Driver's License Renewal Research Articles

Online driver license renewal and road user injury and fatality in Washington State

Objectives Washington State implemented a new policy in 2004 that allowed drivers younger than 70 years old to renew their driver license by mail or online at every other renewal. Drivers aged 70 years and older were still required to renew in-person every 6 years. The purpose of this study was to evaluate whether this policy change was associated with motor vehicle crash (MVC) injury and fatality among drivers, non-drivers, and all road users aged 45–69 years. Methods Controlled interrupted time series analysis models were fit to compare injury and fatality rates for these road users affected by the requirement to older road users not affected by the requirement (70 years and older). Differential level and slope changes in injury and fatality rates were used to estimate associations with the change in the license renewal requirement. Results We did not find evidence that implementation of online driver license renewal in Washington was associated with increased injury or fatality rates among drivers, non-drivers, or all road users aged 45–69 years relative to those aged 70 years and older. Conclusions Allowing driver license renewal online or by mail at every other renewal appears to be a safe strategy for less restrictive driver licensing for drivers aged 45–69 years. Future research should continue to evaluate the potential impacts of in-person and online renewal policies.

Mandatory Vision Test for Driver License Renewal in Association With Traffic Fatality and Injury Among Older Road Users in Utah.

In 2011, Utah began requiring that drivers aged 65years and older pass a vision test at each license renewal. This study aims to investigate if the mandatory vision test associated with motor vehicle fatality and injury rates in older road users. We fit controlled interrupted time series analysis models to compare fatality and injury rates for older adults (65+) affected by the law to younger adults (45-64) unaffected by the law. The models yielded estimates of differential level and slope changes in fatality and injury rates, which we used to estimate policy associations. We did not find evidence that implementing an accelerated vision test for older adults in Utah was associated with a reduction in injury or fatality rates among older (65+) drivers and non-drivers relative to those aged 45-64. Other strategies might be considered to prevent fatal motor vehicle crashes (MVCs) in older adults.

Driver License Renewal Requirements Predict Driving Mobility Among Older Drivers With Health-Related Travel Difficulties

Given the importance of driving mobility for older adults in the United States, it is important to examine how license renewal policies are related to driving mobility and whether the driving mobility of older adults with health limitations may be especially affected by such policies. The present study examined the association between license renewal requirements and driving mobility in a national sample of 89,757 older adults aged 62 and older in the United States ( M age = 71.57, standard deviation age = 7.48). Using generalized estimating equations, the associations between two driver licensing requirements (in-person renewal and length of renewal cycle) and two indicators of driving mobility (driving status and annual driving mileage) were examined. Results indicated that in-person license renewal was significantly associated with lower driving mileage but not driving status. The association between in-person license renewal and lower driving mileage was greater for people who reported a health-related travel difficulty: in states requiring in-person license renewal, drivers with a health-related travel difficulty had driven 590 fewer miles in the previous year compared with drivers without such difficulties. Among people who experienced in-person license renewal requirements, a longer time between renewals was not significantly associated with driving status or annual mileage. The findings of the current study, combined with previous work showing a lack of safety benefits of in-person license renewal, suggest that in-person license renewal requirements may unnecessarily restrict the driving mobility of some older adults.

Association between mandatory cognitive testing for license renewal and motor vehicle collisions and road injuries.

We examined whether the policy amendment from March 2017 for a cognitive screening test for older drivers at driver's license renewal was associated with the decreased risk of motor vehicle collisions for drivers and the increased risk of injuries for pedestrians and cyclists among older people. This was a controlled interrupted time-series study. We used police-reported data on the number of collisions as drivers and injuries as pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As the outcome measures, we used the ratio of the monthly number of collisions per population among drivers of three groups aged 75 years or older (75-79, 80-84, and ≥85 years), who were targeted or exposed by the policy, to that among drivers aged 70 to 74 years, who were unaffected or unexposed by the policy and would serve as controls. The ratio of pedestrian and cyclist injuries was also calculated, as previous studies have shown a concomitant increase in these injuries after the introduction of cognitive screening for driver's licenses. During the study period, there were 602,885 collisions as drivers and 196,889 injuries as pedestrians and cyclists among people aged 70 years or older. After the policy amendment in March 2017, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were -3670 (95% confidence interval: -5125, -2104) and 959 (95% confidence interval: 24, 1834), respectively. Following the policy amendment, there was a decrease in motor vehicle collisions as drivers and an increase in road injuries as pedestrians and cyclists among older people.

