Thank you.
Madam Chair and committee members, it is a great pleasure and honour for me to present today. I thank you for this opportunity. I will make my presentation in English, but I would be happy to answer questions in either English or French.
The research I have been conducting aims to support older adults in enjoying independence and quality of life. Chronic diseases present a serious threat to this goal.
I would like to touch on two issues in relation to chronic diseases today. The first is caregiving and the second is driving.
The role of caregivers, who are typically family members, is becoming increasingly important as greater numbers of older adults remain in the community. There is recognition at various levels of government that seniors want to age in place. Yet it is difficult to imagine how strategies to support aging in place can be effective without a caregiving component. The longevity of many adults and the potential increase in the number of chronic diseases and disabilities they will experience mean that many children will end up caring for very old parents, even as they themselves progress well into their senior years.
It is well documented that caregiving creates considerable strain on a large segment of the population, but it is important to emphasize that a healthy caregiver is the best resource for a care recipient. In today's situation, few older adults in need of support can remain in the community without caregivers.
The problems faced by caregivers and the negative health outcomes of caregiving are among the major contributing factors leading to the institutionalization of care recipients. This illustrates the reliance of the public sector on caregivers.
Health care providers perceive informal caregivers as an important source of contribution. However, it is not clear if caregivers can provide more than they already do, nor what roles caregivers should play versus the state. At a minimum, we need to support caregivers to ensure a sustainable and effective health care system. To provide this support, it is reasonable to propose that the equitable allocation of health care and social program resources should include caregivers.
A variety of interventions have been proposed to support caregivers. However, most interventions studied to date have targeted the most strained caregivers rather than focusing on a population-based approach. It would be desirable to examine the feasibility of implementing community-based interventions.
A recent report from the Special Senate Committee on Aging has also suggested national programs, such as a national respite program. As we consider such interventions, it is important to bear in mind that approaches based on illness prevention and maintenance of good health in caregivers are likely to be superior to reactive approaches that focus on treatment of caregivers in poor health.
While much effort will be required to support caregivers, it is worthwhile remembering that caregiving does not occur in isolation. Caregiving and its impact have ramifications for individuals and the whole society.
The effectiveness of caregiving as an activity depends on a host of individual and system-based supports. Therefore, it is increasingly evident that the caregiving situation and the needs of caregivers overlap to a large extent with those of the public system of care. The extent to which the public system supports caregivers will indicate the value it places on aging in place.
Now let me touch on the issue of chronic diseases and safe driving. In 2001, along with colleagues, I published a study in which we projected a significant increase in vehicle occupant fatalities involving people aged 65 and over. Others also published similar dire scenarios. Yet despite important increases in the number of older adults and their greater use of the automobile, these projections did not materialize.
It is true that when we account for their exposure or kilometres driven, older drivers have an at-fault crash risk equivalent to that of younger drivers. However, in absolute terms, older drivers have fewer crashes than any other age group because they drive less and tend to self-regulate.
Older drivers as a group do not pose a great threat, nor will they in the near future. Nonetheless, we should do everything we can to assist them in being as safe as possible and to identify drivers who are unsafe.
Of course, this also applies to drivers of all ages. Let me emphasize that crashes are preventable events and that we all have a role to play toward their elimination, regardless of our age or position in society.
The driving challenges that older drivers experience are linked typically to health-related changes. Hence in most Canadian jurisdictions, physicians are mandated to report drivers who are unsafe due to medical conditions. This mandate exists despite physicians' reports that they lack the necessary knowledge and tools in a clinic setting to evaluate fitness to drive.
The existence of a knowledge gap does not mean we should rush the implementation of new tools without first substantiating the evidence of their effectiveness and studying the full impact of their implementation.
We are seeing evidence of such a rush starting to happen in Canada. British Columbia put in place a new five-minute screening tool to identify drivers who may have a cognitive impairment affecting their ability to drive safely. The adoption of the tool is based on a single study with multiple methodological limitations, and there is little evidence that adopting the tool represents a significant advance over current practice.
There is, however, evidence of the potential for harm. There is a genuine risk that, based on the tool, some drivers may be deemed unsafe to drive and be required to relinquish their driving privilege even though they may be safe enough to pass an on-road examination. Furthermore, some of the drivers labelled as “safe" by the tool may fail the on-road examination. The harm that may come from individuals losing their driving privilege when safe or being allowed on the road when unsafe is substantial. Moreover, my preliminary review of the test suggests that 50% of all drivers aged 70 and over would be required to undertake further testing. We would not accept this level of uncertainty with other medical tests.
In short, this new five-minute screening test does not meet physicians' needs, and, perhaps more importantly, its use risks erosion of the confidence older adults have in their physicians, and may even discourage some older adults from seeing their physicians for health concerns if they perceive they may risk losing their driving privilege without cause.
The burden of the process is also placed squarely on the shoulders of older drivers who risk losing their mobility or incurring unnecessary costs to prove they are safe—a comprehensive driving evaluation costs around $500. Unsafe drivers should not remain on the road, but using a flawed process represents an unfair social and financial burden on older drivers. Furthermore, we don't have the capacity to do a comprehensive driving evaluation for half of all drivers aged 70 or more, and such an approach is not supported by data. In B.C., the preferred approach for a comprehensive driving evaluation is not referral to specially trained occupational therapists, who are in my view the professionals with the best expertise to evaluate driving skills, but rather referral to a private, for-profit provider. Here, again, the evidence to support this approach is lacking.
Any process to identify at-risk or unsafe drivers needs to be developed carefully and be grounded in sound research methodology and evidence. The Canadian Institutes of Health Research, in its foresight, has invested in Candrive, a national program of research that uses appropriate scientific rigour to answer many of the pressing issues related to older drivers. Such issues include, to name just a few, identifying unsafe drivers, enhancing driving skills, and understanding the impact of transitioning to non-driving status. There are several research groups in other countries working on the same issues. Hence, much high-quality evidence will be available soon to support the development of sound, evidence-based policies.
In closing, I would like to emphasize again that chronic diseases are significant threats to the independence and quality of life of aging Canadians. Mitigation of this threat will require the adoption of innovative policies grounded in the best possible evidence. While this evidence is being acquired, we must resist the reflexive implementation of policies simply because there is a need.
Thank you.