Safe Driving

Background

People age 50 and older make nearly 90 percent of their local trips by private vehicle. The number of older drivers is growing quickly, and these drivers are keeping their licenses longer and driving more often. According to the Federal Highway Administration, in 2014, over 90 percent of people age 50-69 were licensed drivers, and over 80 percent of people age 70-80 were licensed drivers. Among those age 85 and older, the licensing rate drops to just under 70 percent.

Incidence of death and injury for older drivers—despite an increase in the number of older drivers, the incidence of older driver crash deaths and fatal crash involvements declined steadily between 1997 and 2008. Driver fatal crash involvement rates declined significantly more for drivers age 70 and older than they did for drivers age 35-54, with drivers age 80 and older experiencing an even more substantial decline. Especially notable were declines in fatal crash involvement rates for intersection crashes and two-vehicle crashes: The fatality rate for older drivers decreased more that for drivers age 35-54, even though such crash types have accounted for a disproportionate number of crashes among older drivers in the past.

A partial explanation for these declines may be that older drivers are regulating their own driving. For example, they may avoid 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, it seems likely that better individual health and physical conditioning, improvements in vehicle crashworthiness, and enhanced emergency medical services and trauma care may also help explain the reduction in crash involvement and death rates.

Despite these welcome trends, people age 65 and older still suffer higher motor vehicle fatalities compared with the general population. A driver age 70 or older is still about three times as likely as someone age 35-54 to sustain a fatal injury in a crash. In large part this is due to increased frailty. Among all age groups, older adults have the lowest crash rate per licensed driver. However, when examining the number of crashes per mile driven, crash incidence rises after age 70. This can be explained, in part, by lower driving exposures. That is, older adults drive fewer miles than younger drivers, and thus they may be more vulnerable in high traffic situations. Additionally, because of their fragility, older adults injure more easily than their younger counterparts and are more likely to die when injured in a crash.

Threats to safe driving arise from various factors. They may be related to the condition of a driver’s vehicle, road and highway conditions, traffic, weather, or time of day. Some safety risks are directly related to drivers themselves, such as cognitive impairment, visual impairment, and physical impairments. Medications may also affect critical driving skills. Research is underway to better understand other functional impairments that may compromise an individual’s ability to drive safely. More knowledge about the indicators of impaired driving skills, and about strategies for remediation, would enable states to design licensing regulations that would allow older adults to drive safely for as long as possible. It would also allow states to accurately identify and effectively regulate unsafe drivers.

In the meantime there are several methods for potentially reducing the number of unsafe older drivers. A discussion of the key strategies follows.

Self-regulation—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 critical for addressing unsafe driving behaviors.

State agency screening and assessment—licensing drivers is a state function, but states differ in their rules for getting and renewing licenses. Many states require vision testing but may rely on license-renewal applicants to self-report medical conditions that might put them at risk. All states do have some avenue for referring drivers believed to be unsafe to the department of motor vehicles. These referrals can be by health professionals, law enforcement officials, or friends and family. In addition many states that allow renewal by mail restrict that convenience to people with clean driving records.

Many motor vehicle department personnel rely on in-person renewal to identify individuals who may need further testing. Signs of functional impairment might include 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. A study by the National Highway Traffic Safety Administration (NHTSA) and the Maryland Motor Vehicle Administration shows that functional screening conducted by trained staff can identify drivers who are at risk of an accident. The research also found that drivers who fail a skills assessment do not necessarily have to stop driving. Effective training of motor vehicle licensing staff helps ensure informed, 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. This guide is a resource for physicians on the links among health, aging, and continued driving competence. It explains how to conduct a functional screening that may provide the basis for referring a driver to a rehabilitation specialist. Health professionals can use the information to counsel patients on how to maintain or regain driving ability. Physicians may also take a web-based training course on these issues to acquire continuing education credits.

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. Nonetheless, AMA ethical guidelines state that “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.”

