A Looming Crisis for Senior Mobility

By 2025, people aged 65 and older will account for 25 percent of U.S. drivers, yet state licensing systems and mobility alternatives for older drivers for the most part are inadequate and inconsistent. A recent AAA Foundation report notes seniors and their families face serious challenges in maintaining personal mobility, including determining whether they remain capable of safely operating a motor vehicle, whether their driving can be improved, or - if unable to drive safely - how they can continue to be mobile.

To address the complex challenges presented by an aging population of motorists, the Foundation brought together a cross section of top transportation and health experts from federal and state governments, insurance industry, medical profession, universities and advocates for the elderly. The workshop final report details specific recommendations to improve licensing systems, including encouraging voluntary reporting of potentially dangerous drivers by health care professionals and others, expanding the use of medical advisory boards, and enhancing the training and education for everyone involved in identifying and protecting high-risk drivers.

"When you hear the thunder, it's too late to build the ark, yet states are not doing enough to prepare for the flood of older drivers that will be behind the wheel in the coming years," AAA Foundation President and CEO Peter Kissinger said. "Nobody should have their car keys taken away simply because they reach a certain age.  Instead, states should screen all drivers applying for new or renewed licenses to ensure they are medically and functionally fit to drive through procedures like eye exams and in-person renewal - but that is not happening. If remedies aren't put in place today, we can expect a significant rise in highway safety deaths in the years ahead. That should concern all of us, young and old alike."

Organizations such as the American Association of Motor Vehicle Administrators (AAMVA) and others have begun the hard work of developing strategies, like model driver screening procedures, to help motorists continue driving for as long as safely possible. And the AAA Foundation believes a continued focus and increased action is needed to ensure consistency across all 50 states. The Foundation's report outlines specific actions that states and licensing agencies should be taking today, including:

• Licensing:

o Base licensing decisions on functional performance and medical fitness to safely operate a motor vehicle, as measured objectively through systematic screening and assessment.

• Standardized training:

o Ensure consistent education and training for clinicians, licensing personnel and law enforcement to teach them about existing laws, regulations, and proper procedures for reporting medically or functionally unfit drivers.

• Recruitment:

o Increase the number of qualified people who can provide comprehensive driver testing and rehabilitation services.

• Mobility Alternatives:

o Encourage communities to increase the availability of affordable alternative transportation options and work with DMVs to centrally collect this information and make it readily available to the public.

The report also notes a significant lack of comprehensiveness and consistency in medical advisory boards (MABs). Fourteen states lack any type of MAB. We recommends that all states establish and fund active MABs to conduct individual case reviews and provide input to policy development. For those states that already have MABs, they should be enhanced by providing greater incentives for physician participation. Beyond the creation of MABs, state licensing policies and practices should put into place standard reporting laws that provide civil immunity for clinicians, law enforcement, and licensing personnel who report people they believe may be medically unfit to drive.

"It's unfortunate that healthcare professionals who believe a patient may be medically unfit to drive in a safe manner do not relay this information to their state DMV to spur further screening," said Kissinger. "Doctors are well positioned to ensure their patients are fit to drive safely, yet they are fearful of being sued or losing patients if they take actions to protect others on the road - that has to change."

"AAA is committed to making sure that mature drivers are able to continue driving as long as safely possible and remain mobile thereafter," said Kathleen Marvaso, AAA National Vice President of Public Affairs. "We encourage all states to have medical advisory boards, comprised of physicians and health care professionals, to review driver capabilities. Having effective medical advisory boards in every state will help ensure the safety of all drivers."

"One of the fundamental roles of the DMV is to ensure drivers are capable of driving safely, and to restrict, suspend or revoke licenses when drivers demonstrate that they are incapable of driving safely," says Neil D. Schuster, president and CEO, AAMVA. "But our charge is also to help people transition to alternative forms of transportation when driving is no longer a safe option. And AAMVA is placing renewed emphasis on these issues."

Older drivers and their caregivers can find helpful information to deal with the very personal and difficult nature of addressing challenges related to senior driving at www.SeniorDrivers.org. For a copy of the full report, 2008 License Policies Workshop Proceedings please visit www.aaafoundation.org.