Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model

Abstract

Abstract:In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.Keywords: traffic medicine; behavioural science; causality; transversal research Clinical SituationA 78-year-old driver with a past history of cardiovascular disease was told his condition would not affect his fitness to drive, as long as he complied with his medication requirement to treat his arrhythmia. The patient is very attached to driving and attributes a feeling of freedom and independence to his car. He lives alone in a remote area and says he needs his car to do his shopping and meet with his friends and family. Recently, he has started suffering from mild cognitive impairment. A neuropsychologic assessment has nevertheless concluded that it was not yet severe enough to justify having to stop driving. It was therefore decided to monitor the situation and plan a transport transition phase within the next two years. He is now followed by an occupational therapist who has recently reported that the patient's condition has worsened and that the patient expresses strong resistance to the idea of giving up driving. A meeting with the physician, the patient's daughter, and the occupational therapist has been scheduled to discuss a solution to the problem and seriously consider driving cessation. Indeed, the patient's mental health state had worsened to a point where he frequently forwent his treatment and occasionally drove with heart palpitations. After forgetting to take his medication several days in a row, his heart condition severely worsened while he was driving. He lost consciousness and his vehicle hit the side of the road before

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