Introduction

Geriatric Essentials

• Drivers >= 70 yr are at higher risk of developing functional deficits that lead to higher collision rates per mile driven.
• Elderly drivers are at higher risk of injury and death because they are less able to withstand trauma.
• Health care practitioners become involved in driving decisions when deficits are identified during routine examination, when family members express concern, or when patients solicit advice. The role of practitioners is to perform functional and medical assessments, which determine overall driving safety, and to communicate recommendations effectively to elderly drivers and family members.

In the US, about 20 million drivers are >= 65 yr; this number is expected to more than double by 2020. Most elderly drivers consider driving essential for maintaining their autonomy. Safe driving requires the integration of complex visual, physical, and cognitive tasks. Many elderly drivers eventually develop mild to moderate deficits in these domains, but because they have consolidated driving into a learned, instinctive pattern, they continue to drive with only minimal impairment. Many also compensate for deficits by limiting their driving to avoid intensive traffic patterns, by driving fewer miles, by limiting trips to shorter distances, and by avoiding driving during twilight or bad weather. For male drivers, the average number of miles driven per person per year declines from about 19,000 miles (30,577 km) at age 35 to 54 to about 5,000 miles (8,047 km) at age 80 to 84. Elderly drivers are also often more cautious, drive more slowly, and take fewer risks.

Elderly drivers have lower collision rates per 100,000 licensed drivers than drivers of all other ages (see Figure 23-1). However, for drivers >= 70, collision rates per 100,000 miles (160,934 km) driven are higher than for drivers of all other ages except those < 20. Collisions are more likely to occur while going through intersections, making left turns, or merging into traffic; failure to yield right-of-way and failure to heed a stop sign or red light are common errors. Collisions are more likely to involve multiple vehicles and to result in serious injuries and fatalities because elderly drivers have more severe comorbidities, which can decrease their ability to withstand trauma. Most traffic fatalities involving elderly drivers occur during the daytime and on weekdays. Alcohol and high driving speed rarely play a role.

This topic was last updated July 2005.