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Approach to the evaluation of older drivers

MaryJoan D Ladden, PhD, RN, FAAN
Section Editor
Kenneth E Schmader, MD
Deputy Editor
H Nancy Sokol, MD


In 2010, the United States (US) census bureau noted that 13.0 percent of the US population is aged 65 or older [1]. By the year 2020, it is predicted that 50 million people will fall into this age range, one-half of whom will be over age 75 [2]. More than 79 percent of people aged 70 and older have a driver’s license in the United States, and more than 60 percent of people aged 75 and older are licensed drivers in Australia, while the proportion of older drivers is rising and drivers are traveling greater distances in later life [3].

Older drivers have become front page news not only because of the aging of the population, but also because they are involved in more fatal car crashes per miles driven than any other age group except teenagers. Drivers over the age of 75 years also have more traffic violations and nonfatal collisions than younger drivers. Two of the most common violations, failure to yield the right of way and failure to obey a traffic sign, often lead to accidents at intersections where situations require a quick response, full peripheral vision, and interaction with other drivers.

These observations have prompted individual states to consider legislation that would tighten license renewal requirements for older drivers. As an example, in 1999 the California state senate debated but did not pass the "Brandi Jo" bill, an amendment requiring drivers ages 75 years and older to take a written, vision, and road test at every renewal period [4]. The bill also proposed shortening the renewal periods from the usual every four years to every year after age 90.

However, while statistics might suggest that severe restrictions should be imposed on older drivers, the task is not that simple. Driving is an important issue for older adults. The majority of Americans rely upon private automobiles for their transportation, and most older adults regard driving as critical to their independence and self-esteem. A cross-sectional telephone survey in the United States, conducted by the Centers for Disease Control and Prevention (CDC) in 2001-2003, found that among survey respondents (48 percent of those surveyed), 75 percent of adults aged 75 to 84 years, and 70 percent of adults aged 85 and older were current drivers [5]. Older adults who are forced to stop driving rely more upon their families, reduce their social activities, and often become depressed.

Furthermore, despite a moderate decline in mental, motor, optic, and auditory functions with aging, many older people drive safely. Driving performance is usually impaired only after a considerable loss of function since most driving patterns are learned and become second nature. In addition, we often regulate our own driving as we age; seniors drive fewer miles, shorter distances, less at night, and seldom in rush hour. In the CDC survey, 82 percent of older drivers (≥age 75) reported that they limited driving for weather conditions, distance, or night [5]. Interestingly, however, only 15 percent limited driving for medical reasons, and none for cognitive impairment. There is consensus among traffic safety experts that older drivers should be kept on the road as long as they can drive safely.


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