Assessing and Improving Fitness to Drive in the Elderly People: A Scoping Review of Policies and Guidelines.

This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world. The Arkesy and O'Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method. Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation. Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

One Stop Shops for Public Services: Evidence from Citizen Service Centers in Brazil

AbstractCitizen Service Centers are government offices where different authorities are co‐located and where several public services are offered in the same physical location. The goal of implementing such One Stop Shops for public services is to solve problems with a malfunctioning government bureaucracy for frontline service delivery. In spite of reforms in at least 70 countries, however, there are few evaluations. This paper evaluates the impact of Poupatempo (“Savetime”), a Brazilian Citizen Service Center reform that has inspired similar programs in other countries. We collect data on one of the most common errands at the Brazilian bureaucracy, driver's license renewal, and evaluate the impact of Poupatempo on the time, number of trips, and payments needed to undertake the renewal, and on other variables representing transaction costs, red tape, and transparency in the citizen‐state interaction. Our difference‐in‐differences estimates indicate large reductions in the time expended by citizens and in proxies for transaction costs, but are less encouraging for the social quality of the licensing procedure, which we also evaluate. We discuss whether incentives to speed up processes prevailed where other steering instruments would have been more appropriate, and explore remedies. We also discuss limitations to establishing a true One Stop Shop.

Driver License Renewal Laws and Older Adults' Daily Driving, United States, 2003-2017.

Around the world, aging populations pose significant concerns regarding their community mobility and transportation safety. Most previous studies in the United States have focused on the associations between driver license renewal laws and crash outcomes among older adults (65 years and older). Few studies have evaluated the impact of driver license renewal laws on older adults' community mobility. This study aimed to identify the associations between driver license renewal laws and older males' and females' daily driving likelihood and duration. The 2003-2017 American Time Use Survey data were merged with driver license renewal legislation using ages 55-64 to control for effects of non-licensure factors (e.g., gasoline price). Weighted Poisson and linear regression models were used to estimate the associations of various driver licensure provisions with older males' and females' daily driving likelihood and duration. A shorter in-person renewal period and the presence of mandatory reporting laws for physicians were associated with a lower daily driving likelihood and shorter driving duration among females aged 75 years or older. The presence of mandatory reporting laws was also associated with reduced daily driving likelihood and duration for males aged 65-74 years. Policymakers should be aware that males and females may respond differently to older driver licensure laws, which may require distinct interventions to preserve their mobility. Future studies should consider the gender disparities when examining the association between driver licensure policies and older adults' transportation safety and mobility.

Behavioural Economic Nudge Policy, Organ-Donation and Heart Transplant Conversion Rates in Alberta, Canada. A Ten-Year Retrospective Analysis