Organizations such as the American Occupational Therapy Association and the Association for Driver Rehabilitation Specialists are developing community resources for assessing drivers and remedying impaired functioning where possible. For example, occupational therapists trained and certified in driver assessment and rehabilitation may help older drivers overcome certain functional impairments that affect driving skills.

Law enforcement reporting—law enforcement 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 increases officers’ knowledge of procedures for reporting at-risk drivers and helps them understand the public safety benefits of writing a citation instead of just issuing a warning. NHTSA has developed a law enforcement training curriculum for state use.

Medical advisory boards—state medical advisory boards (MABs) can evaluate referred individuals and recommend appropriate, individualized licensing conditions. Recommendations might include restrictions on time of day or areas for driving, use of assistive technology, and requirements to return for further testing. MABs can recommend rehabilitation or remediation techniques to enhance fitness to drive. All 50 states and the District of Columbia have some form of medical review of drivers. But only two licensing agencies directly employed medical advisers. Most were volunteers or paid consultants.

Evidence-based licensing guidelines—establishing an evidence-based system to identify and address drivers who have functional impairments to driving has proven difficult. The American Association of Motor Vehicle Administrators and NHTSA have proposed somewhat controversial evidence-based guidelines for driver licensing. Some states have implemented pilot programs to test evidence-based licensing. For example, in 2007 the California Department of Motor Vehicles (DMV) tested an evidence-based driver assessment program for license renewals involving a physical exam, cognitive exam, and road test. However, a California DMV evaluation of this program showed that it did not definitively decrease the crash risk of program participants and may have caused some drivers to stop driving prematurely.

Alternative transportation—a number of states have created taskforces to work on keeping older adults safe and mobile. These taskforces 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—nondriving activity that has the potential to distract the driver and increase the risk of crashing can take three forms:

  • visual distractions—taking one’s eyes off the road,
  • manual distractions—taking one’s hands off the steering wheel, and
  • cognitive distractions—taking one’s mind off what one is doing.

There are myriad distractions: using a cell phone, eating and drinking, talking to passengers, grooming, reading maps, using a navigation system, watching a video, changing the radio station, and the like. In-car Wi-Fi and voice-recognition software makes driver distraction even more of a concern.

Although all distractions can compromise safe driving, texting on a smartphone or other device is especially 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 handheld or hands-free, delays a driver’s braking reactions similar to having a blood-alcohol concentration at the legal limit of .08 percent.

There were 3,179 fatalities and 431,000 injuries due to driver distraction in 2014; the number of injuries rose 9 percent from 2011. Distracted driving accounts for 15 percent to 30 percent of all vehicular crashes, and experts suspect that these statistics may underestimate the role of distraction in fatal crashes. Driver surveys show that two-thirds of motorists report using cell phones while driving and one-eighth of them report texting while driving.

No federal laws govern distraction in private vehicles using private devices. But a 2009 executive order bans federal employees from texting while driving while in government-issued vehicles or using a government-issued phone. Federal employees also may not text while driving using their personal vehicle and phone if they are using either to conduct government business. In addition, in 2011 the National Transportation Safety Board recommended that all states and the District of Columbia ban the nonemergency use of portable electronic devices (other than those designed to support the task of driving) while driving. And the Moving Ahead for Progress in the 21st Century Act offers incentive grants to states that prohibit text-messaging by all drivers and ban cell phone use by teen drivers.

Many states have responded to the call to ban texting while driving. As of 2016, 46 states, along with District of Columbia, Puerto Rico, Guam, and the US Virgin Islands, ban text messaging for all drivers. In addition, 14 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands ban all drivers from using handheld cell phones while driving. Thirty-eight states and the District of Columbia ban all cell phone use by novice drivers, and 20 states and the District of Columbia do so for school bus drivers.

Distracted walking can lead to injury for pedestrians as well. A survey by Liberty Mutual found that more than half of the adult respondents (55 percent) indicated that texting or emailing while crossing the street is dangerous. Nevertheless pedestrian injuries due to cell phone use tripled between 2004 and 2010.

