Aging Baby Boomers—A Blessing or Challenge for Driver Licensing Authorities

Introduction. In less than 5 years, the first wave of baby boomers will begin turning 65, with the last wave of boomers entering their senior years in January 2029. Currently, boomers make up a significant percentage of the population in Canada, the United States, and other developed countries. The baby boom generation has had a profound impact on our society over the last six decades, and this large cohort will continue to exert its influence for several decades to come. Central to this article is the rapid growth in the number of persons 65 years of age and older, beginning in 2011, with a corresponding increase in the number of older drivers. The demographic shift has important implications for licensing authorities, the regulatory bodies charged with licensing and ‘fitness to drive’ decisions. Objectives. The objectives of this paper are to summarize the published scientific literature on licensing policies and procedures currently in use for older drivers, discuss their limitations, and provide recommendations for meeting the upcoming challenges of an aging baby boomer population of drivers. Method. Online searches were conducted using the following databases: PsycINFO, MEDLINE, Scopus, and TRIS. Google and Google Scholar also were searched for scientific articles. References identified from database and online searches were examined for relevant articles. Results. A number of studies have investigated the utility of different licensing policies and procedures for identifying older drivers who may be at risk for impaired driving performance. Overall, results suggest that current policies and procedures are ineffective in identifying high-risk older drivers. The results also emphasize the need for a different approach for the identification of high risk older drivers by licensing agencies. Recommendations to assist with that goal are provided. Conclusions. The aging of the baby boomer population, combined with the projected high crash rates for this cohort of drivers as it moves through the senior years, underscores the need for cost-effective, accurate, and efficient methods for identifying and assessing the subgroup of older drivers whose driving has declined to an unsafe level. That subgroup consists of individuals with medical conditions (and treatments) affecting driving performance. The demographic shift has been a blessing for licensing authorities in that it has created awareness of the need for a reexamination of licensing policies and procedures designed to identify those older drivers who may no longer be safe to drive. If that awareness becomes translated into effective policies and procedures that appropriately target the medically at-risk/impaired older driver rather than the older driver per se, the result will be an increase in the safety and mobility of the older driving population and increased public safety overall. However, a continued focus on older drivers rather than medically at-risk drivers will result in a costly, ineffective, and overburdened system.

[1]  Michael D Keall,et al.  Association Between Older Driver Characteristics, On-Road Driving Test Performance, and Crash Liability , 2004, Traffic injury prevention.

[2]  M K Janke,et al.  Accidents, mileage, and the exaggeration of risk. , 1991, Accident; analysis and prevention.

[3]  Leonard Evans Age and fatality risk from similar severity impacts , 2001 .

[4]  C Lundberg,et al.  Can a Physician Recognize an Older Driver with Increased Crash Risk Potential? , 1996, Journal of the American Geriatrics Society.

[5]  B Dulisse,et al.  Older drivers and risk to other road users. , 1997, Accident; analysis and prevention.

[6]  L. Hakamies‐Blomqvist,et al.  Medical Screening of Older Drivers as a Traffic Safety Measure—A Comparative Finnish‐Swedish Evaluation Study , 1996, Journal of the American Geriatrics Society.

[7]  A. McKnight,et al.  Age-Based Road Test Policy Evaluation , 1996 .

[8]  N. Pachana,et al.  Alzheimer and vascular dementias and driving. A prospective road and laboratory study. , 1995, JAMA.

[9]  Thomas Müller-Bohn,et al.  Cost-Benefit Analysis , 2015 .

[10]  J. Haxby,et al.  Motor vehicle crashes in dementia of the alzheimer type , 1988, Annals of neurology.

[11]  S. Marshall,et al.  Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[12]  L. Tune,et al.  Driving in Patients with Dementia , 1988, Journal of the American Geriatrics Society.

[13]  A R Dobbs,et al.  Evaluating the Driving Competence of Dementia Patients , 1997, Alzheimer disease and associated disorders.

[14]  Suzanne G. Leveille,et al.  Trends in obesity and arthritis among baby boomers and their predecessors, 1971-2002. , 2005, American journal of public health.

[15]  Murray Mackay CRASH PROTECTION FOR OLDER PERSONS , 1988 .

[16]  R. Barr Recent Changes in Driving among Older Adults , 1991, Human factors.

[17]  Sarah M Viamonte,et al.  A Cost-Benefit Analysis of Risk-Reduction Strategies Targeted at Older Drivers , 2006, Traffic injury prevention.

[18]  L. Bonneux,et al.  High coronary heart disease rates among Dutch women of the baby boom, born 1945-1959: age-cohort analysis and projection. , 2003, European journal of public health.

[19]  D B Reuben,et al.  Driving and dementia California's approach to a medical and policy dilemma. , 1996, The Western journal of medicine.

[20]  Kathryn Ziegler-Graham,et al.  Forecasting the global burden of Alzheimer’s disease , 2007, Alzheimer's & Dementia.

