Commentary: Here’s how seniors should assess their fitness for driving

SINGAPORE: Recent car accidents involving senior drivers in Singapore have stirred public discussion about whether the elderly should stop driving by a certain age or be subject to tighter regulations.
As our population ages, the issue of elderly drivers on our roads becomes more pressing. As a geriatrician, I see the complexities and nuances of this issue firsthand.
During my consult with Mr L, a 78-year-old retiree, I observed Mr L’s pride in his driving ability and his family’s anxiety about his safety. Mr L has been driving for over 50 years, and his car is a symbol of independence and freedom. It allows him to visit friends, attend community events, and maintain an independent, active lifestyle.
However, recent incidents have raised concerns among his family members about his driving skills. They noticed that he occasionally forgot routes to familiar places, missed turns or hesitated at intersections. These lapses made them worry for his safety and that of other road users.
Mr L’s daughter was hesitant to broach the subject, fearing it might upset him, but she felt it was essential to address these concerns. It was a delicate balance – respecting Mr L’s autonomy and acknowledging the legitimate safety issues related to his memory challenges.
There are several age-related conditions that can impair an elderly person’s ability to drive safely.
Visual impairments through macular degeneration, cataracts and glaucoma can make it difficult for seniors to see road signs, judge distances and drive at night. Hearing loss can hinder the ability to detect horns, sirens and other auditory signals.
Conditions such as arthritis, sarcopenia and general frailty can significantly impact an elderly individual’s ability to control a vehicle. These physical limitations can affect steering and braking, thereby compromising road safety.
In terms of cognitive abilities, dementia or other neuro-degenerative diseases can impair memory, judgment, planning, visuospatial abilities and reaction times, which are key components of safe driving.
Finally, many seniors may take medications that can cause drowsiness, dizziness or other side effects detrimental to driving.
In my experience, many elderly patients continue to drive without realising that age-related declines in vision, reaction time and cognitive function have made driving more challenging and riskier. It is only after a close call or an accident that the reality of these changes becomes apparent.
Seniors should carefully evaluate their driving experiences. Frequent instances of disorientation, increased anxiety while driving, or receiving multiple traffic violations are significant warning signs that should not be ignored.
Proactive self-assessment is crucial. Seniors can visit a registered General Practitioner or family physician who will evaluate their overall health, vision, hearing and cognitive abilities. Regular health check-ups can help detect health issues that might impair driving, while annual vision and hearing tests can ensure any impairments are addressed promptly.
Seniors could also consider taking driving refresher courses, which are tailored for seniors to update their driving skills and knowledge of current road regulations.
All holders of a qualified driving licence aged 65 years of above in Singapore must be certified fit to drive by a Singapore-registered medical practitioner for their license to remain valid. This certification must be renewed every three years.
For those licensed to operate heavy motor vehicles, certification must be completed annually and an additional proficient driving test result is required.
For those unsure about their driving abilities, several hospitals such as Tan Tock Seng Hospital offer comprehensive assessments that can offer valuable insights. These assessments require a doctor’s referral.
An off-road assessment involves tests to evaluate physical, cognitive and perceptual abilities, including reaction times and decision-making skills.
An on-road assessment takes place with a specialised driving instructor in a vehicle equipped with dual braking control. The instructor evaluates a senior’s driving in real traffic conditions, assessing their ability to follow traffic rules and respond to various driving scenarios.
Caregivers and family members play a critical role in monitoring an elderly driver’s fitness. Warning signs include frequent near-misses and unexplained dents and scratches to the car.
Sudden behavioral changes, such as driving too slowly, stopping abruptly or ignoring traffic signals, are red flags. Getting lost on familiar routes or mixing up locations are also serious concerns.
Losing the ability to drive can significantly impact an elderly person’s quality of life and lead to feelings of isolation and dependency.  It is vital to approach this issue with sensitivity and empathy, offering support and alternatives to help maintain a senior’s independence as much as possible.
First, choose the right time and place. A calm, private setting is ideal.
Express concern, not criticism. Frame the conversation around their safety and well-being. Provide evidence by gently mentioning specific incidents as reasons for concern.
Next, suggest alternative transportation options, such as family carpooling, public transport, or ride-sharing services.
Finally, offer to seek professional advice for your senior loved one. A healthcare professional’s objective assessment can support the discussion.
After a candid conversation with Mr L and his family, we explored alternatives that would allow him to maintain his active lifestyle without compromising safety. We discussed community transport options and Mr L’s family also offered to drive him to his social engagements, creating opportunities for more quality time together.
Coincidentally, Mr L’s Certificate of Entitlement (COE) was due for renewal. Recognising this as an opportune moment, Mr L made the difficult but wise decision to give up his car. With these supportive measures in place, he found that he could still enjoy his independence and stay connected with his community, while his family felt reassured about his safety.
It is crucial to remember that driving is a privilege, accompanied by the responsibility to ensure one is fit to drive safely. For seniors, this means regularly assessing their health and driving abilities, and being open to conversations about when it might be time to stop driving.
For those with senior loved ones, understanding the conditions that affect elderly drivers, encouraging proactive self-assessment, and being supportive in these discussions are essential steps.
By doing so, we can help keep our roads safe while maintaining the dignity and well-being of our elderly population.
Dr Claudia Koh is Senior Consultant in Geriatric Medicine at Khoo Teck Puat Hospital.