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Vision testing, in-person license renewal, and medical reporting are the most promising policies to improve outcomes related to older drivers

Dugan E, Barton KN, Coyle C, Man CM.  US policies to enhance older driver safety: A systematic review of the literature  Journal of Aging & Social Policy. 2013; 25: 335-352.

Review question

What are the United States (U.S.) policies that have beneficial outcomes, such as reducing fatality or risk of car accident, for older adults who drive?


The number of older drivers in the U.S. is expected to significantly increase, with more than 20% of all drivers being aged 65 or older by 2030.

While previous research has shown that older drivers are among the safest on the road, older drivers have increased risk for age-related changes and chronic diseases that may impair important driving skills.

This review examined U.S. policies relating to older drivers and whether they were associated with positive outcomes.

How the review was done

A detailed search of 11 electronic databases for studies published from 1991 to January 2013 was conducted. Studies focusing on drivers aged 65 and older that looked at least one policy related to older drivers, as well as a transportation-related outcome, such as fatality, were included in the review.

A total of 1,944 studies were identified in searches, and 29 were included in the review after assessments for eligibility.

The authors did not acknowledge any funding sources for this review.

What the researchers found

There was limited research on policies of medical reporting and medical review, and it could not be determined whether voluntary or mandatory medical reporting requirements were more effective at reducing fatalities. However, this policy was effective at preventing medically unfit older adults from driving.

The review found that states that required older individuals to undergo an in-person license renewal (with the possibility of more intensive assessment protocol) had a moderate reduction in risk for fatal crashes involving adults 85 and older, and for being at fault in crashes for older drivers. Vision testing at renewal was also effective in reducing risk for fatal crashes.

The review did not find evidence supporting accelerated renewal cycles, knowledge tests or age-based testing for older drivers as policies to reduce crashes or fatalities.


Ultimately, the review found that the policies leading to beneficial outcomes with empirical support were vision testing at license renewal, a mandated in-person renewal, and the use of either voluntary or mandatory medical reporting. These policies were moderately effective at reducing risks and fatalities for older individuals.

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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 (

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