Identifying Policy Approaches to Extending the Safe Mobility of Older Adults
The objective of this project was to examine effective policies and practices in driver licensing of older and medically at-risk drivers and offer practical guidance to driver licensing officials and policymakers.
As the United States population ages, it will become increasingly important to understand and effectively address the mobility needs of older adults spread throughout various types of communities and travel environments, and representing a wide range of medical, functional, and personal characteristics. Driving and driver licensing play an important role in safe mobility for older adults and will continue to do so. However, states and stakeholders face complex challenges in implementing driver licensing policies and practices for older drivers that effectively balance public safety and individual mobility. States currently use a variety of licensing practices with provisions for older drivers including shorter renewal periods, more frequent vision testing, and in-person renewal requirements. Some form of medical review process is also part of most licensing practices for older drivers. Nevertheless, much remains to be learned about the impact of various licensing policies on older-driver crash risk and mobility.
To achieve the research objective, four major tasks were undertaken. The first was to review the literature examining older-driver policies internationally and their impact on crashes, traffic safety, and mobility. The second was to conduct in-depth interviews with representatives from licensing authorities to learn more about current practices, successes, challenges, needs, and recommendations. The third was to conduct multivariate analyses using data from a large-scale multi-site prospective cohort study of aging drivers, Longitudinal Research on Aging Drivers (LongROAD), which is funded by the AAA Foundation for Traffic Safety, to examine individual and environmental factors that may mediate or moderate the effectiveness of different licensing policies. The final task was to develop recommendations to offer practical guidance to driver licensing officials and policymakers. The final report discusses each of the tasks that were conducted. For each of first three tasks (international literature review, in-depth interviews, and analysis of LongROAD data), detailed information is provided about the background of the task, the methods or approach used to complete the task, the results from the task, and overall conclusions. These sections are followed by the recommendations developed in the final task, which are grouped into licensing renewal, physician reporting and referrals by others, the medical review process, and partnerships to promote older driver safety and mobility.
Collectively, results from this study indicate that there is considerable variability across jurisdictions in terms of the combination of licensing policies and practices in place. These results reaffirm the conclusions reached by previous investigators, and are not surprising given the unique needs, resources, and priorities in each jurisdiction. At the same time, similarities were found in several areas of policy and practice, including: the use of restricted/conditional licenses, the offer of some type of immunity/confidentiality for physician reporting, provisions for accepting referrals from others, and having in place a medical review and assessment process. The recommendations for improving licensing policies and practices are in keeping with many of the prior recommendations outlined in the report. However, research on the safety effects of licensing policies and practices is still limited, even though its importance has been recognized by researchers, licensing representatives, and other stakeholders.
A number of research questions and issues of interest were identified by specific area of licensing policy and practice. Collectively, they speak to the need for continuing and expanding research on the safety outcomes associated with specific policies, taking into account the effects of other policies in place, as well as other potential confounding variables such as differences in individual and jurisdictional characteristics not related to licensing (e.g., roadway features and driving conditions). In addition, they point to the importance of better understanding the safety outcomes associated with various practices and programs, such as education and training of licensing staff and professionals who refer or work with older drivers in various capacities. There is also an opportunity to more fully explore the mechanisms by which safety outcomes are realized and the effects of such outcomes on older adults’ mobility and wellbeing. Finally, there would be great benefit in conducting translational research to help states design and implement comprehensive coalitions and collaborations to support older-adult safe mobility of which licensing agencies would be a part, based on successful and promising elements of existing models.