Remember ME - You Me and Dementia

September 17, 2009

USA: Staying Sharp With Age - Importance for Airline Pilots

. Photograph by courtesy: Enrique Galeano Morales NEW YORK, NY / Aviation Week / Business and Commercial Aviation / September 17, 2009 Staying Sharp With Age - Part II By Patrick R. Veillette, Ph.D. The ability to learn new operating procedures, new aircraft systems and such definitely becomes more difficult as a pilot ages. Recent research on learning has found that older people tend to rely on their previous knowledge, and don't retain newly learned material in long-term memory as well. Thus when pilots set out to learn something new such as a different FMS, they'll rely on the skills and general knowledge acquired over a longer period of time. These studies have shown that older participants (60 to 70) were slower and made more errors than younger pilots, especially on tasks requiring more information processing. One possible cause may lie in changes in cognitive processing associated with increasing age. "Age-Related Group and Individual Differences in Aircraft Pilot Cognition," a joint study between Loyola Marymount University and UCLA's Department of Psychiatry and Biobehavioral Sciences observed significant age-related differences in tests of psychomotor skills (mental events that have motor consequences or vice versa), information processing speed, attention, executive ability, verbal and visual learning, and memory. The study confirms the findings of other research on pilot cognition and aging. This decline in a person's cognition appears to be gradual across the age range. There was no appreciable acceleration of cognitive loss with pilot age. Rather, a linear decline best describes pilot cognition differences between ages 28 and 62.While scientific protocol prevented the authors from extrapolating effects to pilots more senior, they did opine it is possible that decline in cognition accelerates after 62. Many of the tests in this study required timed performance. The association of slower completion times with older pilots indicates, among other things, a fundamental slowing in psychomotor speed and cognition. Although such slowing may minimally impact pilot performance in routine flight situations, it could be a more significant factor in non-routine or emergency flight situations that demand prompt pilot analysis and decision making. One contributing factor to the cognitive slowing observed in older pilots is cardiovascular status. In a study of 671 men, most of whom had been pilots or air traffic controllers or both, mild to moderate degrees of cardiovascular disease were associated with slower psychomotor performance. Much of the typical downward trend in performance with age is a reflection of cardiovascular diseases rather than age, per se. While cardiovascular-related incapacitation of a pilot resulting in an accident is rare, the vascular condition presumably has a more common and subtle impact on pilot cognitive functioning. And a growing body of evidence suggests that "cardio" exercise can at least partially mitigate age-related slowing across a variety of psychological and physiological measures and thus could potentially reduce the risk of older pilots in demanding, quick-response, inflight situations. Fatigue is another important issue regarding the performance and safety of the aging pilot. Mark Rosekind, former principal investigator of human fatigue at the NASA Ames Research Center, along with co-author Linda Connell, the director of the NASA ASRS system, found that with normal aging, nighttime sleep becomes shorter, lighter and more disturbed with more awakenings and transient arousals, and daytime sleepiness increases. Among crewmembers in the study of long-haul operations, pilots aged 50 to 60 averaged 3.5 times more sleep loss per day than those aged 20 to 30. This correlated well with laboratory studies that indicate greater variability among older persons in sleep and circadian rhythms. The NASA results, published in the aeromedical journal Aviation Space and Environmental Medicine, noted that sleep loss of as little as one hour per night causes a cumulative increase in physiological sleepiness during the day. Furthermore, the magnitude of the sleep loss accumulated over successive duty days can be significant. Rosekind and Connell concluded that countermeasures for circadian disruption and sleep loss may need to be adapted for different age groups and/or circadian types. Individuals do not age physiologically at the same rate, and since variations in cognitive function between individuals increases greatly as age increases, it's extremely difficult to predict an individual's functional level. Thus a 62-year-old pilot can be super sharp whereas one 18 years his junior may never be. This variation made it extremely difficult for aeromedical researchers to argue for or against mandatory retirement ages. Some individuals, because of genetics, health, exercise, diet and such, will continue to remain relatively sharp for their age group, whereas others were never that sharp in the first place or will decline at a more rapid rate. As to the question of when these aspects of aging begin to degrade cockpit performance enough to constitute a threat to flight operations, the normal aeromedical certification provides no answer. Dr. Anthony Evans, chief of ICAO's Aviation Medicine Section, opines, "As we don't have adequate assessment tools to accurately determine who is in one group or another, a one-size-fits-all approach, based on average risk, is the fairest system. Without a retirement age, the logical conclusion is that pilots will operate until they fail a medical or an operational check. Without a cultural change, there will continue to be a reluctance (by medical examiners and check pilots) to fail an experienced pilot, with his career (perhaps a glittering one) ending in failure." He noted that, "Medical evaluations and simulator checks developed to determine whether pilots have age-related problems would help identify those who are no longer fit for flight, but are far from being 100-percent accurate." I watched a colleague go through a cognitive evaluation after being accused of exhibiting signs of "cognitive decline" and can attest that it is not a process anyone would welcome to maintain flying privileges. Before undergoing such an evaluation, consult an aeromedical advisor to assist in your preparation since one's pilot certificate could be riding on the results. There are some online and in-clinic preparatory courses available to help individuals prepare, with the online courses requiring self-discipline. One of the attributes that the cognitive psychologists will examine in making such an assessment is the subject's attention skills including concentration, patience and restrained compulsivity. Some of the common tests will require the pilot to learn a new sequence of letters on a computer, scan to find the correct letter and use working memory to store a letter's location. This allows clicking the letter to shift attention quickly and move the mouse and click on the next letter. The individual's speed and accuracy are both graded. The tests may also examine visuospatial skills by discerning line widths, angles and completion of line drawing. Others skills to be tested will be eye-hand coordination, deductive and inductive logic, memory and communication. Unfortunately in the evaluation of my colleague two different psychologists came up with contrary diagnoses. Because the industry hasn't come up with a defined limit of what is acceptable performance vs. unacceptable, the aviation manager is left to decide if it is time to remove the pilot from the roster. The issue of pilot aging is a tough one for managers to handle, since they must weigh expertise and loyalty against slowed reaction and comprehension. By staying alert to those changes and proactive in crew pairing a superior level of safety can be maintained. There inevitably does come a time when a pilot should exit the cockpit for good, but the right time depends on the individual, not the calendar.[rc] AVIATION WEEK Copyright 2009, The McGraw-Hill Companies, Inc.