• License Restriction,
• Rehabilitation,
• Education, Counseling, and Alternative Transportation, and
• Training.

Licensing Restrictions by Thomas L. Miller, Ph.D., University of South Florida

Driver licensing agencies balance the public's right to safety with each person's need for mobility and independence. Limiting or denying the privilege to drive can cause hardship, especially where public transportation is not available. However, Miller claimed "various human factor studies report that anywhere from 85% to 95% of highway crashes may be attributed to human error." Age-related deterioration in physical and/or cognitive functions can contribute to deterioration in driving ability. Automobile crashes are the leading cause of accidental death for motorists from 65 to 74, and people over 55 will comprise one-third of drivers by the year 2000. The challenge for licensing agencies is to restrict those seniors whose driving is impaired while preserving as much mobility as possible for as many older drivers as possible.

Licensing agencies need information on the cause-and-effect relationships between medical conditions and decreased driving ability. Without research relating stages of functional impairment to increased driving risk, agencies may restrict the licenses of older drivers unnecessarily, and some older people may be driving when medical conditions put them at high risk for crashes.

There is also a need to standardize procedures for reporting medical conditions and develop guidelines for appropriate licensing restrictions. U. S. states and Canadian provinces vary in what they specify physicians are to report, and respect for confidentiality keeps physicians from reporting conditions when there are no medical or legal guidelines. When licensing agencies do receive medical information, they need guidelines that specify appropriate licensing restrictions for each person's driving experience and degree of impairment.

Miller recommended ten actions to help agencies make decisions on licensing restrictions:

1. Find out if research supports current restriction practices,
2. Study the feasibility of standardizing restriction criteria across the United States and Canada,
3. Research relationships between functional impairments and driving performance,
4. Standardize the vocabulary used across the U.S. and Canada when referring to functional impairments and types of licensing restrictions,
5. Include information about licensing restrictions in crash reports,
6. Develop guidelines for physicians reporting medical conditions,
7. Learn the role previous driving experience plays in helping older drivers to compensate for impairments,
8. Use a system of automated testing and simulation tools to identify medical conditions that affect driving,
9. Educate license examination personnel to the limitations of visual screening and ways drivers cheat on vision tests (e.g., wearing contact lenses or memorizing correct responses), and
10. Find the relationship between visual impairments and driving performance.

Rehabilitation of Elderly Drivers by Sonia Coleman, M.Ed., OTR/L, National Rehabilitation Hospital

As vision and physical impairments develop in older drivers, some may respond more slowly to new or rapidly changing situations. When these problems affect driving, health professionals can retrain older people to help them improve their driving. Older drivers with physical disabilities resulting from a stroke or other debilitating event often seek assistance with compensating skills to use when driving. Drivers with mental disabilities are less likely to be aware of deteriorating driving skills; they depend on referrals from physicians, licensing agencies, or other concerned people to get them involved in rehabilitation programs.

According to Coleman, driver rehabilitation is available from "occupational therapists (OTs), physical therapists, vocational counselors, speech therapists, optometrists, and psychologists." It is the OT's role to help a person be as independent as possible. OTs teach older drivers compensatory strategies for slowed reaction times. OTs and physical therapists help older drivers improve arm and leg strength so they can safely drive a car; they also train drivers to use adaptive equipment to continue driving with a physical disability. In addition, they guide elderly drivers to choose the best time of day to drive safely and to use public transportation. Vocational counselors help older drivers who work or are involved in volunteer activities to find positions that are close to home and do not require night driving. Other health professionals train elderly drivers to improve decision-making skills or offer vision training, eye exercises, and corrective lenses to improve eyesight.

Elderly drivers learn about such services when they are hospitalized for a condition that results in impaired driving ability. Unfortunately, healthy elderly drivers are seldom aware of these services, and evaluations to qualify drivers to receive services from medical professionals are expensive and not covered by medical insurance. When older drivers turn to less costly commercial driving schools, they often find they do not get the kind of help they need.

