Chuck Weirauch investigates the issues of an aging pilot population and aeromedical concerns associated with it.

With more than half of US airline pilots now over the age of 50, and the average age trending higher each year (American Airlines reports that the average age of its pilots is 53), it may be time to take another look at some of the health issues that often emerge as these pilots move towards the FAA mandatory retirement age of 65.

That's a bit harder to do now than it was back before December 13, 2007, when the Fair Treatment for Experienced Pilots Act was signed into law by President Bush to allow both pilots on a domestic flight to be up to age 65. In January of that year, backed by its own research and that of many supporters in the scientific, academic and airline industry communities, the FAA had determined that there was no statistical proof that older pilots posed a greater risk than younger, less-experienced peers.

One such February 2007 study, conducted by the Stanford University/Veteran's Administration Aging Clinical Research Center in Palo Alto, California, verified the FAA's conclusion. The three-year study of non-commercial pilots found that the extent of aviation expertise and greater number of years of education resulted in higher flight simulator performance.

The study also concluded that while older pilots initially performed worse than younger pilots, older pilots showed less of a decline in overall flight summary scores than younger pilots, and over time their traffic avoidance performances improved more than that of younger pilots. The conclusions, reported in Neurology, the scientific journal of the American Academy of Neurology, also found pilots with advanced FAA pilot ratings and certifications showed less performance decline over time, regardless of age.

But with the increasing complexity of commercial airline cockpits, more crowded skies and the rising average age of commercial pilots, have things changed much since 2007 as to how age may be affecting airline pilot performance? Are there any emerging health issues that pilots should know more about, so that they would become more aware of them and take steps to help address these issues on a personal level? Should the FAA require more stringent rules for Class 1 medical certifications, based on more recent medical research?

To try to discover answers to some of these questions, CAT conducted research to come up with more recent studies in these areas. While there seems to be a dearth of more recent investigations, representatives from two primary aeromedical organizations were able to provide some insights into the aging pilot issue.

No Medical Certification Changes Dr. Michael Berry is the past president of the Aerospace Medical Association (AsMA). He is also the FAA's Deputy Federal Air Surgeon. According to Berry, the federal regulatory agency is currently not looking to change or add anything to the Code of Federal Regulations (CFR) Part 67 Medical Standards and Certification concerning medical conditions related to aging commercial pilots.

“I think that any of the conditions that we are concerned about in an aging pilot population are already taken care of, or covered in Part 67,” Berry said. “Do I think that there should be something different from an aging pilot perspective added in to the kind of standards that are covered in Part 67? At the present time, no, I don't think so. Whether you are dealing with an age 60 or age 65 pilot, the current medical exam appears to be doing an adequate screening job in finding people with medical problems.”

CAMA Input Dr. Clayton Cowl is President-Elect of the Civil Aviation Medical Association (CAMA) and directs the Aerospace Medicine section at Mayo Clinic in Rochester, MN. He is also Chair of the Division of Preventive Occupational and Aerospace Medicine at Mayo. While CAMA is not advocating more stringent or more frequent testing for older pilots holding FAA first-class and second-class medical certificates, he cited a number of medical conditions that pilots might keep in mind to self-monitor that relate to advanced technology in the cockpit.

“What is interesting is the increasing complexity of the cockpit, with some of the technology that we see becoming greater and greater,” Cowl said. “So there may be cognitive issues that perhaps were not in play 15 years ago, and with this technology being available even to the recreational pilot.”

Cowl gave glass cockpits as an example. Just the colors in a glass cockpit can sometimes be problematic for the aging pilot, he reported. The glass cockpit's red and green lighting has become much more of an issue with older pilots, particularly those who have a color-deficiency and never had a problem with gauges.

With more tablet computers in the cockpit that provide navigational and other information, such as approach plates available on iPads, there can be some issues with coloration and adequate lighting with those devices for older pilots. And as people age, going back-and-forth between near vision on an iPad to distance vision repeatedly can be more challenging for pilots with presbyopia, or older-age sight depth reduction, he explained.

“The issue of safety in an aging population is not unique to aviation,” Cowl summed up. “In general, as people age, there is a probability of various medical conditions that can arise, like high blood pressure and the risk for coronary disease. The risk of diabetes is particularly important as pilots increase their body mass index. As the aging pilots' weight increases, one thing to remember is sleep-disorder-related breathing in particular obstructive sleep apnea. Sleep apnea is related to cognitive abnormalities. The other thing that you have to think about, particularly in the GA population, is polypharmacy, or multiple prescriptions. And a lot of pilots don't recognize that some over-the-counter medications have sedating side effects.”

Hypoxia Training Although neither CAMA nor AsMA is calling for more extensive Class 1 and Class 2 medical certification, the aerospace medical organizations do advocate more hypoxia training.

According to AsMA president Jeff Sventek, this may be more of an issue for newer commercial pilots who have no military experience, since many older pilots served in the military and received such training during that time.

“There really isn't a trend that we are seeing more and more hypoxia because people have not been exposed to it in a chamber environment,” Sventek said. “However, earlier at one point, I felt very strongly that anyone working toward a commercial certification should be exposed to hypoxia, and it could be in an altitude chamber where you get the pressure phenomena or there are a lot of sophisticated mixed gases or reduce oxygen breathing systems. I still think that it would be very beneficial for those who are getting a commercial ticket, and believe that anybody who is flying for pay should probably be required to have that experience at least once in their flying career.”

Cowl said that CAMA also advocates appropriate hypoxia awareness training through a mixed-gas paradigm or a chamber experience. Studies have shown that even at 5,000 feet above sea level, pilots can start getting night-vision decline, and at 7,000 to 8,000 feet, they can start seeing a reduction of their field of vision. What aerospace medicine may be missing are these sort of low-level hypoxia events where there may be some cognitive abnormalities that might not necessarily be able to be detected outside of large randomized clinical trials, Cowl added.

“Flight departments that incorporate hypoxia awareness training recognize its importance, and thankfully hypoxia does not happen very frequently,” Cowl stated. “But if it does, you can have serious outcomes. It's always a risk-versus-benefit of the cost of doing the training. So the question is, are you going to invest in your people or not? People will invest thousands of dollars on the aircraft, but sometimes are not willing to invest the time, effort and expense on the most important part of the aircraft, which is the pilot. We know that in an unpressurized cockpit environment, even low-level hypoxia can play a role in cognitive impairment.”

Automated Warning To help prevent hypoxia events for general aviation pilots, Mayo Clinic is working with the FAA to develop an automated system that would sound a warning and flash a message on glass cockpit screens that tell a pilot to put on an oxygen mask when the system detects that cockpit oxygen levels are too low. While Cowl describes the technology as being “on the horizon”, initial tests will be conducted with the FAA during this June and July.