“This was surprising, as we know that older drivers stop driving based on the advice of their physicians and, if reported to licensing authorities, few regain driving privileges,” said lead author Yll Agimi, Ph.D., M.P.H., M.S., a health data scientist at Salient CGRT Inc. who did the research while a doctoral student at Pitt Public Health. “Physicians are required to ensure the well-being of patients with dementia by also monitoring their driving competence. That leads us to conclude that other licensing requirements may act as the principal means of identifying at-risk older drivers, before physicians identify and report a patient with a medical impairment, such as dementia.”
Previous studies have shown that drivers with dementia perform
significantly worse in on-road testing, compared to those without
dementia. Prevalence of dementia increases with age, from 9 percent
among adults ages 65 and older, to 30 percent among those over 85.
At the time of the study, three states – Pennsylvania, Oregon and California
– required physicians to report drivers with dementia to licensing
authorities. Twenty-seven states provided legal protection to physicians
who report their patients, regardless of whether such reporting is
required by law.
Only five states do not require that drivers present in-person –
which is thought to allow licensing personnel to assess driving fitness –
for license renewal at least once within two or three renewal cycles.
Two states require road testing at licensing renewal, and 36 states
require vision testing.
Agimi and his colleagues analyzed the crash-related hospital
admissions from the states reporting data between 2004 and 2009. Among
136,987 hospitalized older drivers, 5,564 had a diagnosis of dementia.
Hospitalized drivers aged 60 to 69 in states with in-person renewal
laws were 37 to 38 percent less likely to have dementia than drivers in
states without such laws and 23 to 28 percent less likely in states
with vision testing at in-person renewal. However, physician reporting
laws were not associated with a lower likelihood of dementia among
hospitalized drivers. These findings held even after the researchers
accounted for other factors that could influence crash rates, ranging
from police enforcement of safe driving to inclement weather.
“The results of our study point to age-based licensing requirements as an effective way to improve safety,” said co-author Steven M. Albert, Ph.D., M.S., chair and professor of the Department of Behavioral and Community Health Sciences
at Pitt Public Health. “But such requirements also may cause social
isolation and depression, and may be seen as ageist and discriminatory.
So it is very important that our findings spur further study to
determine the best approach to ensure safe driving for all on the road
while avoiding a negative impact on the mental health of older adults.”
Additional authors of this study are Ada O. Youk, Ph.D., and
Patricia Documet, M.D., Dr.P.H., of Pitt Public Health, and Claudia A.
Steiner, M.D., M.P.H., Agency for Healthcare Research and Quality (AHRQ) at the time of study.
This work was supported by an Association of Schools and Programs of Public Health/National Highway Traffic Safety Administration
fellowship awarded to Agimi, and data access obtained through
collaboration with the Healthcare Cost and Utilization Project, AHRQ of
the U.S. Department of Health and Human Services.