Should There Be Mandatory Driving Tests for Older Drivers?

Recently, in a city near Toronto, Canada, a 73-year-old man drove his car onto the sidewalk, killing a woman and maiming another. According to the Hamilton Spectator,

Police say the 73-year-old driver may have had a medical issue that contributed to the crash ... "Multiple people calling in an erratic driver so someone who is all over the roadway," said Insp. Derek Davis. "While police were on route there was a collision." Davis says police don't believe the driver purposely left the road and that it was "happenstance" the pedestrians were in the SUV's path.

An interesting choice of words, reminding me of a James Bond movie, where Goldfinger says to Bond: "Once is happenstance; twice is coincidence, and three times is enemy action." On this issue, we are at the enemy action stage; a lot of people are being killed by drivers who have medical incidents, who are driving while taking serious medications, or no longer have the vision, hearing or reaction time needed to drive safely. (To be fair, the vast majority of older drivers are really experienced, slow down, don’t drive on highways or at night, know their limitations and adapt.)

In an earlier post, When is it time to hang up the car keys? I suggested that instead of waiting for the keys to be taken away, we should be forcefully throwing them away and looking at alternatives. But that's easy for me to say; I live in a city that offers alternatives. Barb Chamberlain of Washington Bikes does too, describing Seattle in When I Get Older: Why I’m Counting on a Multimodal System:

When that day comes — someone pries the car keys out of your fingers or you’re smart and give them up without being asked — you may be pretty happy that we invested in completing sidewalks with curb cuts so you can get to the bus stop and get down to the coffee shop to hang out with your buddies and talk about the good old days... I expect riding my bike to keep me younger longer than my folks (who were pretty robust physically well into their 80s as it was). When I get a bit wobbly for two wheels I’ll switch to three. If the day comes when I have to stop riding, transit will still be there for me.

The problem is that three quarters of older Americans live in communities that don’t have the density to support public transit. They really have no choice about driving. When they lose their licenses, they lose everything, and it can lead to a death spiral of loneliness and isolation. That's one of the reasons so few states have mandatory driving re-tests. Anne McCartt of the Insurance Institute for Highway Safety (IIHS) tells Emily Yoffe of Slate:

"For most states, and most people in highway safety, the goal would be keeping older people driving as safely and as long as they can. Taking a license away is a major thing to do. It has a big effect on mobility and independence and states need good evidence before they impose this."

There's no good roadmap for testing

In the United States, the requirements for medical notes or testing for older drivers is all over the map. According to the IIHS:

In 18 states, there are shorter renewal periods required for drivers older than a specified age. Eighteen states require more frequent vision screening/testing for older drivers. In those states that allow drivers to renew their licenses by mail or online, 16 states and the District of Columbia do not allow this option for older drivers. Colorado limits drivers 66 and older to renewing only by mail every other renewal cycle while drivers under age 66 can renew by mail or online up to 2 consecutive renewals. In addition, the District of Columbia requires a physician's approval for drivers 70 and older to renew their licenses. Illinois requires applicants older than 75 to take a road test at every renewal.

In Europe, regulations are all over the map, too. According to the European Commission, some countries require a medical review every renewal starting at age 70; Finland has by far the toughest standard starting at the earliest age: "After age 45, medical review every five years, covering general health status and vision. Renewal requires medical examination and verification of ability by two people."

Do these requirements make a difference or are they unfair to older drivers?

One of the few evaluations of existing driver testing programmes has compared Finnish and Swedish licensing practices. Finland requires regular medical check-ups in conjunction with licence renewal, whereas Sweden has no such age-related control. A comparison of Finland and Sweden shows no apparent reduction in crashes as a result of the Swedish programme. However, Finland had a higher rate of fatalities among unprotected older road users than Sweden, arguably the result of an increase in the number of older pedestrians who had lost their driving licence.

In short, forcing older drivers out of their cars makes them more likely to be hit and killed by other drivers. Now that's counterintuitive.

Another study of drivers in Europe concluded that chronological age is "only a weak predictor of safe driving performance" and that all of this testing is pointless and counterproductive. In a review of the literature and licensing policies:

We find no evidence from the literature demonstrating that the benefits from age-based driver screening would outweigh the disadvantages, and we find the European policies, to a large extent, coercive and not evidence based. Based on research evidence, the policies are likely to limit the mobility and potentially worsen the safety of older persons.

So the North American and European consensus appears to be that the most sensible thing to do is let everyone keep driving until they start hitting things and people, because mobility! And freedom! And, more realistically, in most parts of North America, the cure is worse than the disease — people really need that mobility to have a life of any kind; it's the only way they can get around.

Which is all fine until it isn't. Eventually, almost everyone has to give up the keys. One U.S. study from 2002 determined the number of years people will need other ways of getting around:

A comparison of the men's and women's driving life expectancies with total life expectancies found that subsequent to driving cessation, men will have about 6 years of dependency on alternative sources of transportation, compared with about 10 years of dependency for women.

Go multi-modal!

Perhaps that's why it is so important for people to think about how they will live, and where they will live, when they can no longer drive. This is why the AARP livability index picked cities with good transit and walkability over the traditional Sunbelt retirement spots. This is why Barb Chamberlain likes Seattle and I like Toronto — there are so many ways to get around. Our towns are multi-modal, but like almost all of the most livable cities at the top of the the AARP index, almost nobody can afford to live there.

Most people in North America love their cars, their garages and their suburban houses. They love their mobility and their freedom — and they're going to keep driving. The government won't take away their keys, and their kids won't either. They love their mobility so much that they don’t see beyond the windshield view, what they're going to do when they can’t drive anymore. And with 75 million aging baby boomers driving down the pike, there are going to be a lot of people who shouldn't really be on the road but have no choice, and then they're in for a rude awakening.