The Measurement of Fatigue and Chronic Fatigue Syndrome

to poorer perception and judgement. Reduced channel capacity (limiting the amount of information which can be handled at one time) makes it increasingly difficult to perform complex manoeuvres such as efficient judging of entry into a busy roundabout and, at the same time, needing to be aware of warning and direction signs. O'Neil et al., in this issue (p 199), draw attention to the special problem ofpatients with signs of dementia continuing to drive in spite of getting lost, and having accidents. Concerned carers reported examples of impaired driving ability like driving the wrong way round roundabouts, up the wrong lane of a dual carriageway and through neighbour's front gardens. The effects of an accident in terms of the injury caused also change with age. For a given impact an older person will more commonly suffer a fracture or other serious trauma and a given injury is more likely to cause death; the curves for injuries and for fatalities thus rise with age even more steeply than for accident involvement. The Automobile Association (AA) recently sponsored a questionnaire study of the views of current elderly drivers. Many of them recognized increasing difficulty with coping with traffic. They were not, however, commonly aware of difficulty at junctions though this is a more frequent site for their accidents than for younger drivers. Many had made sensible modifications to driving habits-reducing night driving, for instance and planning journeys to avoid heavy traffic. Many recognized that at some time they would have to give up driving and to a large extent would rely on their family doctor to advise them when the time had come. The occasion of the routine health assessment of older patients could be a good opportunity for doctors to give such advice. Medical Aspects ofFitness to Drive, published by the Medical Commission on Accident Prevention (MCAP)l, contains useful advice in dealing with potentially difficult doctor/patient relationships which may arise. There remains, however, scope for advice from relatives and friends, as well as the family doctor, as described in the booklet Helping the Older Driver2 produced by the MCAP and the AA. It would be helpful to know more about the circumstances and reasons which cause people to give up driving. Drivers may recognize that they have lost their confidence, relatives may be concerned about safety, the doctor may give advice or the licence may be withdrawn following an accident. The …