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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
Daniel J Sullivan, MD, MPH


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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Literature review current through: Dec 2017. | This topic last updated: Nov 14, 2017.
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  1. http://www.census.gov/newsroom/releases/archives/2010_census/cb11-cn192.html (Accessed on August 07, 2014).
  2. National Institute on Aging. www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Figure4.htm (Accessed on November 08, 2010).
  3. Coxon K, Chevalier A, Lo S, et al. Behind the Wheel: Predictors of Driving Exposure in Older Drivers. J Am Geriatr Soc 2015; 63:1137.
  4. California State Senate Proceedings Website. Available at: www.leginfo.ca.gov/ (Accessed on October 12, 2011).
  5. Betz ME, Lowenstein SR. Driving patterns of older adults: results from the Second Injury Control and Risk Survey. J Am Geriatr Soc 2010; 58:1931.
  6. Fain MJ. Should older drivers have to prove that they are able to drive? Arch Intern Med 2003; 163:2126.
  7. Fitten LJ. Driver screening for older adults. Arch Intern Med 2003; 163:2129.
  8. Molnar FJ, Patel A, Marshall SC, et al. Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: A systematic review. J Am Geriatr Soc 2006; 54:1809.
  9. Carr DB, Ott BR. The older adult driver with cognitive impairment: "It's a very frustrating life". JAMA 2010; 303:1632.
  10. Iverson DJ, Gronseth GS, Reger MA, et al. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74:1316.
  11. Jang RW, Man-Son-Hing M, Molnar FJ, et al. Family physicians' attitudes and practices regarding assessments of medical fitness to drive in older persons. J Gen Intern Med 2007; 22:531.
  12. Sims RV, Owsley C, Allman RM, et al. A preliminary assessment of the medical and functional factors associated with vehicle crashes by older adults. J Am Geriatr Soc 1998; 46:556.
  13. Koepsell TD, Wolf ME, McCloskey L, et al. Medical conditions and motor vehicle collision injuries in older adults. J Am Geriatr Soc 1994; 42:695.
  14. Ball K, Owsley C, Sloane ME, et al. Visual attention problems as a predictor of vehicle crashes in older drivers. Invest Ophthalmol Vis Sci 1993; 34:3110.
  15. Odenheimer GL, Beaudet M, Jette AM, et al. Performance-based driving evaluation of the elderly driver: safety, reliability, and validity. J Gerontol 1994; 49:M153.
  16. Marottoli RA, Richardson ED, Stowe MH, et al. Development of a test battery to identify older drivers at risk for self-reported adverse driving events. J Am Geriatr Soc 1998; 46:562.
  17. Sims RV, McGwin G Jr, Allman RM, et al. Exploratory study of incident vehicle crashes among older drivers. J Gerontol A Biol Sci Med Sci 2000; 55:M22.
  18. Fitten LJ, Perryman KM, Wilkinson CJ, et al. Alzheimer and vascular dementias and driving. A prospective road and laboratory study. JAMA 1995; 273:1360.
  19. Gallo JJ, Rebok GW, Lesikar SE. The driving habits of adults aged 60 years and older. J Am Geriatr Soc 1999; 47:335.
  20. Foley DJ, Wallace RB, Eberhard J. Risk factors for motor vehicle crashes among older drivers in a rural community. J Am Geriatr Soc 1995; 43:776.
  21. Hemmelgarn B, Suissa S, Huang A, et al. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997; 278:27.
  22. Ball KK, Roenker DL, Wadley VG, et al. Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? J Am Geriatr Soc 2006; 54:77.
  23. Summala H, Mieminen T, Punto M. Maintaining lane position with peripheral vision during in-vehicle tasks. Hum Factors 1996; 38:442.
  24. Rizzo M. Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving. JAMA 2011; 305:1018.
  25. Retchin SM, Anapolle J. An overview of the older driver. Clin Geriatr Med 1993; 9:279.
  26. Health Care Financing Administration Office of National Cost Estimates. National health expenditures 1988; Health Care Financing. Rev 11:1:290.
  27. Meuleners LB, Duke J, Lee AH, et al. Psychoactive medications and crash involvement requiring hospitalization for older drivers: a population-based study. J Am Geriatr Soc 2011; 59:1575.
  28. Abrams W, Beers M, Berkow R. Older drivers. In: Merck Manual of Geriatrics, 2nd ed, Whitehouse Station, NJ 1995. p.1420.
  29. Warshaw G, Moqeeth S. Hearing Impairment. In: Practical Ambulatory Geriatrics, Yoshikawa TT, Cobbs EL, Brummel-Smith K (Eds), Mosby, St. Louis 1998. p.118.
  30. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil 1986; 67:387.
  31. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39:142.
  32. Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: a marker of physical frailty. J Am Geriatr Soc 1992; 40:203.
  33. Flowers CW Jr, Baker RS. Eye Disorders. In: Practical Ambulatory Geriatrics, Yoshikawa TT, Cobbs EL, Brummel-Smith K (Eds), Mosby, St. Louis 1998. p.482.
