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INTRODUCTION: Since 1991, the Japan Civil Aviation Bureau has allowed pilots over the age of 60 to continue flying for the airlines, subject to regular medical review. To date, we now have almost 18 yr of hands-on experience in the aeromedical assessment of senior pilots. This paper shares some of our findings. METHODS: Medical data for all pilots over 60 yr of age, including examination findings, results from screening, and causes of unfitness, were reviewed. Postal questionnaires were used to survey medical status, and subjective changes in memory and fatigue resistance in pilots between the ages of 60 to 64 yr old, and also in subjects who had been denied medicals at the age of 60. RESULTS: There is greater variation in medical fitness of pilots with age, and an increase in the number of denials of medical certification. Malignancy and coronary artery disease both tended to increase with age. During 2005-2007, 30 (7%) of 499 otherwise healthy pilots were denied certification as a consequence of abnormal brain MRI screening findings, mainly because of asymptomatic cerebral infarction. Over half of pilots stated that their memory and fatigue resistance had subjectively diminished with age. DISCUSSION: Since the International Civil Aviation Organization (ICAO) amended the upper age limit for commercial pilots in 2006 it is likely that there will be an increase in the number of senior pilots worldwide. We question the value of routine MRI screening in the senior pilot age group. Aeromedical decision makers must understand the relationship between age, health, and safe piloting in the modern flight environment to ensure the maintenance of flight safety.
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