Safe Driving: Policy

License renewal

In this policy: LocalState

State and local governments should improve public safety by requiring all drivers to renew licenses in person at regular intervals.

Alternatives to driving

In this policy: LocalState

State and local governments should provide information and counseling on alternative modes of transportation.

Denial appeals

In this policy: LocalState

State and local governments should create and use appropriate procedures for drivers who want to appeal license denials, suspensions, and revocations.

Enforcing suspended license laws

In this policy: LocalState

State and local governments should support and promote increased enforcement and penalties for those who continue to drive after their licenses have been suspended or revoked.

Public education

In this policy: FederalLocalState

Governments should support the expansion of public education programs on safe driving—including programs that encourage self-assessment and self-regulation—and should increase the number of qualified professionals performing scientifically based driver assessment, rehabilitation, and education.

The federal Department of Transportation (DOT) and the state governments should promote the development and dissemination of information on the interaction between health and driving functions for distribution to the public and to health, aging, and transportation professionals.

Education programs should also discourage all road users (drivers, pedestrians, bicyclists, etc.) from engaging in distracting activities that could put them, and others, in harm’s way.

Model licensing systems

In this policy: FederalLocalState

The DOT, including the National Highway Safety Administration (NHTSA) and Federal Highway Administration (FHWA), and other agencies should cooperate in encouraging states to develop, implement, and evaluate model driver licensing systems. This could include improved driver assessment, individualized licensing options, and uniform medical guidelines for counseling and licensing functionally impaired drivers.

State and local governments should use effective, evidence-based assessment models to identify at-risk drivers. The licensing agency should:

  • require assessment of functional impairments, such as reduced vision or cognitive skills;
  • provide counseling and referrals that enable individuals to seek professional evaluation and remediation for functional impairments;
  • require that individuals who exhibit functional impairments be given a road test tailored to identify impediments to safe driving; and
  • take appropriate action, including issuing licenses tailored to the individual, based on road test results.

State and local governments should establish medical advisory boards that evaluate individuals whose driving capacity may be impaired and that advise motor vehicle administrators on medical issues. These boards should include physicians and other professionals who are immune from liability claims by individuals under review.

Training, referral, and immunity

In this policy: FederalLocalState

State and local governments should:

  • support training of law enforcement personnel that emphasizes identification of at-risk drivers and referral to licensing authorities for further screening and assessment;
  • support training of physicians, advanced practice registered nurses (APRNs), nurses, and allied health professionals to screen and assess at-risk drivers and to directly encourage patients to seek rehabilitation, education, limitations on driving, or other measures to enhance safety as needed;
  • encourage physicians, APRNs, nurses, and allied health professionals to voluntarily report patients who pose a threat to the safety of themselves or the public yet ignore a physician’s advice to stop driving, consistent with the American Medical Association (AMA) ethics policy; and
  • support immunity from liability claims for physicians, APRNs, nurses, and allied health professionals who act in good faith in reporting potentially at-risk drivers to licensing authorities.

The federal government should continue to encourage activities leading to greater training of, and referral activity by, law enforcement and medical professionals, consistent with the AMA’s ethics policy.

Distracted driving

In this policy: FederalLocalState

Policymakers should adopt policies that promote safe driving, free of distractions, including those caused by the use of cell phones, text-messaging devices, or other electronic devices, for all drivers and operators of all modes of transportation that it has the authority to regulate.

Congress should adopt legislation that encourages states to enact policies—including appropriate legislation and regulation—that promote safe driving behavior, free of distractions, for all drivers and operators of all modes of transportation under state regulatory authority.

States should pass primary laws that prohibit the use of wireless devices for voice or text communication while driving and should make fines for violations expensive enough to act as an effective deterrent.

Research

In this policy: Federal

Congress should fund additional research by NHTSA, the National Institute on Aging, and FHWA to determine the relationship between driving performance and age-related functional limitations.

Certification standards

In this policy: Federal

Congress and the NHTSA should support the development of standards for driver assessment, education, and rehabilitation certification.