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Overview of the Older Driver

By David B. Carr, MD, Alan A. and Edith L. Wolff Professor of Geriatric Medicine, Professor of Medicine and Neurology, and Clinical Director, Division of Geriatrics and Nutritional Science, Washington University School of Medicine
Peggy P. Barco, MS, BSW, OTD, OTR/L, SCDCM, CDRS, Assistant Professor of Occupational Therapy and Medicine, Washington University Medical School

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For adults, driving is the most important method of independent transportation. In 2011, there were 35 million licensed drivers ≥ 65 yr in the US, including many ≥ 80 yr ( Percentage of Drivers by Age and Sex). Progressive disease that impairs driving in older adults may have two serious adverse outcomes: injury or death resulting from a motor vehicle crash (MVC) or driving cessation.

Percentage of Drivers by Age and Sex










≥ 80



Adapted from the U.S. Department of Transportation 2009 National Household Travel Survey.

Older drivers on average have a lower number of MVCs than drivers of all other ages. However, because the number of miles driven per year also declines with age ( Annual Miles Per Licensed Driver by Age, 2009 ), the crash rate per mile for drivers 70 is higher than that for drivers of all other ages except those < 20 yr (see Figure: Motor vehicle crashes per 100 million miles driven by age group (2008–2009).). The overall motor vehicle fatality rate has dropped for older adults—as it has for people of all ages (see Figure: Motor vehicle traffic fatality rates by age group (2002–2011). )—probably because of improved vehicle crashworthiness, improved trauma systems, and roadway improvements. Older drivers also have the lowest absolute crash rate per year. However, the oldest old (> 80 yr) have the highest traffic death rates per 100,000 population among all age groups, which, given their lower absolute number of MVCs, indicates a higher degree of vulnerability for a given MVC. In 2008, > 5,500 older adults were killed and > 183,000 were injured in MVCs in the US.

Annual Miles Per Licensed Driver by Age, 2009

Age of Driver

Annual Miles









≥ 65


Adapted from the U.S. Department of Transportation 2009 National Household Travel Survey.

Motor vehicle crashes per 100 million miles driven by age group (2008–2009).

Figure from Online Auto Insurance News; used with permission. Available at Data adapted from the AAA Foundation for Traffic Safety.

Motor vehicle traffic fatality rates by age group (2002–2011).

Adapted from the National Highway Traffic Safety Administration's (NHTSA) Safety Facts 2011. Available at

Safe driving requires the integration of complex visual, physical, and cognitive processes, and some older drivers may have mild to moderate deficits in one or more of these domains. Many older drivers successfully self-regulate their behavior and compensate for deficits by avoiding rush hour, driving fewer miles per year, limiting trips to shorter distances, and avoiding driving during twilight, nighttime, or inclement weather. Also, older drivers tend to be more cautious, drive more slowly, and take fewer risks. However, some older adults, because they deny or lack insight regarding limitations (eg, vision impairment, dementia, slower reaction time) or have a strong desire to maintain independence, continue to drive despite significant impairment of skills that relate to safe driving ability.

Most MVCs involving older drivers occur during the daytime and on weekdays. These MVCs often result from failing to yield the right-of-way, not heeding stop signs or red lights, or not maintaining proper lane positioning and tend to occur in more complex driving situations (eg, while going through intersections, making left turns, or merging into traffic). MVCs are more likely to involve multiple vehicles and to result in serious injuries and fatalities. Unlike in younger drivers, alcohol, texting, cell phone use, and speeding rarely play a role in MVCs involving older drivers; however, this situation may change in future aging cohorts.

When MVCs do occur, older adults seem to be more vulnerable to injury because

  • They have less capacity to withstand trauma.

  • They often have more comorbidities.

  • Many MVCs are driver-side impact (eg, occur while making left turns), making the driver more vulnerable and likely to be injured.

  • They may be more likely than younger drivers to drive very old cars without air bags or other improvements in crash protection.


Health care practitioners become involved in driving decisions when deficits are identified during routine examination, a serious medical condition or illness manifests, patients solicit advice, family members express concern, or law enforcement cites unsafe driving behaviors. The role of practitioners is to do detailed functional and medical assessments related to driving safety (see Functional Assessment of the Older Driver and see Medical Assessment of the Older Driver). Another useful resource is the American geriatric Association's Physician's Guide to Assessing and Counseling Older Drivers.

Driving history should be reviewed; details of driving habits and past violations, MVCs, close calls, or getting lost may point to general or specific impairments. The Alzheimer's Association's warning signs of unsafe driving include the following:

  • Forgetting how to locate familiar destinations

  • Not obeying traffic signs

  • Making slow or poor decisions while driving

  • Driving at an inappropriate speed

  • Becoming angry or confused while driving

  • Hitting curbs

  • Not keeping within lanes

  • Making errors at intersections

  • Confusing the gas and brake pedals

  • Returning late from a routine drive

  • Forgetting the destination during a drive

Some impairments may obligate practitioners to refer a patient to the state Department of Motor Vehicles for additional testing or driving restrictions. (See the National Highway Traffic Safety Administration's [NHTSA] Physician’s Guide to Assessing and Counseling Older Drivers for state licensing requirements and reporting regulations.)

Key Points

  • The number of older adults is growing rapidly.

  • Driving cessation is inevitable for many older adults and can have negative outcomes (eg, social isolation, depression, fewer driving destinations).

  • Age-related and disease-related changes in physical, motor, sensory, and cognitive function can impair driving ability and account for some of the increase in MVC rates per miles driven.

  • Many older drivers self-regulate their behavior.

  • Older adults are more vulnerable to injury in an MVC than younger adults.

  • The role of practitioners is to do functional and medical assessments, which may help determine overall driving safety, and to communicate recommendations effectively to older drivers and their family members.

  • State licensing requirements and reporting regulations that pertain to older drivers are available from the National Highway Traffic Safety Administration.

Resources In This Article