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Like younger people in the US, older individuals rely most heavily on automobiles for transportation. People age 50 and older make nearly 90 percent of their local trips by private vehicle. The number of older drivers is growing at a fast pace, and these drivers are keeping their licenses longer and driving more. In 2008, nearly 90 percent of people 65 and older were licensed drivers (94% men; 75% women).
Despite the increase in the numbers of older drivers, older driver crash deaths and fatal crash involvements declined steadily during the past decade (1997–2008). Declines in the rates of older driver fatal crashes were found per licensed driver and per mile traveled. Relative to drivers age 35–54, driver fatal crash involvement rates declined at significantly faster rates for drivers age 70 and older, and an even more substantial decline was experienced by drivers 80 and older. A partial explanation may be that older drivers are policing themselves; for example, avoiding driving at dark or on high-speed roads. State licensing policies that reinforce these self-imposed limitations may contribute to the declines as well. Given that the odds of an older person surviving a crash have also improved, better individual health and physical conditioning, improvements in vehicle crashworthiness, and enhanced emergency medical services and trauma care may also help to explain the reduction in crash rates.
Despite these welcome trends, people age 65 and older constituted less than 13 percent of the US population in 2008, but they suffered 15 percent of all traffic fatalities. A driver 70 years or older is still about 3 times as likely as someone age 35 to 54 to sustain a fatal injury in a crash. This is due in large part to their increased frailty. Older adults have the lowest crash rate per licensed driver of all driving age groups; however, when analyzed by crashes per mile driven, the data show a rise in crash incidence after age 70. This can be explained, in part, by the fact that older adults drive fewer miles than younger drivers, thus skewing the data somewhat. Additionally, older people injure more easily than their younger counterparts and are more likely to die when injured in a crash.
Risks to safe driving arise from various factors. They may be related to the condition of a driver’s vehicle or be wholly circumstantial, such as road and highway conditions, traffic, weather, or time of day. But some safety risks are directly related to drivers themselves, such as cognitive impairment (e.g., reduced attention skills or inability to exercise proper judgment) and visual impairment (e.g., reduced visual acuity or peripheral vision). Physical functioning, such as reduced range of motion or motor control, may also affect driving capacity. While functional ability varies considerably among older individuals, as a whole this group is more likely than younger people to experience the kind of functional impairments that could affect driving skills.
There are several methods for potentially reducing the numbers of unsafe older drivers:
- State Agency Screening and Assessment
- Medical Professional Screening
- Law Enforcement Reporting
- Medical Advisory Boards
- Evidence-based Licensing Guidelines
- Programs to Combat Distracted Driving
- Provision of Alternative Transportation
Many people assess their own age-related changes in their driving ability. They adjust their driving to include such behaviors as driving only during daylight hours or at off-peak traffic times and avoiding left turns. Encouraging informed self-assessment and self-regulation is a key strategy to address unsafe driving behaviors.
State Agency Screening
Licensing drivers is a state function, and states differ in their rules for getting and renewing licenses. Many states require vision testing and rely on license-renewal applicants to self-report medical conditions that might put them at risk. All states have some avenue for referring drivers believed unsafe—whether by health professionals, law enforcement officials, or friends and family—to the department of motor vehicles. Many states that allow renewal by mail restrict that convenience to those with a clean driving record, while others require older people to take a road test when renewing their license. Trained motor vehicle department staff can screen all individuals when they apply for or renew their license, provide them with health questionnaires or rely on in-person renewal to identify individuals who may need further testing because they exhibit functional impairments, such as confusion or vision problems, known to affect driving skills. Most states give motor vehicle departments the discretion to require some kind of testing or obtain medical information to determine the existence or extent of a driving impairment. Training helps staff make informed and fair decisions about driver functioning that are not based on stereotypes about age or disability.
Medical Professionals Screening
The American Medical Association (AMA), in cooperation with the NHTSA, released the 2010 edition of The Physician’s Guide to Assessing and Counseling Older Drivers to advise doctors on the links among health, aging, and continued driving competence. Health professionals can use the information to counsel patients to understand, maintain, or regain driving ability. The guide also explains how to conduct a functional screening that may provide the basis for referring a driver to a rehabilitation specialist. However, most physicians do not favor mandatory reporting of patients who may be at risk. They believe it compromises the physician-patient relationship and they prefer to address concerns directly with their patients. Referrals are more likely to happen, though, in states that protect health professionals from liability claims.
Organizations such as the American Occupational Therapy Association and the Association for Driver Rehabilitation Specialists are also developing community resources for assessing drivers and remedying impaired functioning where trained specialists help older drivers overcome certain functional impairments that affect driving skills. Currently, however, certified driver rehabilitation specialists are few in number and unavailable in most communities, and many health professionals are unaware of the relationship between impaired functioning and driver risk.
Law Enforcement Reporting
Police officers can be a key resource in addressing the problem of unsafe older drivers. Yet officers often lack the training needed to identify potential impairments to driving beyond the use of alcohol or controlled substances. Training would increase officers’ knowledge of procedures for reporting at-risk drivers and help them understand the public safety benefits of writing a citation, as opposed to just issuing a warning.
Medical Advisory Boards
State medical advisory boards (MABs), found in various formats in all 50 states, can evaluate referred individuals and recommend appropriate, individualized licensing conditions which might include restrictions on time of day or areas for driving, the use of assistive technology, and/or requirements to return for further testing if a progressive disease or condition is involved. MABs can also recommend rehabilitation or remediation techniques to enhance certain individuals’ fitness to drive.
Evidence Based Licensing Guidelines
In order to identify and address drivers with functional impairments to driving, regardless of age, the American Association of Motor Vehicle Administrators (AAMVA) and the National Highway Transportation Safety Administration (NHTSA) are working to establish evidence-based guidelines for driver licensing.
A number of states have created task forces to work on keeping older people safe and mobile. The groups raise awareness about the needs of older drivers and provide resources to help older drivers assess and maintain skills. They also may consider how to provide alternative transportation for those who are driving less or not at all.
“Distracted driving” describes any nondriving activity in which a person engages that has the potential to distract him or her from the primary task of driving and increase the risk of crashing. The three types of distraction are:
- visual—taking your eyes off the road,
- manual—taking your hands off the wheel, and
- cognitive—taking your mind off what you are doing.
Examples of these distractions include: using a cell phone, eating and drinking, talking to passengers, grooming, reading maps, using a PDA or navigation system, changing the radio station or CD. While all distractions can compromise safe driving, texting on a smart phone or other device is the most alarming because it involves all three types of distraction. Drivers who use handheld devices are four times more likely to get into crashes serious enough to injure themselves. Using a cell phone while driving, whether it’s handheld or hands-free, delays a driver's reactions as much as having a blood alcohol concentration at the legal limit of .08 percent.
The proportion of drivers reportedly distracted at the time of a fatal crash increased from 8 percent in 2004 to 11 percent in 2008. That year nearly 6,000 people lost their lives, and an estimated 515,000 people were injured, in police-reported crashes in which at least one form of driver distraction was reported on the report. There are no federal laws governing distraction in cars. Thirty-eight states and territories have banned driving while using handheld devices or texting. The bans take the form of both primary laws (laws in which an officer can ticket the driver for the offense without any other traffic offense taking place) and secondary laws (where an officer can issue a ticket only if the driver has been pulled over for another driving violation). More prevalent and stronger state anti-driver-distraction laws and enforcement of those laws are needed to address this growing threat to road safety.
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