  34. Warshaw, G, Moqeeth, S. Hearing Impairment. In: Practical Ambulatory Geriatrics, Yoshikawa TT, Cobbs EL, Brummel-Smith K (Eds), Mosby, St. Louis 1998. p.118.
  35. Mulrow CD, Lichtenstein MJ. Screening for hearing impairment in the elderly: rationale and strategy. J Gen Intern Med 1991; 6:249.
  36. Valcour VG, Masaki KH, Blanchette PL. Self-reported driving, cognitive status, and physician awareness of cognitive impairment. J Am Geriatr Soc 2002; 50:1265.
  37. Man-Son-Hing M, Marshall SC, Molnar FJ, Wilson KG. Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. J Am Geriatr Soc 2007; 55:878.
  38. Ott BR, Heindel WC, Papandonatos GD, et al. A longitudinal study of drivers with Alzheimer disease. Neurology 2008; 70:1171.
  39. Ball K, Edwards JD, Ross LA, McGwin G Jr. Cognitive training decreases motor vehicle collision involvement of older drivers. J Am Geriatr Soc 2010; 58:2107.
  40. Stutts JC, Stewart JR, Martell C. Cognitive test performance and crash risk in an older driver population. Accid Anal Prev 1998; 30:337.
  41. Freund B, Gravenstein S, Ferris R, et al. Drawing clocks and driving cars. J Gen Intern Med 2005; 20:240.
  42. Marottoli RA, Cooney LM Jr, Wagner R, et al. Predictors of automobile crashes and moving violations among elderly drivers. Ann Intern Med 1994; 121:842.
  43. Hunt L, Morris JC, Edwards D, Wilson BS. Driving performance in persons with mild senile dementia of the Alzheimer type. J Am Geriatr Soc 1993; 41:747.
  44. Trobe JD, Waller PF, Cook-Flannagan CA, et al. Crashes and violations among drivers with Alzheimer disease. Arch Neurol 1996; 53:411.
  45. Scialfa C, Ference J, Boone J, et al. Predicting older adults' driving difficulties using the Roadwise Review. J Gerontol B Psychol Sci Soc Sci 2010; 65:434.
  46. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189.
  47. Joseph PG, O'Donnell MJ, Teo KK, et al. The mini-mental state examination, clinical factors, and motor vehicle crash risk. J Am Geriatr Soc 2014; 62:1419.
  48. Rapoport MJ, Herrmann N, Molnar FJ, et al. Sharing the responsibility for assessing the risk of the driver with dementia. CMAJ 2007; 177:599.
  49. Hunt LA, Murphy CF, Carr D, et al. Reliability of the Washington University Road Test. A performance-based assessment for drivers with dementia of the Alzheimer type. Arch Neurol 1997; 54:707.
  50. Cushman LA, Stein K, Duffy CJ. Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality. Neurology 2008; 71:888.
  51. Wood JM, Anstey KJ, Kerr GK, et al. A multidomain approach for predicting older driver safety under in-traffic road conditions. J Am Geriatr Soc 2008; 56:986.
  52. Jones Ross RW, Scialfa CT, Cordazzo ST. Predicting On-Road Driving Performance and Safety in Cognitively Impaired Older Adults. J Am Geriatr Soc 2015; 63:2365.
  53. Betz ME, Jones VC, Lowenstein SR. Physicians and advance planning for 'driving retirement'. Am J Med 2014; 127:689.
  54. Friedland RP. Strategies for driving cessation in Alzheimer Disease. Alzheimer Dis Assoc Disord 1997; 11 Suppl 1:73.
  55. Grabowski DC, Campbell CM, Morrisey MA. Elderly licensure laws and motor vehicle fatalities. JAMA 2004; 291:2840.
  56. Cable G, Reisner M, Gerges S, Thirumavalavan V. Knowledge, attitudes, and practices of geriatricians regarding patients with dementia who are potentially dangerous automobile drivers: a national survey. J Am Geriatr Soc 2000; 48:14.
  57. Scherlis E. Are physicians liable for injuries caused by impaired patients. Medical Malpractice 1996; VIII:3.
  58. Marottoli R. The assessment of older drivers. In: Principles of Geriatric Medicine and Gerontology, 4th ed, Hazzard WR, Blass JP, Halter JB, Ouslander JG (Eds), McGraw-Hill, New York 1999.
  59. Highway traffic act, 1990. Section c.H.8, s. 203 [1]. Government of Ontario.
  60. Redelmeier DA, Yarnell CJ, Thiruchelvam D, Tibshirani RJ. Physicians' warnings for unfit drivers and the risk of trauma from road crashes. N Engl J Med 2012; 367:1228.
  61. Physician's Guide to Assessing and Counseling Older Drivers. Available at: www.ama-assn.org/ama/pub/category/10791.html (Accessed on October 12, 2011).