Purpose The Canadian Province of Alberta has no presumed consent for organ- donation, and has had chronically low deceased-donation rates. To address this, the government sponsored a public organ-donation registry, which was launched in 2013. Registration was encouraged by using a behavioural economic “nudge”, of prompted choice to enrol at driver's license renewal. We determined the effect of this nudge policy on heart donation rates, and the relative production efficiency of heart transplants (HTx) in Alberta over 10 years, spanning this policy change. Methods Retrospective analysis of administrative and medical transplant databases was conducted from 01/2007 to 12/2016, using interrupted time-series measures of quarterly recipient listings, heart organ offers and transplants. The baseline period 2007-2013 served to reconstruct the counterfactual after the policy rollout. Heart offers were designated by source of origin. Time-related changes were assessed using linear regression, and HTx efficiency was plotted quarterly, using a simple production-frontier model. Results 451 unique individuals were listed for HTx, while 2661 donor heart offers were made from all sources, including 439 (16.5%) from within Alberta. HTx occurred following 306 offers, a conversion rate of 11.5%. Simultaneously, 68 listed patients (15.4%) died while awaiting HTx. A time related 41% increase in donor heart offers from 59.2 to 83.7 per quarter (p Conclusion Nudge policies to increase organ donation did not result in an early increase in the population adjusted heart organ donation rate within Alberta. Improved efficiency in the use of organs offered, rather than increased donor organ numbers may be present the greatest opportunity to improve HTx completion in Alberta.

A Study on the Driver's License Renewal and Return Policy through the Recognition of the Elderly's Driving Pattern

A Study on the Driver's License Renewal and Return Policy through the Recognition of the Elderly's Driving Pattern

Relationship between neuropsychological tests and driver's license renewal tests in Parkinson's disease

ABSTRACTObjective: To determine whether the standard Spanish driving test (ASDE test) was able to identify patients with Parkinson's disease (PD) at risk of unsafe driving and to examine the relationship between the ASDE test and the Useful Field of View (UFOV) as well as with a battery of neuropsychological tests in drivers with PD.Methods: Thirty-seven patients with PD and 33 controls matched by age and education level were included in an observational study. All participants were active drivers and patients with PD underwent study procedures after taking the medication in the “on” period. Subjects with a Mini-Mental State Examination (MMSE) score ≤ 24 were excluded. Neuropsychological tests (Repeatable Battery for Neuropsychological Status [RBANS], Trail Making Test [TMT-A and -B], and Block Design test), driving performance tests (ASDE Driver Test and UFOV), and daytime sleepiness (Epworth Sleepiness Scale) were assessed.Results: The PD group performed significantly worse than healthy controls in the ASDE Motor Coordination tests. No significant differences were observed in anticipation speed, multiple reaction time, concentrated attention, and resistance to monotony. All participants successfully completed the UFOV tests. Statistically significant differences between patients with PD and controls were found in processing speed (UFOV1; P =.03) and more patients with PD were found in the categories of higher driving risk levels (P =.03). In addition, patients with PD showed worse scores than healthy controls in visuospatial capacities (Line Orientation), psychomotor speed (Coding and TMT-A), memory (List Recognition, Story Recall), and executive function (TMT-B). The driving tests (ASDE and UFOV) showed a low sensitivity and a high specificity but a higher percentage of patients in the PD group failed in multiple reaction time, concentrated attention, and resistance to monotony. In addition, 18.9% of patients with PD showed a cutoff of 4 for UFOV risk. In the discriminant analysis, Line Orientation (visuospatial/constructive domain) and Figure Recall (delayed memory) were found to be statistically significant with a rate of correct classification of unsafe drivers with PD of 78.2%. In addition, normal results on the Line Orientation item were associated with a 1.5 times higher probability of non-risky driving in the multivariate analysis.Conclusions: At early stages of the disease, about 19% of patients with PD showed difficulties that may affect their driving capabilities. Line Orientation and Figure Recall are useful to alert clinicians to the risk of unsafe driving. For this reason, patients with PD should be evaluated for driving abilities more regularly to determine the extent of deficits that may influence driving performance.

