Aging
Every person understands that his or her abilities cannot be maintained
indefinitely as he or she ages. On average, performance on laboratory tests of discrete
sensorymotor and cognitive skills can be shown to decrease with increasing age.[388]
However, there are large differences among individuals. Again, except at extreme
points of performance failure (e.g., severe impairment of vision or hearing), the
contribution of isolated changes in physiologic or cognitive performance is difficult
to relate to real work situations.[389]
[390]
For one thing, the work environment is often rich with redundant cues involing multiple
sensory modalities. For another, technological compensation may be possible, as
with the use of hearing aids or glasses. Finally, along with possible physiologic
changes of age typically comes greater experience with a variety of situations.
For many individuals, the lessons learned from experience more than offset the modest
degree of physiologic impairment they face as they grow older. This compensation
has, in fact, been documented for skilled typists, chess players, and bridge players.
[391]
Middle-aged individuals can utilize their
experience to solve everyday problems better than young individuals; however, for
the elderly (on average), compensation by experience is no longer sufficient to offset
cognitive slowing.[389]
Age takes a toll on short-term
(or "working") memory,[392]
[393]
[394]
and there is evidence that aged workers are
more sensitive to the interruptions of attention that are so prevalent in dynamic
environments.[395]
Nevertheless, few of these deficits
have been documented in complex work settings, largely because it is so difficult
to measure performance in these domains. The issue of the aging anesthesiologist
has raised considerable controversy among anesthesiologists.[396]
[397]
[398]
What do other industries do about this issue? A U.S. Federal
Aviation Administration (FAA) regulation (colloquially known as the "Age 60 Rule")
bans pilots older than 60 years of age from flying under Part 121 of the FAA regulations,
described earlier. This rule may soon be extended to pilots of commuter aircraft
(less than 30 seats), regulated under Part 135, as part of an overall thrust to increase
safety in commuter air transport. There are no such regulations for business or
general aviation pilots. The Age 60 Rule has been in force since 1959, the rationale
being that "increased speeds and passenger loads of commercial airliners placed greater
demands on pilots with respect to their physical fitness and piloting skills."[399]
Some may argue that the increasingly challenging nature of anesthesia practice also
places greater demands on anesthetists than ever before.
The Age 60 Rule has been the topic of much debate, and the U.S.
Congress mandated a review of the rule in 1979, resulting in several studies by a
variety of investigators and agencies.[399]
[400]
[401]
[402]
[403]
[404]
The conclusions of these studies are in part
contradictory. However, the most recent analysis of available data indicates no
increase in accidents per hours flown as pilots approach their 60th year and only
a slight hint that class III medical certificate pilots (i.e., private pilots) have
an increased accident rate when they are older than 63 years of age.[399]
This issue is very complex, and the regulators are extremely conservative.
FAA regulations do require air transport pilots (encompassing all Part 121 pilots)
to pass
"class I" medical examinations every 6 months. However, the medical examination
process appears to be largely aimed at identifying individuals with chronic medical
conditions that put them at risk for sudden incapacitation (such as significant coronary
heart disease). Pilot incapacitation during high-workload phases of flight has been
shown in simulator testing[405]
to lead to a significant
rate of crashes, even when there is a second pilot at the controls. These physical
examinations may weed out pilots with severe cognitive or sensory-motor deficiencies,
but they are not designed to assess subtle aspects of performance changes resulting
from age. Of course, there are no requirements for medical examination or certification
of anesthesiologists.
It is likely that age alone does not independently cause a significant
performance decrement, but age correlates with other factors that are likely to affect
performance. The concern about aging professionals revolves more around the loss
of knowledge and skill as one gets farther from initial training, rather than the
loss of fundamental mental capacities. Thus, the originally well-trained practitioner
who keeps abreast of the changing standard of care, and who exercises emergency skills
frequently, is less likely to be affected by advancing age than is the marginal practitioner
whose knowledge and skills were frozen immediately after completion of training and
who practices in a low-complexity environment. The FAA regulations deal with this
issue for air transport pilots by requiring frequent (every 6 months) evaluations
of performance by FAA-certified check pilots. These evaluations are performed both
during actual flights and in realistic simulators, and they, in essence, check fitness
for duty regardless of age. There is currently no similar program in anesthesia
to assess the competency of practitioners at any age, except for initial board certification,
which is voluntary. Periodic recertification is now required by the American Board
of Anesthesiology for diplomats attaining certification after the year 2000, but
it is not mandatory to be Board-certified to practice anesthesia, and the recertification
examinations are not likely to be as intense, as thorough, or as frequent as those
required for air transport pilots.
 |
