TOO OLD TO DRIVE?
It takes more than age to determine when it’s time to take away the keys
In 2020, drivers 75 years old and above numbered more than 17 million. And that was two years before the leading edge of the baby boom started reaching its mid-70s. Now those numbers are climbing, along with the candles on their cakes.
That’s not necessarily a bad thing, experts say. Many older drivers retain their skills later into life, carmakers are equipping cars to make them safer, and roadways are being designed for increased safety. Still, forces are at work on older bodies that put aging drivers — and those around them — at risk.
Aging often brings impairments to vision, including cataracts, macular degeneration and loss of peripheral vision, as well as other physical and cognitive problems. Cataracts can be corrected, but drivers often struggle through a period when reduced vision makes driving difficult — if not dangerous — before cataracts become disabling enough for Medicare, the health insurance of most older Americans, to cover the cost of their removal.
Even so, deterioration in vision may not prevent a driver from renewing a license. There is no uniformity in how state motor vehicle administrations assess vision problems, according to a study published in 2021 by the Insurance Information Institute. Maryland, for instance, requires proof of adequate vision at age 40 and at every eightyear renewal thereafter, and Oregon at age 50. But eight other states don’t require proof at any age, while Texas requires a vision test at age 79 and Florida at age 80.
Washington, D.C., requires all drivers to show proof of adequate vision for each eight-year renewal
Cognitive skills are a complex mix of visual perception and processing and the ability to pay attention and juggle multiple tasks at once.
and requires those over 70 to renew in person. Younger drivers in Virginia, who renew every eight years, are required to show proof of adequate vision only every other renewal. In contrast, drivers 75 years and older have to renew their license every five years and must do so in person with proof of adequate vision.
Vision isn’t the only impediment to safe driving. Michelle Andreoli, an ophthalmologist who is clinical spokesperson for the American Academy of Ophthalmology, said that in her clinical practice, “vision is often not the thing that really worries me . ... We should really care about the cognitive functioning of people driving on highways, and that’s often not tested in most states.”
Diminished cognitive skills — confusion that results from forgetting your route on the way to a destination, for instance — can negatively impact driving. Cognitive skills are a complex mix of visual perception and processing and the ability to pay attention and juggle multiple tasks at once. A driver with a green light may not be able to react fast enough to avoid a pedestrian stepping off the curb against the light. Or someone distracted by a billboard may not notice two lanes merging.
Older drivers may also have diseases common in old age, such as arthritis, that affect mobility, or conditions including seizures or epilepsy that can result in loss of consciousness. Another threat: medications that can make drivers drowsy and inattentive. Older drivers with increasing ailments may use them more heavily or may be more affected by them than younger people.
Not all of these problems have solutions, but some are being offset by better road engineering and added equipment for cars to make driving safer for older — and other — drivers, according to several studies.
Factors that have contributed to safer driving include improved roadway signs with larger, brighter and easier-to-read letters; more left-turn signals (left turns across traffic, road merges and intersections in general are common problems for older drivers); larger, easier-to-see numbers on car dashboards; and backup cameras. Sidecurtain air bags have been a success in helping prevent deaths and injuries among older drivers who might be more vulnerable in crashes because of increased frailty.
Up to a point, aging drivers do quite well. According to the AAA Foundation for Traffic Safety, drivers in their 60s were the safest among age cohorts by most measures. But the rate for all crashes and those involving injury and death went up after that.
Fatal crash rates were the highest per 100 miles driven for drivers over 80, even though the rates have been trending down for older drivers in general. The rate of fatal crashes for drivers 70 and older peaked in 1997, when auto manufacturers were beginning to research and install equipment that could help keep drivers safe.
There has been “success on multiple fronts,” especially because of changes in car and roadway design, said Jessica Cicchino, vice president for research at the Insurance Institute for Highway Safety. “Today’s older drivers are not the same as yesterday’s.” They are healthier than in previous decades and are driving safer vehicles, she said.
However, older drivers tend to hang on to their cars longer, so they may not be benefiting from the safety changes automakers have made, she said. More recent improvements include systems that beep when a driver drifts out of a lane; automatic braking systems that stop or slow a car when a potential collision is detected; and nightvision systems that help drivers spot pedestrians in the dark.
One of the biggest challenges in keeping unsafe aging drivers off the road is convincing them that it’s time to turn over the keys.
“It’s a complete lifechanger” when someone stops — or is forced to stop — driving, said Anne M. Menke, a former risk manager for the Ophthalmic Mutual Insurance Co.
“The American Medical Association advises physicians that ‘in situations where clear evidence of substantial driving impairment implies a strong threat to patient and public safety, and where the physician’s advice to discontinue driving privileges is ignored, it is desirable and ethical to notify the Department of Motor Vehicles,’ ” Menke wrote in a Q&A on the subject. “Some states require physicians to report, others allow but do not mandate reports, while a few consider a report a breach of confidentiality. There could be liability and penalties if a physician does not act in accordance with state laws on reporting and confidentiality,” she counseled.
Part of the problem in keeping older drivers safe is that the difficulties are addressed piecemeal by different professions with different focuses, including gerontologists, highway administration officials, automotive engineers and others, said Elizabeth Dugan, an associate professor of gerontology at the University of Massachusetts. “There’s not a National Institute of Older Driver Studies,” she said. “We need better evidence on what makes drivers unsafe” and what can help, said Dugan, who has written extensively about healthy aging for Consumer Reports and other organizations.
One thing that does seem to work is requiring drivers to report in person for license renewal. Mandatory inperson renewal was associated with a 31 percent reduction in fatal crashes involving drivers 85 or older, according to one study. Passing vision tests also produced a similar decline in fatal crashes for those drivers, although there appeared to be no benefit from combining the two.
Many older drivers don’t see eye doctors or can’t afford to. Primary care providers have their hands full and may not be able to follow through with patients who have trouble driving because they can’t turn their heads or remember where they are going — or have gotten shorter and haven’t changed their seat settings sufficiently to reach car pedals easily.
As long as there are other cars on the roads, self-driving cars won’t solve the problems of crashes, said Dugan. Avoiding dangers posed by all those human drivers would require too many algorithms, she said. But we need to do more to improve safety, said Dugan.
“If we’re going to have 100-year lives, we need cars that a 90-year-old can drive comfortably.”
Fatal crash rates were the highest per 100 miles driven for drivers over 80, even though the rates have been trending down for older drivers in general.