How do we know when it’s time for someone to hang up the car keys?

The Bottom Line

  • Requiring in-person driver’s licence renewal for older adults of a specific age (e.g., 75 or 80) is strongly supported as a policy that reduces the rate of crash fatalities among drivers 85 and older.
  • The evidence is mixed about the effectiveness of vision testing at licence renewal in reducing fatalities among older drivers.
  • Medical reporting is effective at removing unfit drivers from the road, but healthcare providers need better information and training about how to talk to and assess their patients about driving, and when to make a formal report to licensing authorities.

No one can deny that the ability to drive is a source of independence whether you are 17 or 80, and can contribute significantly to your quality of life. But when it comes to road safety, statistics show that both the youngest and oldest drivers among us are most at risk of being involved in motor vehicle accidents.

And with the 65+ age group being the fastest growing segment of the population, the number of older drivers on the road is also increasing rapidly. As we grow older, we are increasingly at risk of developing a health condition that can affect our driving ability. For instance, the Canadian Automobile Association (CAA) notes that:
- over the years our pupils get smaller and can affect our ability to drive safely;
- hearing loss can affect our ability to react to our surroundings; and
- diminishing motor skills can affect reaction time (1).

There are many other more specific declines in health that seniors are at risk for that can affect the ability to drive, such as arthritis, strokes, heart conditions and cognitive conditions like dementia.

So how does an older individual or their doctor, relatives or caregivers, know when it’s best for someone to hang up the car keys for good?

Governments in many jurisdictions are grappling with this question, but given the wide range of abilities among older adults and the strong emotions associated with the ability to drive, there are no easy answers.

Most jurisdictions in Canada and the U.S. have various policies regarding mandatory driver testing for older adults, as well as regulations that require medical professionals to report to driver licence authorities when someone is considered no longer fit to drive.

In Canada, these rules vary by individual provinces and territories, and in the U.S. each state determines the rules. For instance, in Ontario all drivers aged 80 and over must renew their licence every two years. Since 2014, that renewal process has included a vision assessment, in-class group education, review of the driver's record and two short exercises, the latter to determine if further assessment is required. Ontario also has definitive regulations about medical professionals reporting people who are no longer fit to drive, regardless of their age (2).

Whether these policies are making the roads safer for all has been the subject of much discussion and research in recent years. A recent systematic review conducted in the U.S. and focused on policies to enhance older driver safety sheds some insight on their effectiveness in reducing motor vehicle crashes involving older adults (3).

The review included 22 studies that looked specifically at licence renewal rules and seven studies focused on medical reporting of older adults who should no longer be driving. All studies involved people over the age of 65 and included some type of transportation-related outcome, such as rates of crashes, fatalities or renewal of licence.

What the research tells us

Not all states have policies requiring in-person licence renewals for older adults. However, the ones that do saw a 17% reduction in risk for fatal crashes among the oldest drivers.

There is mixed evidence about the effectiveness of vision tests as part of the license renewal process. Several studies found that states that require vision tests as part of the licence renewal process have lowered the relative risk of fatal crashes. For instance, in Florida, after a new requirement for visual testing for older drivers was implemented, fatalities for drivers aged 80 and over decreased significantly, by 17%. However, a study examining 10 years of data across the U.S. found that vision tests for all older drivers do not offer independent benefits toward lowering fatal crash rates among older drivers.

The review also included studies that examined other types of aged-based testing at licence renewal, such as cognitive or functional tests, but found little support for the effectiveness of these measures. Likewise, neither driver education programs or knowledge tests geared specifically to older adults produced any benefit for older drivers.

The studies that looked at medical reporting found that these regulations were effective at removing unfit drivers from the road. However, only a small fraction of older drivers is ever the subject of a medical report, and there is limited research on the topic, so it wasn’t possible to determine if voluntary or mandatory medical reporting requirements were more effective at reducing fatalities. But both approaches were effective at forcing reported drivers to cease driving.

It was also noted that many healthcare providers admit they are unsure about how, what, or when to submit a medical report. A survey of members of the American Geriatrics Society found that 87% felt obligated to assess driving competency, but only 40% had ever made a referral for a formal driving evaluation.

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Author Details


  1. Canadian Automobile Association. Seniors driving [Internet]. Ottawa: Canada, 2017. Available from:
  2. Ministry of Transportation. Medical review of drivers [Internet]. Government of Ontario, Toronto: Canada, 2020. Available from:
  3. Dugan E, Barton KN, Coyle C, Lee CM. US policies to enhance older driver safety: a systematic review of the literature. Journal of Aging and Social Policy, 2013; 25(4): 335-52.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.