At the time of the writing of this editorial, there is a 'high profile' inquest going on in Toronto concerning driving and the elderly. Two years ago, an elderly woman making a right hand turn struck and killed a young woman. The young woman was then dragged under the car for almost a kilometre with the driver apparently unaware. There was no suggestion that the elderly driver had any physical or cognitive impairment that affected her driving. However, despite the absence of cognitive impairment, this was felt to be a case that could raise the profile of cognitive impairment and the aging driver. The inquest has not concluded, but fortunately initial testimony has stressed that most elderly drivers are competent to drive.
The same day that my testimony at this inquest was reported in the papers, another story was reported, more gruesome than the first. A 25-year-old Texas woman struck a homeless man, impaled him on her windshield, and then locked him and the car in the garage while he slowly bled to death over two or three days. She and her friends then removed the body and 'dumped' it in a garbage bin. For some reason, the first case has sparked an intense interest in whether or not the elderly should drive, but I have not read or heard any musing about restricting the driving privileges of 25-year-olds. Perhaps all young people should have random drug testing to maintain their driving privileges (a presumed factor in the Texas incident)!
Clearly, the difference in the two cases from a geriatrician's perspective is as follows: The incident with the elderly driver is immediately generalized to reflect all the elderly, whereas the incident with the young driver is a reflection of her actions, and her actions alone. In the first case, the trial judge last year pronounced that the woman's ability to drive was 'impaired by age.' I have yet to identify any evidence that shows age is an independent risk factor for driving. Rather, it is the morbidity that accompanies aging that impairs driving. I suspect that any slowing of reaction time and reflexes in the elderly is more than compensated by better judgment and increased caution. Even though we know that a large number of the over 80 population has cognitive impairment, we do not have accurate information on how many still drive, vital information to have if any screening endeavours are considered.
This issue focuses on cancer and the elderly and, as I have discussed in the past, the presumption is often made that the elderly should be treated less aggressively than should younger patients, even though comorbidity is a more important factor than age alone. The lesson, brought home once again by this inquest, is that management must be tailored to the individual and based on comprehensive assessment, not just a single factor such as age.
Fortunately, in this issue we feature articles by experts who do not fall prey to age bias. Dr. Townsley and Dr. Hedley discuss pancreatic cancer in the elderly, and other articles address the issues of cardiac tumours (Desai and Butany), ovarian cancer (Gould and McMeekin), male breast cancer (Glück and Friedenreich), and screening for colorectal cancer (Rossos and Yeung). As well, we have our usual assortment of other articles, including a special piece on estrogen and the aging brain by Elise Levinoff and Dr. Howard Chertkow, one of Canada's leading investigators in the field of cognitive impairment.
Enjoy this issue.
