7. Older Drivers

Overview

In 2003, almost 15 percent of licensed drivers in the United States were at least 65 years old. By 2030 this proportion will rise to at least 20 percent. As drivers age, their physical and mental abilities, driving behaviors, and crash risks all change, though age itself does not determine driving performance. Many features of the current system of roads, traffic signals and controls, laws, licensing practices, and vehicles were not designed to accommodate older drivers. Older Americans are increasingly dependent on driving to maintain their mobility, independence, and health. The challenge is to balance mobility for older drivers with safety for all road users.

Trends. From 1982 to 2003, the proportion of older licensed drivers (65 and above) rose from 11.2 percent to 14.6 percent while the proportion of older drivers in fatal crashes rose more rapidly, from 7.0 percent to 11.2 percent.

By 2030, the Census Bureau estimates that the resident population over age 65 will double, to over 71 million, and will comprise 19.1 percent of the total population. The licensed driver population likely will grow even faster. The proportion of people over age 65 who held a driver's license rose from 63 percent in 1982 to 80 percent in 2003. If the licensure rate remains at 80 percent, by 2030 there will be twice as many older drivers in the United States as there are today - as many as 57 million licensed drivers 65 and older. Currently 90 percent of people 65 to 69 are licensed, as are 86 percent of people 70 to 74. The licensure rate probably will increase because tomorrow's older people likely will be healthier and more accustomed to driving than today's. By 2030, if 85 percent of older people are licensed there will be 61 million licensed drivers at least 65 years old.

Older driver characteristics. Certain changes are inevitable as drivers age (NCHRP, 2004, Section III).

• Physical capabilities diminish. Hearing, muscle tone, reaction time, and vision (especially at night) all decline, though at very different rates for different people.
  
  
• Fragility increases. The same force produces more serious injuries to a 70-year-old than to a 20-year-old. Injuries take longer to heal.
  
  
• Older drivers use more medications, which may be necessary to control disease or health conditions but which also may cause drowsiness or otherwise affect driving. Older drivers are less likely than younger people to be impaired by alcohol or recreational drugs.
  
  
• Older drivers rarely drive aggressively or speed. But they may exhibit other risky behaviors such as driving more slowly than prevailing traffic or not accurately judging the speed of an oncoming vehicle while making a left turn.
  
  
• Most older drivers reduce their driving mileage as their lifestyles change. Many older drivers recognize and voluntarily do not drive in situations in which they feel uncomfortable, such as at night, on high-speed roads, or in unfamiliar situations (Staplin and Lococo, 2003, p. 25).

Fatal: crashes per 30,000 drivers All: crashes per 100 drivers

Source: IIHS (2005)

These characteristics produce the following results.

• The older driver crash rate per licensed driver is lower than for younger drivers.
  
  
• Because older drivers are more fragile, a crash is more likely to produce a serious injury or fatality than for younger drivers. Thus the fatal crash rate per licensed driver increases for the oldest drivers.
  
  
• And because older drivers drive fewer miles annually than younger drivers, their fatal crash rate per mile traveled is higher than for all but the youngest drivers.

Strategies to Reduce Crashes and Injuries Involving Older Drivers

The overall goal is to enable older drivers to retain as much mobility through driving as is consistent with safety on the road for themselves, their passengers, and other road users. "Safe mobility for life" is the phrase used in the U.S. Department of Transportation's plan (USDOT, 2003). Four behavioral strategies address this goal.

• Educate and train older drivers to assess their driving capabilities and limitations, improve their skills when possible, and voluntarily limit their driving to circumstances in which they can drive safely. This can be accomplished through formal courses or through communications and outreach provided directly to older drivers or to families, friends, and organizations that deal regularly with older drivers.
  
  
• Help drivers adapt to medical or functional conditions that may affect driving, through treatment (such as eyeglasses or cataract surgery to improve vision) or through vehicle adaptations (such as extra mirrors, extended gear shift levers, or hand controls).
  
  
• Identify older drivers who cannot drive safely in certain situations or at all, and restrict or revoke their driver's licenses. This involves two steps:
  
  
  • Bring these drivers to the attention of the motor vehicle department through license renewal procedures or through referral from law enforcement, physicians, family, or friends.
    
    
  • At the motor vehicle department, assess their driving abilities and take appropriate action to re-issue an unrestricted license, issue a restricted license, or revoke the license.
    
