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Effectiveness: Proven for identifying drivers whose driving should be limited. 4 Star Proven for identifying drivers whose driving should be limited. Cost: $$
Use: High
Time: Medium

State licensing agencies vary considerably in their procedures for screening and evaluating a driver’s abilities and skills (Potts et al., 2004; Pomidor, 2019; Lococo, Stutts, et al., 2017; NHTSA, 2017).

The Model Driver Screening and Evaluation Program Guidelines for Motor Vehicle Administrators (Staplin & Lococo, 2003) was developed as part of the final stage in a research program that investigated the relationships between functional impairment and driving skills, methods to screen for functional impairment, and the cost, time, legal, ethical, and policy implications of the guidelines (Staplin et al., 2003a).The goal of these guidelines is to keep drivers on the road as long as they can drive safely through early identification and assessment together with counseling, remediation, and license restriction when needed (Staplin & Lococo, 2003). The guidelines, tested in Maryland, outline a complete process of driver referral, screening, assessment, counseling, and licensing action (Staplin & Lococo, 2003; Staplin et al., 2003b). They include nine visual inspection tests licensing agency personnel can administer to screen for functional ability (Staplin & Lococo, 2003). The results of a survey of State motor vehicle departments outline some of the legal, policy, cost, and other criteria required before the implementation of guidelines in some States.

In 2008 the screening and testing of older drivers was a major discussion at the North American License Policies Workshop sponsored by AAAFTS. One of the general themes of this workshop was “while certain declines are generally associated with aging, consensus is lacking on whether or at what age people should be required to be screened or tested. Regardless, it is generally accepted that final licensing decisions should be based on functional performance, not age, as there is wide variation in how people age” (Molnar & Eby, 2008, p.3). In 2009 NHTSA and AAMVA developed the Driver Fitness Medical Guidelines, which provides guidance for driver licensing authorities by medical condition based on available evidence.


The AAAFTS publishes the database, Driver Licensing Policies and Practices, showing each State's driver licensing policies and practices regarding older and medically at-risk drivers. This database was updated in 2019 (Graham et al., 2020). Additionally, the IIHS (2021a) maintains a list of license renewal procedures by State that compares older driver requirements to the general population. See Countermeasure “License Restrictions” for more information.


There is strong evidence that State screening and assessment programs identify some drivers who should not be driving at all or whose driving should be limited. The Maryland pilot test of the model guidelines concluded, “the analysis results ... have provided perhaps the best evidence to date that functional capacity screening, conducted quickly and efficiently, in diverse settings, can yield scientifically valid predictions about the risk of driving impairment experienced by older individuals” (Staplin et al., 2003b). In a study evaluating the use of a screening tool on Alabama drivers 18 to 87, older drivers (65 and older) performed significantly worse than drivers younger than 65 years old, and older drivers with a crash history performed worse than older drivers without crashes (Edwards et al., 2008).


Costs associated with the model guideline functional screening include both administrative and support service expenses (Staplin et al., 2003a).

Time to implement:

States should be able to modify their driver license screening and assessment procedures in 4 to 6 months.