In 2017, one out of every five licensed drivers in the United States was age 65 years or older. Concern about older drivers has grown along with the number of older drivers on the roads, reinforced by sensationalized media reports about rare but tragic fatalities caused by impaired older drivers. As a group, the 43.6 million older licensed drivers are very safe, with lower absolute yearly crash rates than younger counterparts and fewer aggressive driving behaviors. According to data from the Insurance Institute for Highway Safety, exposure-adjusted crash risk increases around age 75 years. However, chronologic age plays less of a role in older adults’ driving outcomes than health issues that threaten the ability to continue driving safely.
Driving is not only a valued instrumental activity of daily living (IADL), but it also provides meaning and a sense of control over one’s life. Former drivers consistently report serious physical, mental, and social consequences of driving cessation. Therefore, the importance of public safety should not automatically outweigh individual autonomy and the right to drive, especially based on age alone. The difficult question remains: How can we identify older drivers who are unsafe or at high risk before a serious event, without placing unnecessary restrictions on their driving?
As a direct contact with intimate understanding of patients’ overall health, clinicians and, in particular, primary care providers remain one of the most trusted stakeholders in determining medical fitness to drive. Unfortunately, medical education contains little, if any, training on how to evaluate medical fitness to drive or communicate to patients when there is concern about their driving. Discussing driving with patients can be difficult and emotional, made more challenging because of time restrictions and competing medical priorities. Clinicians need the tools to navigate these situations, including clinical assessments to objectively evaluate patients’ driving-related functional abilities and a broader understanding of the roles driving and transportation mobility play in quality of life at every age.
In this chapter, we will lay out the underlying skills and abilities necessary for driving safety at every age; describe age-related physiologic changes and how they impact driving safety; consider tools for clinical environments to assess driving risk; outline the process and impacts of driving cessation; and finally discuss developing technologies with the potential to improve transportation mobility across the life span.
R. “I wish we could normalize driving health:” a qualitative study of clinician discussions with older drivers. J Gen Intern Med
MJ. Driving self-restriction in high-risk conditions: how do older drivers compare to others? J Safety Res