ONLINE TRAINING OF LICENSE OFFICE PROFESSIONALS TO SCREEN APPLICANTS FOR MEDICAL IMPAIRMENT

In states with voluntary reporting of possibly medically impaired drivers, previous research shows fewer than expected reports from license office professionals. Medical conditions that potentially impair driving are fairly common among older licensed drivers. Therefore, a crucial opportunity exists in license offices for early identification of impaired drivers prior to involvement in a traffic crash or incident. This study explores the development, implementation, and evaluation of an online training for license office professionals to identify likely medical impairment among driver license renewal applicants. Following statewide rollout to over 180 privatized license offices, 85.9% of users found the training helpful and relevant, and 96.8% rated the training as “Very Good” or “Excellent” among trainees who responded to a survey embedded within the training (N = 183). The challenges of an agency-wide training release precluded an experimental design, but volume of reports of potentially impaired drivers was used to gauge training efficacy. In the 12 months prior to the training’s release, 24 reports were made; in the year following release, 20 reports were made. Although the training was applicable, useful, and highly rated by trainees, it did not immediately increase the volume of reports made. In five of the evaluated months after release of the training zero reports were made. External factors, such as the impact of the privatization of government agencies with critical public safety roles should be evaluated and reported. Stronger policies, training mechanisms, and structural changes in licensing authorities are likely needed to improve screening efforts.

PERPANJANGAN SURAT IZIN MENGEMUDI MELALUI MOBIL LAYANAN DAN SIM CORNER

Abstract: In order to realize the welfare, the government continues its efforts to improve the public service, including the extension of a driver's license. Driver's license renewal service is done at counters the common crowd, like in the Mall, Supermarket, Roads, and so forth without being followed by the specified requirements, including not doing medical tests. In the perspective of elimination of administrative law requirements, in particular health condition is not in accordance with nature and permission functions. Because a person's health condition may change at any time decreased, and in a certain degree could endanger driving license holders, as well as other road user community. For the retest medis is essential in driver's license renewal.Key Word: driving license, health condition, endangering

Trend analysis of the driving ability change from data of the driver license renewal training for the elderly

Trend analysis of the driving ability change from data of the driver license renewal training for the elderly

Driver license renewal policies and fatal crash involvement rates of older drivers, United States, 1986-2011.

BackgroundOlder drivers experience elevated risk of motor vehicle crash involvement, injury, and death. Several states attempt to address these risks through driver license renewal policies; however, little is known about their effects.MethodsData from 46 U.S. states from years 1986–2011 were examined. Associations between driver licensing policies and population-based fatal crash involvement rates of drivers aged 55 years and older, in 5-year age groups, were estimated using population-averaged negative binomial regression. Estimates were adjusted for seasonality, time trends, other traffic safety laws, and economic factors. Ratios of relative risks (RRR), which compared changes in fatal crash involvement rates of older drivers associated with changes in licensing policies to corresponding changes in fatal crashes of drivers ages 40–54, were computed to account for other possible sources of confounding.ResultsMandatory in-person renewal was associated with a 31% reduction in the fatal crash involvement rates of drivers ages 85 and older (RRR: 0.69, 95% Confidence Interval [CI]: 0.48–0.97). When in-person renewal was not required, requiring drivers to pass a vision test was associated with a similar reduction for drivers ages 85+ (RRR: 0.64, 95% CI: 0.49–0.85). When in-person renewal was required, however, requiring a vision test was not associated with any additional reduction, nor was requiring a knowledge test or an on-road driving test. Requiring more frequent license renewal and requiring healthcare providers to report concerns about patients’ driving ability to licensing authorities were not associated with statistically significant reductions in fatal crash involvement rates of older drivers. No policy examined was found to have a significant impact on fatal crash involvement of drivers younger than 85.ConclusionsRequiring drivers to renew their license in person, or to pass a vision test if not renewing in person, was associated with significant reductions in population-based fatal crash involvement rates for drivers ages 85 and older. The study could not determine how these effects were achieved, for example by specifically removing unsafe older drivers from the driving population or by fostering premature driving cessation. Other policies examined were not found to reduce fatal crash involvement rates of older drivers.

Obstructive sleep apnea and driving: A Canadian Thoracic Society and Canadian Sleep Society position paper.

