A wheel dilemma: should you be on or off the road?

The medical fitness to drive guidelines were updated in 2022 by the Road Safety Authority of Ireland, (RSA) and the National Office for Traffic Medicine at the Royal College of Physicians of Ireland (RCPI) but what changes were made?

The biggest one was the rise in the age of routine medical certification of drivers. Prior to February 2022 any driver who reached the age of 70 had to be medically assessed before getting their licence renewed. That has now changed to 75. Drivers under 75 will no longer have to supply a medical report confirming their fitness to drive unless they have an identified or specified illness or are required to do so by law.

This follows research in jurisdictions where they don’t have routine medical certification for older drivers. The research showed that lower numbers of older people died in traffic accidents. Professor Des O’Neill, consultant physician in geriatric and stroke medicine in Tallaght University Hospital is also programme director of the National Office for Traffic Medicine and he supports the change.

“This change is welcome in terms of recognising that older drivers are an exceptionally responsible group of drivers. In addition, the change is supported by international research indicating that routine medical screening of older drivers is not only ineffective but may actually unintentionally increase injury and death among older people as pedestrians.”

The changes related to medical fitness to drive have been supported by an updated National Driver Licence Service (NDLS) information leaflet on medical assessment for fitness to drive. This is available for download on the NDLS website and is aimed at the general public as well as GPs, occupational therapists and public health professionals who have to decide on a person’s fitness to drive.

why you need to be healthy to drive

But why is health important for drivers? Your health is important, as driving any motor vehicle requires:

Driver responsibilities

As drivers we have to take responsibility in relation to our fitness to drive. The bottom line is that you don’t just have to stop driving if your doctor says so. You have to stop if you know yourself you are having problems that impact your driving. This is what you are expected to do:

Health professionals responsibilties

Health professionals also have obligations around deciding on patients’ fitness to drive.

Difficult subject

Being told that you can’t drive can be unwelcome news for patients and one that can be taken badly. ‘GP shopping’ was known to take place in the past where patients left their GP practice and signed up with another in the hope that driving will be permitted. New guidelines to support GPs now include a question about how long a person has been with their GP practice. The guidelines for GPs are to carry out a very thorough examination of the patient and to seek their medical file from their previous doctor.

While doctors have an ethical obligation and potentially a legal one to give clear advice to drivers in cases where an illness or injury may increase their risk of impairment while driving they often describe telling patients that they can’t drive as “an emotionally charged task” and consider themselves as “reluctant regulators”.

GPs recognise that restricting people’s driving or telling them to cease driving is a significant event that can have psychological and social consequences for the patient.

Doctors and the Road Safety Authority are sensitive to the fact that there is a delicate balance between ensuring safety of other road users while at the same time not unnecessarily or unjustifiably taking people off the road, the NDLS states.

In fact, if your GP is unsure as to what level your medical condition or disability impacts your driving ability, they can refer you for a driving assessment and then the results of that will dictate whether you can continue driving. For more information, visit https://ddai.ie/driver-assessment-and-instruction/130-driving-assessment.

Need to talk ahead of time

Many people intuitively restrict their driving as they get older – perhaps not driving at night or not driving long distances anymore. However, everyone needs to think ahead of time about the point where it is no longer safe for them to drive and where they will need to identify alternatives. This way, discussions won’t be so fraught when the situation arises down the line.

Farmers - note on fitness to drive tractors/farm vehicles.

The group one licence category includes category W covering tractors used in agriculture and forestry. The task of driving a tractor either on the road, on the farm or in forestry is complex in terms of the skills required for controlling the vehicle and managing challenging driving environments, says the NDLS.

“For these reasons, it is especially important that tractor drivers monitor and manage their health, adhere to prescribed medication and consult their doctor if they notice any changes in their medical condition. Some due consideration should be given to the complexity of the driving task if it involves large trailers or farm equipment, or large vehicles such as combine harvesters.”

Epilepsy, diabetes, cardiovascular issues and strokes are among many of the medical conditions that can affect a person’s ability to drive.

Note: more stringent rules apply for group two drivers (buses and trucks) than for group one drivers (cars, motorcycles and work vehicles) because of the higher standard of physical and mental fitness required.

Epilepsy

Epileptic attacks are the most frequent medical cause of collapse at the wheel. Drivers must notify the NDLS if they are diagnosed with epilepsy and they are not permitted to drive until they are a year free of seizures.

TIAs

The rules around TIAs (transischemic attacks (mini strokes) are less strict than they were. If you have a TIA you are not permitted to drive for one week and you don’t have to inform the NDLS.

Stroke

If you have a stroke you are not permitted to drive for four weeks provided your clinical recovery is satisfactory. You don’t need to inform the NDLS unless there is significant residual neurological deficit four weeks after the episode.

Angina

You are not permitted to drive when angina symptoms occur at rest, with emotion, or at the wheel. Drivers should notify NDLS. Those affected are permitted to drive provided satisfactory symptom control is achieved.

Diabetes mellitus

Driving is permitted as long as the condition is controlled and the person is under medical supervision and educated about the dangers of hypoglycaemia (low blood sugar). Symptoms of hypoglycaemia can include dizziness and difficulty concentrating.

Psychiatric conditions

A person with certain psychiatric conditions is not permitted to drive during an acute attack, eg mania. The decision about driving is based on medical assessment. Side effects of medication are also taken into account when the decision about driving is made.

Dementia

The person’s ability to drive is medically assessed and monitored regularly.

Vision

Any conditions likely to cause progressive loss of vision must be reported to the NDLS. This includes, but is not limited to, macular degeneration, glaucoma, retinitis pigmentosa, and diabetic retinopathy, vision limited to one eye (monocular vision) and double vision.

Sleep disorders

The NDLS should be informed if you have conditions like narcolepsy or sleep apnoea which may cause you to fall asleep during daytime.

Further information

Full details of all these conditions and more are available on the National Driver Licence Service (NDLS) website where you can also find leaflets related to individual medical conditions including driving during pregnancy at www.ndls.ie

It is your responsibility as a driver to:

Group one licence holders: Cars, motorcycles and works vehicles – licenced for

up to 10 years.

Group two licence holders: Buses and trucks – licensed for up

to five years.

Read more

Long COVID - the road to recovery

Living well with a chronic condition