Coleman suggested that meeting the rehabilitation needs of older drivers should begin with standardized driver education training for all health professionals. These trained health professionals would receive referrals from licensing agencies and evaluate each older driver's needs. Health professional could recommend rehabilitation through specific health service providers, through an educational program like "55 Alive," or through a commercial driving school. Coleman felt instructors at commercial schools should also be trained in the special needs of older drivers. Finally, Coleman called for insurance companies to cover the cost of driver rehabilitation programs. Coleman concluded that driver licensing agencies, health professionals, and commercial driving schools could work together to create an effective, affordable rehabilitation program for older drivers.

Education, Counseling, and Forms of Support by Donn W. Maryott, New York State Department of Motor Vehicles

Maryott divided this article into three sections: (1) Education (Classroom/In-Car), (2) Counseling, and (3) Transportation Alternatives.

Education (Classroom/In-Car) -- Elderly drivers may need to study the skills required to drive, ride, and walk on modern highways; the laws of nature and traffic that apply to driving; and the results of age-related deterioration. Maryott felt government agencies at all levels should be involved in providing such classes. Classes would cover: the importance of using seatbelts, compensating strategies for age-related disabilities, the effects of medications on driving, using public transportation, and standard drivers' education topics with emphasis on new signs, signals, markings, and technical innovations. Training would combine classroom work with simulation and behind-the-wheel experience. Such training, using skilled instructors and quality materials, would be expensive. Maryott suggested the costs be shared by the older drivers, insurance companies, and government agencies.

Counseling -- Elderly drivers need to know what transportation options are available to help them maintain independence and mobility when their driving is restricted or they can no longer drive. Some options include: public transportation, car pooling, help from family and friends, and special senior busing services. Counseling and information distribution are provided by community senior centers, transportation counseling programs, religious centers, and chapters of retirement groups such as the American Association of Retired Persons.

Transportation Alternatives -- In some rural and suburban areas, public transportation is not available. Seniors who cannot drive, because of physical or mental disabilities or because of the high cost of owning and maintaining private vehicles, need safe, convenient, affordable public transportation. Expanded public transportation should be supplemented by private-sector arrangements. Senior centers can organize van or automobile transportation, and shopping malls might provide shuttle buses for seniors (who are a significant portion of the consumer market). Churches could arrange car pools for seniors wishing to attend services. No-fee or low-fee transportation co-ops should be organized to respond to telephone requests from older persons. Finally, senior groups can work to facilitate car pooling.

Training Elderly Drivers by Alma M. Fonseca, Ed.D., Texas A&M University

Older drivers do not want to lose the independence and mobility they gain from driving; however, some do not keep up with changes in traffic laws, adapt to new safety measures such as seatbelts, or acknowledge deteriorating driving ability caused by changes in visual, mental, and physical capacities. Those who do seek programs to improve their driving capabilities find many instructors are not trained to meet the needs of older drivers and many programs do not have essential hands-on components. In addition, existing programs reach only a few older drivers, and those they reach are often good drivers.

Training programs need to attract more older drivers, especially those from rural areas or those who are very old, economically disadvantaged, or poorly educated. Programs need to teach basic driving skills and skills to compensate for age-related deficiencies. To be effective, existing eight-hour programs may need to be longer and include in-car training. Course content and instructional methods must be tailored to the older learner. Two types of courses are needed: (1) refresher courses for experienced older drivers and (2) beginner courses for older people just starting to drive (e.g., recent widows who depended on husbands for transportation). Fonseca pointed out that many national driver education programs still do not include instruction on the importance of using seatbelts--especially vital to older drivers who are frail and easily injured.

Fonseca recommended that licensing agencies serve as a link to refer older drivers to training programs, either when they come in to renew or through the mail when notices are sent. Illinois connects licensing and training through a "Seniors on the Go!" program. When older drivers complete this classroom and in-car training and pass a vision test, they receive a certificate good for one year to present as proof they are eligible for license renewal. Some states require drivers with many traffic violations to take training. An Oregon program ("Re-Examination Evaluation Program") is designed for people whose driving qualifications are questionable. Program personnel check medical histories and test for slowed reflex time, evidence of dementia, and knowledge of traffic regulations. Finally, they assess behind-the-wheel performance before counseling drivers on compensating strategies or recommending a retraining program.