MEETING WITH EXPERTS
Ranks 11, 15, 21, and 30: Extent of DMV Testing for License Renewal
Regarding vision screening at renewal, one MAB physician consultant mentioned a study published in the Journal of the American Medical Association that found State-mandated tests of visual acuity were associated with a lower fatal crash risk for drivers 70 and older (Levy, Vernick, and Howard, 1995). This finding indicates vision screening at renewal (for drivers 70 and older) has public safety benefits. Another MAB physician said the MAB just recommended to its administrator that visual exams be eliminated at renewal for drivers between 20 and 40. Starting at 40 (when vision starts to change) is when the DMV should have vision screening as part of the renewal process. Drivers who are younger than 20 and have low-vision or eye diseases would already have been flagged by vision screening for initial licensure. Drivers who have developed an eye disease between initial licensure and renewal vision screening at age 40 will be identified at renewal when they are asked whether they have any of the listed medical conditions.
One attendee commented that currently in her jurisdiction, drivers renewing their licenses must have their vision tested every 5 years. Legislation to require drivers 70 and older to renew every 2 years and have a vision test was put “on hold” until at least 2006 in this jurisdiction. Although meeting attendees agreed it has become increasingly acceptable to consider driver age in the determination of license renewal practices, DMVs still face legislative barriers to implementing such testing.
Regarding road testing for license renewal, one MAB physician consultant said the study published by Levy et al. (1995) found State-mandated road tests at renewal for drivers 70 and older did not reduce the fatal crash risk. Therefore, by itself, it is not a useful mechanism for identifying at-risk drivers.
Regarding knowledge testing at renewal, one MAB physician consultant said the Levy et al. (1995) study found State-mandated knowledge tests, when added to vision testing of drivers 70 and older, reduced the fatal crash risk. This finding indicates that knowledge testing at renewal (for drivers 70 and older) has public safety benefits. One meeting attendee said in her jurisdiction, a knowledge test might be included in the renewal process, along with a road test, if the renewal examiner sees signs of cognitive impairment.
Several meeting attendees said sometimes when drivers fail the knowledge test it is because of a language barrier. Employees need to be sensitive to that. Concerning older drivers and knowledge testing, one jurisdiction produces large-print paper knowledge tests, which are easier for older drivers to take than computer-based knowledge tests and smaller-print tests. Oral knowledge tests are also useful for older people with low levels of education who have not taken a test since they obtained their original licenses. Such tests should include a lot of traffic signs. One attendee noted that computer-based knowledge tests, even when given on touch screens, are upsetting to some senior citizens.
Regarding the implementation of functional screening at license renewal, it was mentioned by one physician in attendance that new public health initiatives are often met with resistance, but many initiatives have overcome the initial resistance (e.g., funding for prenatal and maternal health, smoking cessation). She said DMVs need to work on getting resources and the requisite changes in the law, to get functional screening in place. In order to get laws changed and funding in place, meeting attendees said legislators must be educated about the importance of functional screening for identifying at-risk drivers.
To address the barrier of funding for functional screening, NHTSA staff in attendance verified that funding under 23 U.S.C. § 402 could be requested for such activities (through the State’s Governor’s Office of Highway Safety). One meeting attendee said it is not feasible, because of time and training constraints, to conduct functional screening within the DMV. Her jurisdiction tried functional screening, but found that for renewals, it was just easier to ask the driver questions than to try to conduct tests. In this particular jurisdiction, if a license is not renewed within 30 minutes, the DMV is required to refund the driver the license renewal fee. When reexamination is necessary to determine whether people are functionally fit to drive, referring them somewhere for testing would be more feasible than trying to conduct tests within the DMV. It may be noted that the conduct of functional screening for reexamination was weighted as less valuable in the RVA (weight = 1.42, rank = 28), than functional screening at license renewal (weight = 1.72, rank = 21).
In one jurisdiction where studies of functional screening are in progress, the meeting participant said it was evident functional screening is not appropriate for all renewalsjust those over 40 (vision) and over 55 (for cognitive, physical, and perceptual testing). In this jurisdiction, functional screening is looked upon as a preventive early interventionthe classic prevention model of early identification leading to remediation and helping to maintain a healthy quality of life. This participant s aid it feeds into the idea that the DMV’s purpose is not to take away licensesits purpose is to help customers drive safely (for their own health, as well as for public safety). In this same jurisdiction, the attendee said license examiners (as opposed to counter personnel) are the appropriate people in the DMV to conduct functional testing.
A NHTSA representative pointed out that until 100 percent of all physicians become aware of all the issues and make recommendations, it seems likely the only reliable fallback method of identifying drivers with medical/functional impairments is a regular assessment at the DMV. Because the validity of functional screening information declines over time, system safety is best served by initiating screening at an age early enough that most if not alldrivers are “functionally intact.” Theoretically, this translates to some time in the decade of the 40’s, for visual functions, and in the 50’s or 60’s, for cognitive functions. However, analyses in the Maryland Pilot Study indicate it will not be cost-effective for a jurisdiction to screen at renewal until at least age 70, and possibly later. This is because it is only at these later ages that a significant number of drivers experience declines that place themselves and others at risk if they continue to drive unaware of their functional status. Further, since reliability of functional screening data for an individual decreases over time, two years is as long as a jurisdiction would want to go without retesting. (Staplin, Gish, and Wagner, 2003).