Untreated patients with obstructive sleep apnea (OSA) are at increased risk for motor vehicle collisions; however, it is unclear how this should be translated into fitness-to-drive recommendations. Accordingly, the Canadian Thoracic Society (CTS) Sleep Disordered Breathing Clinical Assembly and the Canadian Sleep Society (CSS) assembled a CTS-CSS working group to propose recommendations with regard to driving in patients with OSA. Recommendations for assessing fitness to drive in noncommercial drivers: 1. Severity of OSA alone is not a reliable predictor of collision risk and, therefore, should not be used in isolation to assess fitness to drive; 2. The severity of sleep apnea should be considered in the context of other factors to assess fitness to drive; 3. The decision to restrict driving is ultimately made by the motor vehicle licensing authority; however, they should take into account the information and recommendations provided by the sleep medicine physician and should follow provincial guidelines; 4. For patients prescribed continuous positive airway pressure (CPAP) therapy, objective CPAP compliance should be documented. Efficacy should also be documented in terms of reversing the symptoms and improvement in sleep apnea based on physiological monitoring; 5. For patients treated with surgery or an oral appliance, verification of adequate sleep apnea treatment should be obtained; and 6. A driver diagnosed with OSA may be recertified as fit to drive based on assessment of symptoms and demonstrating compliance with treatment. The assessment should be aligned with the provincial driver's license renewal period. Commercial vehicles: Assessment of fitness to drive should be more stringent for patients operating commercial vehicles. In general, the CTS-CSS working group was in agreement with the Medical Expert Panel recommendations to the Federal Motor Carrier Safety Administration in the United States; these recommendations were adapted for Canadian practitioners.

The overall program effects of California's 3-Tier Assessment System pilot on crashes and mobility among senior drivers

IntroductionIn 2007, the California Department of Motor Vehicles (DMV) undertook a pilot study of the 3-Tier Assessment System, the purpose of which was to examine, in a large-scale real-time public agency setting, the effectiveness of this method for both reducing the crash risk of individual drivers and for extending the safe driving years of Californian drivers of all ages. MethodThe 3-Tier Assessment System consisted of tiered series of screening tools incorporated into the in-office driver's license renewal process. These screening tools identified drivers with various kinds of functional limitations (physical, visual, and cognitive/perceptual), that might impact safe driving. Paired with the screening tools were educational materials designed to improve drivers' knowledge of their own limitations, including compensating techniques. The present study is a population-based evaluation of the effects of the pilot on subsequent crash risk and mobility outcomes (including delicensure) of participating drivers age 70 and older. Pilot participants were compared with two control groups processed according to standard California DMV license renewal procedures. Because the 3-Tier Assessment System was designed to identify limitations normally associated with aging, the present analyses focus on drivers age 70 and older. However, it should be emphasized that during the 3-Tier pilot the screening tools were applied to drivers of all ages. ResultsThere were two main findings. First, there were no consistent, statistically significant differences between the pilot and control groups in crash risk in the two years following screening. Second, pilot participants experienced statistically significant effects on mobility. These effects included delays in time to complete their license renewal, an increase in the number of assigned license restrictions, and an increase in the number of customers failing to renew their driving privilege. ConclusionsBased on these findings, suggestions for further research are made. Impact on industryNone.

