Report 6 of the Council on Scientific Affairs (A-03)

Older Driver Safety

Summary

Objective. To describe public health concerns associated with older drivers and discuss efforts to optimize the safety of these drivers, including current and past American Medical Association (AMA) initiatives.

Methods. Statistics and scientific data were gathered from government publications and from literature searches in the MEDLINE database for articles published from January 1990 through January 2003. English-language references containing information relevant to crash risk factors and the assessment and rehabilitation of older drivers were examined further. The report also reflects the dialogue between researchers in the field of driver safety and representatives from specialty societies, patient advocacy groups, and government agencies who participated in the AMA’s Older Drivers Project.

Results. Older drivers suffer a disproportionately high rate of motor vehicle fatalities compared with other adult drivers. This disproportion is due to an increased rate of crash per vehicle mile driven, and an increased risk of fatality in the event of a crash. Crash rates begin to rise at age 70 years and continue to increase with advancing age. In addition, older adults are 5 to 6 times more likely to die of a comparable injury than their younger counterparts. Pre-crash factors may include decline in driving abilities, how well the individual adapts his/her driving behaviors to compensate for declining abilities, and the incompatibility of the vehicle and road with the driver’s physical and functional capacities. During a crash, physical fragility and failure of the vehicle to provide appropriate protection may contribute to injuries and fatalities. After a crash, the individual’s course of recovery depends on his/her baseline health and physiologic reserve and the level of health care provided.

Conclusions. Enabling older drivers to continue to drive safely involves optimizing the driver’s baseline health, functional abilities, and driving behaviors through health care and rehabilitation; optimizing the driving environment by adapting roads, traffic control, and signage to accommodate the older driver’s capabilities; and optimizing the vehicle by implementing design features that enhance the older driver’s comfort, access to vital information, and protection in the event of a crash. When an individual is no longer safe to drive, he/she requires sympathetic communication of this information by the health care professional and/or driver licensing agency and access to senior-friendly transportation.

Physicians play a major role in helping their older patients maintain their driving safety, yet lack of well-defined medical and legal guidelines may pose a barrier to fulfilling this role. The AMA and other medical organizations continue to address this need through physician education and the production of tools for physicians. Physicians are encouraged to utilize these tools as needed to aid them in the management of their older patients’ driving safety.

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 2003 AMA Annual Meeting:

The AMA:

1. Recognizes that the safety of older drivers is a growing public health concern that is best addressed through multi-sector efforts to optimize vehicle design, the driving environment, and the individual’s driving capabilities, and (a) believes that because physicians play an essential role in helping patients slow their rate of functional decline, physicians should increase their awareness of the medical conditions, medications, and functional deficits that may impair an individual’s driving performance, and counsel and manage their patients accordingly; (b) encourages physicians to familiarize themselves with driver assessment and rehabilitation options, refer their patients to such programs whenever appropriate, and defer recommendations on permanent driving cessation until establishing that a patient’s driving safety cannot be maintained through medical interventions or driver rehabilitation; (c) urges physicians to know and adhere to their state’s reporting statutes for medically at-risk drivers; and (d) encourages continued scientific investigation into strategies for the assessment and management of driving safety in the clinical setting. (Policy)
2. Encourages physicians to use the Physician’s Guide to Assessing and Counseling Older Drivers as an educational tool to assist them in helping their patients. (Policy)

Also see:  Wang CC, Carr DB, for the Older Drivers Project.  Older driver safety. A report from the Older Drivers Project.  J Am Geriatr Soc. 2004;52:143-149.

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