Aging often leads to vision problems, including cataracts, macular degeneration and loss of peripheral vision, as well as other physical and cognitive problems. Cataracts can be corrected, but drivers often struggle to get through a period where reduced vision makes driving difficult or even dangerous before cataracts become sufficiently handicapping Medicare, the health insurance for most older Americans, to cover moving costs.
Even so, deteriorating vision may not prevent a driver from renewing their license. According to a study published in 2021 by the Insurance Information Institute. Maryland, for example, requires proof of adequate vision at age 40 and at every eight-year renewal thereafter and Oregon at age 50. But eight other states require no proof at any age, while Texas requires a vision test at 79 and Florida at 80.
DC requires all drivers to show proof of adequate vision for every eight-year renewal and requires those over 70 to renew in person. Young drivers in Virginia, who renew every eight years, are required to show proof of adequate vision only at each renewal. In contrast, drivers 75 and older must renew their license every five years and must do so in person with adequate proof of vision.
Slower reactions, diminished cognitive abilities
Vision is not the only obstacle to safe driving. Michelle Andreoli, an ophthalmologist and clinical spokesperson for the American Academy of Ophthalmology, said that in her clinical practice, “vision is often not the thing I really worry about. … We should really care about cognitive functioning of people driving on freeways, and it’s often untested in most states.
Decreased cognitive abilities – the confusion resulting from forgetting your route on the way to a destination, for example – can have a negative impact on driving. Cognitive skills are a complex mix of visual perception and processing and the ability to pay attention and juggle multiple tasks at once. A driver with a green light may not be able to react quickly enough to prevent a pedestrian from running off the sidewalk into the light. Or someone distracted by a billboard may not notice the merging of two lanes.
Elderly drivers may also have illnesses common in the elderly, such as arthritis, which affect mobility, or conditions such as seizures or epilepsy which can cause loss of consciousness. Another threat is drugs that can make drivers drowsy and inattentive. Older drivers with increasing illnesses may use them more heavily or may be more affected by them than younger people.
Not all of these problems have solutions, but some are offset by better road engineering and added car equipment to make driving safer for older drivers and others, according to several studies.
Factors that have contributed to safer driving include improved road signs with larger, brighter and easier to read letters; no more left turn signals (left turns go through traffic, road crossings and intersections in general are common problems for older drivers); larger, easier-to-see numbers on car dashboards; and reversing cameras. Side-curtain airbags have been successful in helping to prevent deaths and injuries among older drivers who may be more vulnerable in the event of a crash due to their increased frailty.
Up to a point, aging drivers do quite well. According to AAA Road Safety Foundation, drivers in their 60s were the safest among age cohorts by most measures. But the rate of all crashes and those involving injury and death increased thereafter. Fatal crash rates were highest per 100 miles driven for drivers over 80, although rates tend to drop for older drivers in general. The fatal accident rate for drivers aged 70 and over peaked in 1997when automakers began researching and installing equipment that could help keep drivers safe.
There has been “success on many fronts,” including due to changes in car and roadway design, said Jessica Cicchino, vice president of research at the Insurance Institute for Highway Safety. “Today’s older drivers are not the same as yesterday’s.” They are healthier than in previous decades and drive safer vehicles, she said.
However, older drivers tend to hang on to their cars longer, so they may not benefit from safety changes made by automakers, she said. More recent improvements include systems that beep when a driver exits a lane; automatic braking systems that stop or slow a car when a potential collision is detected; and night vision systems that help drivers spot pedestrians in the dark.
When it’s time to return the keys
One of the biggest challenges in getting dangerous aging drivers off the road is convincing them it’s time to hand over the keys.
“It’s completely life changing” when someone stops – or is forced to stop – driving, said Anne M. Menke, former risk manager for the Ophthalmic Mutual Insurance Co.
“The American Medical Association advises physicians that “in situations where clear evidence of a substantial impairment in conduct involves a substantial threat to patient and public safety, and where the physician’s advice to discontinue privileges of driving is ignored, it is desirable and ethical to notify the Department of Motor Vehicles,” Menke wrote in a Q&A on the topic. “Some states require physicians to report, others allow but do not compel reporting, while a few consider reporting a breach of confidentiality. There could be liability and penalties if a physician does not is not acting in accordance with state reporting and confidentiality laws,” she advised.
Part of the problem with keeping older drivers safe is that the difficulties are dealt with piecemeal by different professions with different objectives, including gerontologists, highway administration officials, automotive engineers and others, a said Elizabeth Dugan, associate professor of gerontology at the University of Massachusetts. “There is no national institute for older driver studies,” she said. “We need better evidence about what makes drivers unsafe” and what can help, said Dugan, who has written extensively on healthy aging for Consumer Reports and other organizations.
One thing that seems to be working is requiring drivers to show up in person for license renewal. Mandatory in-person renewal was associated with a 31% reduction in fatal crashes involving drivers aged 85 or older, according to a study. Passing vision tests also resulted in a similar drop in fatal crashes for these drivers, although there appears to be no benefit to combining the two.
Many older drivers do not see an eye doctor or cannot afford to do so. Primary care providers have their hands full and may not be able to keep up with patients who have difficulty driving because they can’t turn their heads or remember where they are going – or where they have become. shorter and have not changed their seat settings enough to easily reach the car pedals.
As long as there are other cars on the road, self-driving cars won’t solve crash problems, Dugan said. Avoiding the dangers posed by all those human drivers would require too many algorithms, she said. But we need to do more to improve safety, Dugan said.
“If we want to have 100-year-old lives, we need cars that a 90-year-old can drive comfortably.”
