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Staying In Control as We Age

Source:, By James Fraser, M.D., Federal Air Surgeon

Age is just a number, right? While the passage of time may bode well for wine, it doesn’t work out quite as well for humans. The performance of nearly all of our body’s systems diminishes with age. If unchecked, that degradation can easily make its way into the cockpit and contribute to the leading cause of accidents — loss of control.

Keeping you in control of your aircraft is one of our highest priorities here in the FAA’s Office of Aerospace Medicine. We strive to keep as many pilots in the cockpit as we can safely certificate. In that context, one of our major concerns is incapacitation. Along with impairment, incapacitation greatly contributes to loss of control accidents. There are two varieties that manifest themselves very differently: sudden incapacitation and subtle incapacitation.

Sudden Incapacitation

This threat is somewhat self-evident. It’s also the one that makes headlines and drives a lot of decision making regarding which conditions are disqualifying. It’s easy to see why; sudden incapacitation represents a clear threat to pilots, passengers, and even people on the ground. The risks are both real and well-documented. One third of all myocardial infarctions (MI), aka heart attacks, present as sudden cardiac death which means that the patient dies within one hour of the onset of symptoms. As if that wasn’t bad enough, the odds of an MI increase dramatically with age. When compared with a male at age 30, a male at age 40 is six times more likely to have an MI. At 60 it jumps to 100 times more. That’s one reason why our medical certification folks and Aviation Medical Examiners are so careful with cardiac issues.

Subtle Incapacitation

As obvious a danger as sudden incapacitation is, subtle incapacitation can be far more insidious. Subtle incapacitation can occur through a degradation of either physical or mental ability. Mental degradation is probably the biggest challenge for pilots because it tends to come on slowly and we are usually not even aware it’s happening. Recent medical literature tells us that anywhere between five and eight percent of people at age 65 have a diagnosable form of dementia. That percentage doubles for every additional five years of age. Since pilots are a microcosm of the general population, there is every reason to believe that these numbers are just as representative within our pilot population. Subtle incapacitation can affect the executive functions of the brain. Things like attention, problem solving, memory, and multi-tasking can all be dramatically impaired, and those are exactly the kind of functions that a pilot really depends on to stay safe and make good decisions.

Because subtle incapacitation can happen so gradually, it is especially hard to self-diagnose. By working with your AME and/or personal physician, you can more easily identify and treat conditions that can lead to it. Your family and fellow aviators are also great resources. Have family members who used to regularly fly with you begged off? Have your hangar buddies asked about your flight review a lot in the last year or two? It’s possible they’ve noticed something you’ve missed about your flying skills. We regularly receive hot line calls and complaints about a pilot’s medical fitness. Sometimes these are from antagonists and without merit. But sometimes they come from worried family members who have good reason for their concern. Although we rarely act on these complaints, the fact that family members feel so strongly should be a wakeup call for all of us. Being a pilot is a big part of who we are, even if it’s not what we do to pay the bills. That can make any conversation about curtailing or limiting how much we fly very difficult. Nevertheless, it’s important to have these conversations as we age to make sure we hear any concerns they may have.

What can you do to prevent incapacitation issues? In addition to maintaining good health and having regular checkups with your doctor, schedule regular checkups with a flight instructor. The standard flight review is a good place to start but as you age, think about increasing the frequency. This activity provides regular feedback on the condition of your flying skills. In addition, time with a CFI will improve your general proficiency — and is a benefit regardless of your medical condition.

Bottom line: it’s important to talk with friends and family and take any steps needed to ensure you maintain the skills necessary to be safe.

James Fraser received a B.A., M.D., and M.P.H. from the University of Oklahoma. He completed a thirty year Navy career and retired as a Captain (O6) in January 2004. He is certified in the specialties of Preventive Medicine (Aerospace Medicine) and Family Practice. He is a Fellow of the Aerospace Medical Association and the American Academy of Family Practice.

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