Guest Editorial

Aging Pilots: Problem or Simply Reality?

Dr. David Salisbury
Dr. David Salisbury

Canada’s pilot population is aging. That is to say, the average age of all the pilots in Canada is older than it was a few years ago. This is due to a number of factors, including the reality that people are living longer and healthier lives. As the baby boom generation ages, the sheer number of older people increases. In addition, economics has slowed the entry of younger pilots into the system. As of June 2010, there are over 5 700 medical certificate holders who are older than 65 in Canada, which is close to 10 percent of the pilot population. We have pilots in their seventies, eighties and even nineties flying in Canada.

What do we know about older pilots? Statistically, they will tend to have more medical conditions of concern to aviation medicine than younger pilots. Most, but not all, will need glasses or other types of corrective lenses. Some will need hearing aids.  They will also have slower reaction times, on average, and will be slower to acquire new knowledge and skills. Age is a major factor but it is not the only determinant of cardiovascular disease risk and the risk of sudden heart attack or stroke. Age is also a major risk factor for various chronic medical conditions such as cancer, diabetes, dementia, etc.

In Canada, legislation prohibits discrimination on the basis of age alone. This is one of the reasons that Canada has no upper age limit on having a pilot’s licence. Most driver’s licence programs in Canada have increased testing requirements in relation to the age of the driver. For example, in Ontario, starting at age 80, drivers must pass vision and written tests every two years and attend a training session to retain their driving privileges. The College of Physicians and Surgeons of Ontario audits every physician’s practice starting at age 70 and every two years thereafter.

Transport Canada (TC) mandates an increase in the frequency of medical examinations after age 40 and adds routine electrocardiograms (ECGs) to the testing requirements to maintain a Category 1 medical certificate. The Civil Aviation Medical Examiner (CAME) and/or the Regional Aviation Medical Officer (RAMO) may order additional clinical or laboratory evaluations based on past medical history and physical findings. The standard of care in Canada would suggest that everyone should have their blood lipids tested after the age of 40 to better evaluate their risk for coronary disease. For licensed pilots, fitness assessments are still individualized processes rather than generalized ones based on age.

How do we reconcile the observations of science with the legislation that prohibits discrimination on the basis of age alone? Do we have any evidence that older pilots are less safe or have more accidents than younger pilots? The fact is that we do not. This issue has been explored extensively in the U.S. and other jurisdictions and there is no clear trend in accidents or incidents related solely to pilot age. What we do know is that from time to time, we have accidents associated with older pilots. The question for all of us at that point is always: “Did we miss something?” What can be learned from this accident investigation that could improve our procedures for pilot medical assessment?

Fitness to fly can and does deteriorate with chronic disease onset and age. Some of that deterioration can be overcome with experience and training. Some can be prevented by adopting a healthier lifestyle (i.e. weight control, exercise, not smoking). Medicine can apply technology, procedures and medications to ameliorate some of these conditions. For example, vision defects can be corrected, cataracts can be surgically removed, hearing aids can compensate for hearing loss, etc. However, it is not so easy to detect or compensate for early mental changes or subtle performance deficits. There are currently no quick and easy tests for the early onset of dementia.

Several exciting initiatives, such as the Candrive program (www.candrive.ca), are underway to both detect and hopefully prevent/correct medical problems in aging drivers. The Advance Cognitive Engineering Lab at Carleton University, which is independent of TC, has undertaken simulator studies on aging pilots. TC Civil Aviation is following these developments closely. At the moment though, the decision regarding continued competence is left up to the pilots and their families. Is that enough? As a society we face similar issues in licensing people to drive. When it comes to driving, we mandate some form of retesting with age. Should we do the same for flying? Is there a role for others (family members, friends, flying colleagues) in assessing fitness to fly?

What is the safety message? As pilots, we need to know our abilities and ourselves. We need to know when the time has come to give up the privilege of flying. All doctors, pilots and regulators need to have an ongoing, informed and dispassionate discussion to address this issue and improve the ability to identify those of us, at any age, who can no longer perform at a safe level, for all our sakes.

David Salisbury
Director, Medicine
Transport Canada Civil Aviation

Dr. Salisbury is the Director of Medicine, Civil Aviation, Transport Canada. He is board certified in Community Medicine and Aerospace Medicine as well as being an active aging pilot who holds a commercial pilot’s licence, a multi-engine class rating and Category 1 instrument rating.

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