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Who Will Guard the Guardians? PART ONE

In the last two posts on this site I compared the 777 airborne beasts to us land-dwelling human machines.  In the end, we did pretty well regarding function and energy use. Where we lost the contest was when it came to the monitoring and maintenance of our respective machinery. As the years and the miles add up, we just don’t have a biological program to continuously monitor and cross check ourselves like the computers and power systems of the airplane.  In the spirit of lessons learned from where we fell short on the comparison to the flying machine, let’s look more deeply into some age-related changes, our self-monitoring capabilities, and how we can avoid mishaps and fatal mistakes.

The single pilot environment that we GA pilots occupy is a unique and special place where we perform only up to the standards we set for ourselves.  We are the sole guardians of our own safety.  We don’t have company supervisors monitoring our approaches to be sure we stay within a dot of the localizer or never descend below minimums.  We establish and enforce our own safety standards and professional goals and that’s where we fly.  So if we are our own guardians, “Who will guard the guardians”? An excellent question first posed by Decimus Iuvenālis, a Roman poet from around 100 AD.  

Normal aging leads to changes in both physiological and psychological functioning.   Age-related changes are largely continuous and subtle rather than discrete and dramatic.  As subtle deteriorations in cognitive capabilities are difficult for us to perceive in ourselves, it makes it hard to carry out that guardian function and to supervise and judge our own abilities.  Recognizing these changes as they creep up on us is complicated and guarding against errors and mistakes is an added burden for the aging GA pilot for safety on the ground and in the air.  Flying airplanes is a process of almost uncountable steps.  One of the deleterious age effects on cognitive function is loss of tight control over these sets of processes in any complex environment and an especially big problem in the cockpit.  The standards of process we set for ourselves have a way of undergoing something safety experts call “process drift,” or continuously getting less precise and sloppy in the demands we make on ourselves that adds further safety risks.  

The AOPA’s Aviation Safety Institute has some terrific overviews on age that detail pilot performance and safety, and I recommend everyone review these articles. The FAA and NTSB have also done exhaustive research on the impact of age on aviation accidents.  The data has to be looked at critically as older pilots have more experience that can protect against accidents.  Even so, when accident rates are plotted against age there is a “U” shaped curve that reflects the fact that younger (and less experienced) pilots have more accidents.  Unfortunately, the rate starts to climb again as pilots age, even taking into account more experience and flight time.  This is also found in the Nall report that tracks GA accidents, and is particularly ominous for aging pilots.  Pilots who are older than 60 years of age are more likely to be involved in fatal accidents and are more likely to be involved in an accident caused by pilot error. “Pilot error” is shorthand for loss of cognitive function resulting in poor information processing and critical decision-making errors.  

Normal age related cognitive changes fall broadly into areas of forgetfulness, decreased ability to maintain focus, and decreased problem-solving capacity linked to difficulties with a kind of memory called “episodic memory”.  This is more than just recollection of events. This is really a critical functional loss for pilots as it leads to a reduced ability to learn, recall and retrieve all sorts of information.  Furthermore, substantial age-related differences are seen in many types of high-level 'executive' functions such as attention to details and task switching. Task switching is a fancy name for a real popular pastime these days that we call, “multitasking.”  It turns out that even the youngest and sharpest minds can’t do more than one thing at a time, the brain just switches its attention back and forth between different tasks and focuses on them sequentially.  Switching attention to the next task slows considerably as the brain ages so handling multi-step tasks slows way down. In addition, slowing down these steps makes older adults more susceptible to any distractions that occur during the thought processing period and throws everything off. 

So the more thoughts, tasks and information that needs to be handled the slower the whole process is managed as the brain ages.  Put all this into the head of a pilot in the cockpit in marginal weather, busy air space, and an instrument approach to minimums and all those Nall statistics take on a very scientific and real basis in the facts of brain function.  The anatomical areas most affected by age are right in the brain’s cognitive wheelhouse and can actually be observed with dynamic, computerized imaging of the brain while a person is performing various cognitive tasks.  These studies are known as fMRI, functional nuclear resonance imaging, and is way cool stuff to neuroscience geeks who peek into your head and can watch you make decisions in real time.

Self-recognition of these changes is hard but everyone has a sense when things just take longer and demand more effort to get things done that were once a breeze.  There are a number of objective cognitive assessment tests that can be ordered by physicians and psychologists, but start simple.  Use some good old crew resource management skills.  Seek honest and critical feedback on your performance from family, friends and flying partners.  Good metrics of flying skills are driving skills. How is your driving lately, any accidents or near misses?  Drive past and missed an exit or just look up on usually familiar roads and don’t know where you are?  If this happens in the air the risks of accidents go up much more than if it happens on the ground.  State driving license renewals vary but most states stop automatic mail renewal and require in-person renewal that includes visual and skills tests after ages that vary from 55 – 85.   Most states also have shortened the time for renewal by several years to keep tighter checks on drivers as age increases.  For pilots, the FAA has mandatory age limits on ATPs flying part 121 operations, but there are no limits on GA pilots.  

So be a good guardian of your own safety and learn a lesson from driving safety models. Schedule yourself at regular intervals for an IPC with a CFII and get an honest assessment of your instrument and flying skills, instrument cross checks, and approaches and landings.  No need to wait two years between BFRs, schedule yourself for one every year and take the results seriously.  To stay safe, you might have to raise your personal minimums and add points to flight risk assessment calculations to make up for deficiencies.  Get frequent hood time with an experienced co-pilot and drill your instrument skills and IMC flight control.  Consider flying difficult or long flights with another experienced pilot to share the demands of the mission.

In the next post we’ll go over the importance of recurrent practice.  We’ll also cover other ways you can counter some of age’s deleterious effects to maintain your cognitive skills and use natural compensations the brain develops to keep your flying skills sharp and you and your passengers safe.

Kenneth Stahl, MD, FACS

Kenneth Stahl, MD, FACS is an expert in adapting principles of aviation safety to the healthcare industry for patient safety. He also writes and teaches pilot safety principles and error avoidance. He is triple board-certified in cardiac surgery, trauma surgery, surgical critical care and general surgery and holds an active ATP certification and a 20-year member of the AOPA. Dr. Stahl practices surgery full-time and is Healthcare Division President for Convergent Performance, an industry leader in teamwork, checklist and accountability training and consulting. He can be reached at [email protected]

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