Medical stuff is all under the purview of RoadSafeBC (previously the OSMV). The requirements vary, based both on what you're driving and how old you have become. For Commercial Drivers, it's something they call Code W. And you know what? The older you get, the more frequently you have to do a medical! There is no 'targeted age group'. But being as I'm 66 and hold a Class 1, my doctor will now need to see me annually (unless I choose to give up my Commercial License, and then I don't need to do anything until 2035).

Which really isn't a problem. Because I'm 66 and choose to hold a Class 1, so it's necessary for me to go through an annual medical check. And why the heck wouldn't anybody want to see their doctor annually, anyway, especially if they're getting older, and yet wish to be given the responsibility to drive a Semi. Or a school bus, full of kids?

But I'll finish responding to Alan McPhee separately.

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