[21]  T Vaa,et al.  Impairments, diseases, age and their relative risks of accident involvement: results from meta-analysis , 2003 .

[22]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2000. , 2002, JAMA.

[23]  J. Fries,et al.  Aging, natural death, and the compression of morbidity. 1980. , 2002, Bulletin of the World Health Organization.

[24]  F. Hobbs,et al.  65+ in the United States. , 1996 .

[25]  G. Mccoy,et al.  Injury to the elderly in road traffic accidents. , 1989, The Journal of trauma.

[26]  G. Cable,et al.  Knowledge, Attitudes, and Practices of Geriatricians Regarding Patients with Dementia Who Are Potentially Dangerous Automobile Drivers: A National Survey , 2000, Journal of the American Geriatrics Society.

[27]  V. Valcour,et al.  The detection of dementia in the primary care setting. , 2000, Archives of internal medicine.

[28]  Lawrence J Cook,et al.  Evaluating the crash and citation rates of Utah drivers licensed with medical conditions, 1992-1996. , 2002, Accident; analysis and prevention.

[29]  S Rosenbloom,et al.  MOBILITY OF THE ELDERLY: GOOD NEWS AND BAD NEWS , 2004 .

[30]  Stuart Vaughan Newstead,et al.  Effectiveness of Mandatory License Testing for Older Drivers in Reducing Crash Risk Among Urban Older Australian Drivers , 2004, Traffic injury prevention.

[31]  S E Torpey LICENCE RE-TESTING OF OLDER DRIVERS , 1986 .

[32]  D B Reuben,et al.  The Aging Driver Medicine, Policy, and Ethics , 1988, Journal of the American Geriatrics Society.

[33]  Stuart Vaughan Newstead,et al.  Some consequences of different older driver licensing procedures in Australia. , 2004, Accident; analysis and prevention.

[34]  J F Fries,et al.  Aging, natural death, and the compression of morbidity. , 1980, The New England journal of medicine.

[35]  M. Mcmurdo,et al.  A survey of attitudes and knowledge of geriatricians to driving in elderly patients. , 1999, Age and ageing.

[36]  S. Godwin,et al.  Improving mobility and safety for older persons , 1988 .

[37]  L Staplin,et al.  Retrospective evaluation of alternative vision screening criteria for older and younger drivers. , 1993, Accident; analysis and prevention.

[38]  Lawrence J. Cook,et al.  EVALUATING DRIVERS LICENSED WITH MEDICAL CONDITIONS IN UTAH, 1992-1996 , 1999 .

[39]  M. Albert,et al.  Performance-based driving evaluation of the elderly driver: safety, reliability, and validity. , 1994, Journal of gerontology.

[40]  S M Rock,et al.  Impact from changes in Illinois drivers license renewal requirements for older drivers. , 1998, Accident; analysis and prevention.

[41]  E. Braver,et al.  Fragility versus excessive crash involvement as determinants of high death rates per vehicle-mile of travel among older drivers. , 2003, Accident; analysis and prevention.

[42]  R. Fisher,et al.  Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. , 2003, Mayo Clinic proceedings.

[43]  S. Retchin,et al.  Performance‐Based Measurements Among Elderly Drivers and Nondrivers , 1988, Journal of the American Geriatrics Society.

[44]  Sandra Rosenbloom,et al.  Sustainability and automobility among the elderly: An international assessment , 2001 .

[45]  Federico Alvarez,et al.  Medical condition and fitness to drive: prospective analysis of the medical-psychological assessment of fitness to drive and accident risk , 2004 .

[46]  J. Vernick,et al.  Relationship between driver's license renewal policies and fatal crashes involving drivers 70 years or older. , 1995, JAMA.

[47]  T. Warke,et al.  Medical restrictions to driving: the awareness of patients and doctors , 1999, Postgraduate medical journal.

[48]  Maria Vegega,et al.  Medical conditions and driving : a review of the literature (1960-2000). , 2005 .

[49]  C. Owsley,et al.  The useful field of view test: a new technique for evaluating age-related declines in visual function. , 1993, Journal of the American Optometric Association.

[50]  D T Levy,et al.  The relationship of age and state license renewal policies to driving licensure rates. , 1995, Accident; analysis and prevention.

[51]  Harold N. Mozar,et al.  Driving and Alzheimer's disease , 1989 .

[52]  A. Williams,et al.  Older driver involvements in police reported crashes and fatal crashes: trends and projections , 2002, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[53]  L. Evans Risk of fatality from physical trauma versus sex and age. , 1988, The Journal of trauma.

[54]  Richard R. Rahr,et al.  A survey of attitudes and knowledge concerning HIV and universal precautions among PA students , 1993 .

[55]  D. O’Neill,et al.  Driver ageing does not cause higher accident rates per km , 2002 .

[56]  D. Grabowski,et al.  Elderly licensure laws and motor vehicle fatalities. , 2004, JAMA.