    
• Increase safety belt use, because safety belts are even more effective for older than for younger occupants.

Vehicular, environmental, and societal strategies are critical to provide safety and mobility for older people. Vehicles can be designed with better crash protection for older and more easily injured occupants, with controls and displays that are easier to see and understand, and with crash warning and crash avoidance technology. These measures will make vehicles safer for everyone, not just older people. Aftermarket vehicle devices such as one-hand joystick driving controls can permit people with some physical limitations to drive. Roadways with separate left turn lanes, protected left turn signal phases, larger and more-visible signage, more-visible lane markings, rumble strips, and a host of other measures will assist all drivers. These subjects are not discussed in this guide because they do not fall under direct SHSO jurisdiction.

Of all the problem areas in this guide, the older driver problem is perhaps the most complex because it involves so many issues beyond traffic safety. Sooner or later, in the interest of safety, most older drivers must restrict or eliminate driving. Frequently, this has substantial effects on the older driver's mobility and on physical and mental health. SHSOs and licensing agencies cannot act alone but must plan and implement their older driver policies and programs as part of integrated community activities to improve older people' safety, mobility, and health. As just one example, some communities have established referral centers where people can go for "one-stop" access to resources for addressing the full range of transportation safety and mobility issues, including driving skills assessment, educational courses, licensing regulations and practices, and public transportation. See Stutts (2005, Chapter 8) for summaries of comprehensive programs for older drivers in five States.

Several recent studies and policy papers discuss the issues involved. See in particular the Department of Transportation's Safe Mobility for a Maturing Society: Challenges and Opportunities (USDOT, 2003) and NCHRP's Guide for Addressing Collisions Involving Older Drivers (NCHRP, 2004) for excellent summaries and references to further information. OECD's Ageing and Transport: Mobility Needs and Safety Issues (OECD, 2001) presents a discussion from a European perspective. The recent NCHRP synthesis, Improving the Safety of Older Road Users (Stutts, 2005), summarizes State activities as of 2005.

Key terms AAA: formerly the American Automobile Association; the organization now uses only the initials AAMVA: American Association of Motor Vehicle Administrators AARP: formerly the American Association of Retired Persons; the organization now uses only the initials AMA: American Medical Association ASA: American Society on Aging Older driver: a driver at least 65 years old.

Countermeasures That Work

Countermeasures to improve older driver safety are listed below and discussed individually in this chapter. The table is intended to give a rough estimate of each countermeasure's effectiveness, use, cost, and time required for implementation. The terms used are described below. Effectiveness, cost, and time to implement can vary substantially from State to State and community to community. Costs for many countermeasures are difficult to measure, so the summary terms are very approximate. See each countermeasure discussion for more information.

1. Communications and Outreach

Countermeasure	Effectiveness	Use	Cost	Time
1.1 Formal courses for older drivers	Uncertain	Low	Low	Short
1.2 General communications and education	Uncertain	Unknown	Low	Short

2. Licensing

Countermeasure	Effectiveness	Use	Cost	Time
2.1 License renewal policies	Unknown	Medium	High	Medium
2.2 Referring older drivers to DMVs	Proven	Low	Medium	Medium
2.3 License screening and testing	Proven	High	Medium	Medium
2.4 Medical advisory boards	Unknown	High	Varies	Medium
2.5 License restrictions	Likely	Unknown	Low	Short

3. Traffic Law Enforcement

Countermeasure	Effectiveness	Use	Cost	Time
3.1 Law enforcement responsibilities	Likely	Medium	Varies	Varies

Effectiveness:

Proven: demonstrated by several high-quality evaluations with consistent results.
Likely: balance of evidence from high-quality evaluations or other sources.
Uncertain: limited and perhaps ambiguous evidence.
Unknown: no high-quality evaluation evidence.
Varies: different methods of implementing this countermeasure produce different results.

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.

See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.

Use:

High: more than two-thirds of the States, or a substantial majority of communities.
Medium: between one-third and two-thirds of States or communities.
Low: fewer than one-third of the States or communities.
Unknown: data not available.

Cost to implement:

High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources.
Medium: requires some additional staff time, equipment, facilities, and/or publicity.
Low: can be implemented with current staff, perhaps with training; limited costs for equipment or facilities.

Time to implement:

Long: more than one year.
Medium: more than three months but less than one year.
Short: three months or less.

These estimates do not include the time required to enact legislation or establish policies.