Trains, Planes, and Automobiles

T he twentieth century has been remarkable for changing transportation trends. Intercity train travel has declined, replaced by the automobile and the airplane. Both desire and necessity have caused dramatic increases in air and highway travel, resulting in greater travel distances and frequency, vehicular numbers and density, and, perhaps most important for older persons, complexity of navigation. This increased usage, as with prior and competing modes of transportation, has been accompanied by more frequent crashes, with substantial injury rates and loss of life. Crash frequency and the attendant human toll have been, in part, mitigated by improved engineering of vehicles and the paths they take, effective vehicular maintenance, public and private education programs, operator competence testing and certification, and governmental oversight and regulation of various elements of this process. With more older persons operating motor vehicles and aircraft, there is greater concern regarding the health status and capacity for vehicular operation by persons in an age epoch of increasing disease, disability, and medication use. In this issue of the Journal, two reports address elements of the older pilot issue. That these reports appear in a general geriatrics journal gives further testimony to the growing impact of older persons on both occupational and recreational aviation. Both papers add to our understanding of medical issues in the older pilot, but both also have limitations. The case report by Boglioliet al' describes an older pilot involved in a solo crash and the autopsy findings that followed. While postmortem examination is critical for understanding more about the health of elders, its value would be greatly enhanced by clinical-pathologic correlation as well as a series of "control" postmortem examination data for contrast. Unfortunately, despite a recent, mandatory Class 3 examination, there was little useful information available about the pilot's precrash health status or whether his clinical status was changing. Also, unfortunately, the patient's toxicologic status at autopsy was not reported. Somewhat puzzling is the statement that the deceased pilot lived in a "nursing home." If this were literally true, there should be concurrent clinical information such as medication use, diagnoses, and functional status. One also wonders if, in this case, the clinical indications for "nursing home" admission would allow piloting under current Federal Aviation Administration regulations. FAA regulations place the burden on the pilot to report changes in health status or medication use in the interexamination interval. The experimental study by Yesavage et af addresses two important issues for pilots: the effects of age and of recent alcohol intake on operational performance. Using flight simulator technology, they found that "older" pilots maintain tested skills as well as younger