Not all older adults have insight into their driving abilities: evidence from an on-road assessment and implications for policy.

PURPOSE To compare self-reported driving ability with objective measures of on-road driving performance in a large cohort of older drivers. METHODS Two hundred and seventy community-living adults aged 70-88 years recruited via the electoral roll completed a standardized assessment of on-road driving performance and questionnaires determining perceptions of their own driving ability, confidence, and driving difficulties. Retrospective self-reported crash data over the previous 5 years were recorded. RESULTS Participants reported difficulty with only selected driving situations, including driving into the sun, in unfamiliar areas, in wet conditions, and at night or dusk. The majority of participants rated their own driving as good to excellent. Of the 47 (17%) drivers who were rated as potentially unsafe to drive, 66% rated their own driving as good to excellent. Drivers who made critical errors, where the driving instructor had to take control of the vehicle, had no lower self-rating of driving ability than the rest of the group. The discrepancy in self-perceptions of driving ability and participants' safety rating on the on-road assessment was significantly associated with self-reported retrospective crash rates, where those drivers who displayed greater overconfidence in their own driving were significantly more likely to report a crash. CONCLUSIONS This study demonstrates that older drivers with the greatest mismatch between actual and self-rated driving ability pose the greatest risk to road safety. Therefore, licensing authorities should not assume that when older individuals' driving abilities begin to decline they will necessarily be aware of these changes and adopt appropriate compensatory driving behaviors; rather, it is essential that evidence-based assessments are adopted.