Background: Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. Objective: To investigate the effect of advanced age on driving safety in drivers with medical conditions. Methods: We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55–64 years, n = 1,386), young-old (65–74 years, n = 1,013), old-old (75–84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. Results: The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20–9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87–4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88–4.12) compared to the middle-aged. Conclusion: Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs.

1.
Centers for Disease Control and Prevention: The state of aging and health in America 2013. Atlanta, GA, US Department of Health and Human Services, 2013.
2.
United Nations: World population ageing. New York, NY, United Nations, 2015.
3.
National Highway Traffic Safety Administration: Traffic safety facts – older population – 2015 data. Washington, DC, US Department of Transportation, 2017.
4.
Highway Loss Data Institute: Estimating the effect of projected changes in the driving population on collision claim frequency. Arlington, VA, Highway Loss Data Institute, 2012.
5.
TRIP: Keeping baby boomers mobile: preserving the mobility and safety of older Americans. Washington, DC, TRIP, 2012.
6.
Centers for Disease Control Prevention, National Center for Injury Prevention and Control: Web-based Injury Statistics Query And Reporting System (WISQARS). Washington, DC, US Department of Health and Human Services, 2015.
7.
Cicchino JB, McCartt AT: Trends in older driver crash involvement rates and survivability in the United States: an update. Accid Anal Prev 2014; 72: 44–54.
8.
Meuser TM, Carr DB, Ulfarsson GF: Motor-vehicle crash history and licensing outcomes for older drivers reported as medically impaired in Missouri. Accid Anal Prev 2009; 41: 246–252.
9.
Lin SF, Beck AN, Finch BK, Hummer RA, Master RK: Trends in US older adult disability: exploring age, period, and cohort effects. Am J Public Health 2012; 102: 2157–2163.
10.
McGwin G Jr, Sims RV, Pulley L, Roseman JM: Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study. Am J Epidemiol 2000; 152: 424–431.
11.
Lotfipour S, Sayegh R, Chakravarthy B, Hoonpongsimanont W, Anderson CL, Fox JC, Vaca FE: Fatality and injury severity of older adult motor vehicle collisions in orange county, California, 1998–2007. West J Emerg Med 2013; 14: 63–68.
12.
Anstey KJ, Wood J, Lord S, Walker JG: Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev 2005; 25: 45–65.
13.
Sifrit KJ, Stutts J, Staplin L, Martell C: Intersection crashes among drivers in their 60s, 70s and 80s. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, San Francisco, CA, 2010.
14.
Andrea DJ, Fildes BN, Triggs TJ: The assessment of safe and unsafe turns by young and older drivers. Annual Proceedings of the Association for the Advancement of Automotive Medicine, Barcelona, Spain, 1999.
15.
Hollis AM, Lee AK, Kapust LR, Phillips LK, Wolkin J, O’Connor MG: The driving competence of 90-year-old drivers: from a hospital-based driving clinic. Traffic Inj Prev 2013; 14: 782–790.
16.
National Highway Traffic Safety Administration: Clinician’s Guide to Assessing and Counseling Older Drivers (ed 3). Washington, DC, US Department of Transportation, 2016.
17.
Moon S, Ranchet M, Tant M, Akinwuntan AE, Devos H: Comparison of unsafe driving across medical conditions. Mayo Clin Proc 2017; 92: 1341–1350.
18.
Van Den Meerschaut C: Rijgeschiktheid. Semper 1998; 226: 1–35.
19.
World Health Organization: Global health and ageing. Geneva, Switzerland, World Health Organization, 2011.
20.
Jacobsen LA, Mather M, Lee M, Kent M: America’s aging population. Popul Bull 2011; 66(1).
21.
Tomassini C: The demographic characteristics of the oldest old in the United Kingdom. Popul Trends 2005;Summer: 15–22.
22.
Devos H: Evaluation and rehabilitation of driving ability in people with neurological conditions (thesis). Leuven, 2011, pp 9–12. https://www.researchgate.net/publication/280298589_Evaluation_and_Rehabilitation_of_Driving_Ability_in_People_with_Neurological_Conditions (accessed December 5, 2017).
23.
Dobbs B: Medical conditions and driving: a review of the scientific literature (1960–2000). Washington, DC, National Highway Traffic Safety Administration, 2005.
24.
Driver and Vehicle Licensing Agency: Assessing fitness to drive: a guide for medical professionals. Swansea, UK, Driver and Vehicle Licensing Agency, 2017.
25.
Austroads: Assessing fitness to drive for commercial and private vehicle drivers. Sydney, Australia, National Transport Commission, 2016.
26.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.
27.
Uc EY, Rizzo M: Driving and neurodegenerative diseases. Curr Neurol Neurosci Rep 2008; 8: 377–383.
28.
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H: Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord 2009; 23: 306–314.
29.
Vaa T: Impairments, diseases, age and their relative risks of accident involvement: results from meta-analysis. Oslo, Norway, Institute of Transport Economics, 2005.
30.
Marshall SC: The role of reduced fitness to drive due to medical impairments in explaining crashes involving older drivers. Traffic Inj Prev 2008; 9: 291–298.
31.
Tefft BC: Motor vehicle crashes, injuries, and deaths in relation to driver age: United States, 1995–2010. Washington, DC, AAA Foundation for Traffic Safety, 2012.
32.
Ranchet M, Tant M, Akinwuntan AE, Morgan JC, Devos H: Fitness-to-drive disagreements in individuals with dementia. Gerontologist 2017; 57: 833–837.
33.
Ranchet M, Tant M, Akinwuntan AE, Neal E, Devos H: Comorbidity in drivers with Parkinson’s disease. J Am Geriatr Soc 2016; 64: 342–346.
34.
Ranchet M, Akinwuntan AE, Tant M, Salch A, Neal E, Devos H: Fitness-to-drive agreements after stroke: medical versus practical recommendations. Eur J Neurol 2016; 23: 1408–1414.
35.
Ranchet M, Akinwuntan AE, Tant M, Neal E, Devos H: Agreement between physician’s recommendation and fitness-to-drive decision in multiple sclerosis. Arch Phys Med Rehabil 2015; 96: 1840–1844.
36.
Devos H, Akinwuntan AE, Gelinas I, George S, Nieuwboer A, Verheyden G: Shifting up a gear: considerations on assessment and rehabilitation of driving in people with neurological conditions. An extended editorial. Physiother Res Int 2012; 17: 125–131.
37.
Carr DB, Ott BR: The older adult driver with cognitive impairment: “It’s a very frustrating life.” JAMA 2010; 303: 1632–1641.
38.
Bacon D, Fisher RS, Morris JC, Rizzo M, Spanaki MV: American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence. Neurology 2007; 68: 1174–1177.
39.
United Nations: World population ageing: 1950–2050. New York, NY, United Nations, 2001.
40.
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 2003; 56: 221–229.
41.
Papa M, Boccardi V, Prestano R, Angellotti E, Desiderio M, Marano L, Rizzo MR, Paolisso G: Comorbidities and crash involvement among younger and older drivers. PLoS One 2014; 9:e94564.
42.
Anstey KJ, Wood J, Caldwell H, Kerr G, Lord SR: Comparison of self-reported crashes, state crash records and an on-road driving assessment in a population-based sample of drivers aged 69–95 years. Traffic Inj Prev 2009; 10: 84–90.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.