Carbohydrate Deficient Transferrin in a Driver's License Regranting Program

Carbohydrate deficient transferrin (CDT) is a common diagnostic marker for detecting chronic alcohol abuse. For over 2.5 years, it has been used in traffic medicine among subjects applying for driver's license renewal or regranting in Belgium. We report on data collected during the program and provide an estimation of an applicable cut-off point in forensic situations. Using this cut-off, the success of the driver's license regranting program is evaluated. CDT was assayed at Ghent University Hospital by capillary zone electrophoresis, measured on the Capillarys 2™ system, in 3977 subjects applying for driver's license regranting. Determination of a cut-off was done by using Bhattacharya statistics and by adding a measurement uncertainty interval. The outcome of the program was evaluated by monitoring CDT values for 163 subjects during one entire year. In 3977 subjects (3481 males and 496 females), CDT values were significantly higher in men compared with women, but there is no need for a gender-specific cut-off value. Drunk drivers under the age of 30 have significantly lower CDT values than older subjects, and a separate cut-off could be calculated. A general cut-off of 2.3% CDT was calculated for the entire study population. Using this cut-off value for evaluating the outcome of the program for 163 subjects, the percentage offenders at the beginning (29%) decreased to 8% after 1 year. Applying a marker for chronic alcohol abuse such as CDT for driver's license renewal or regranting is a powerful tool. Analysis of data collected over 2.5 years reveals a favorable outcome of the program and a useful cut-off point could be determined.

The Social and Policy Predictors of Driving Mobility Among Older Adults

This research was designed to identify the impact of state driver's license renewal requirements on the driving mobility (i.e., the reduction or cessation of driving) of older (70 years or older) drivers in the United States. Nationally representative data from four waves (1993–2000) of the Asset and Health Dynamics of the Oldest Old study were linked to state policies on relicensing and used in a longitudinal logistic regression analysis. The author assessed the driving behaviors of a sample of 9,638 men and women. The findings demonstrate that the driving mobility of older people is influenced by state relicensing policies. The analysis indicates that five policies—accelerated renewal, mental testing, peripheral vision testing, renewal in person at age 70+ (as opposed to renewal by mail or online), and restricted licensing—have a significant effect on an older driver's decision to reduce or cease driving. The driving patterns of older adults are influenced not only by their health and socioeconomic backgrounds, but also by state relicensing policies. In terms of public policy, this result shows that there is a mechanism for extending the years of independent mobility for older people: restricted licensing.

Long-Term Outcomes of Patients With Necrotizing Fasciitis

Necrotizing fasciitis is an aggressive infection affecting the skin and soft tissue. It has a very high acute mortality. The long-term survival and cause of death of patients who survive an index hospitalization for necrotizing fasciitis are not known. To define the long-term survival of patients who survive an index admission for necrotizing fasciitis. We hypothesize that survivors will have a shorter life span than population controls. Long-term follow-up of a registry of patients from 1989 to 2006 who survived a hospitalization for necrotizing fasciitis. Last date of follow-up was January 1, 2008. A university-based Burn and Trauma Center. A prospective registry of patients with necrotizing fasciitis has been collected from 1989 to 2006. This registry was linked to data from the Department of Health, Department of Motor Vehicles, and the University Hospital Medical Records Department in January 2008 to obtain follow-up and vital status data. None. Date and cause of death were abstracted from death certificates. Date of last live follow-up was determined from the medical record and by the last driver's license renewal. The death rate of the cohort was standardized for age and sex against 2005 statewide mortality rates. Cause of death was collated into infectious and noninfectious and compared with the statewide causes of death. Statistical analysis included standardized mortality rates, Kaplan-Meier survival curves, and Aalen's additive hazard model. Three hundred forty-five patients of the 377 in the registry survived at least 30 days and were analyzed. Average age at presentation was 49 years (range, 1-86; median, 49). Patients were followed up an average of 3.3 years (range, 0.0-15.7; median, 2.4). Eighty-seven of these patients died (25%). Median survival was 10.0 years (95% confidence interval: 7.25-13.11). There was a trend toward higher mortality in women. Twelve of the 87 deaths were due to infectious causes. Using three different statistical analytic techniques, there was a statistically significant increase in the long-term death rate when compared with population-based controls. Infectious causes of death were statistically higher than controls as well. Patients who survive an episode of necrotizing fasciitis are at continued risk for premature death; many of these deaths were due to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis. These patients should be counseled, followed, and immunized to minimize chances of death. Modification of other risk factors for death such as obesity, diabetes, smoking, and atherosclerotic disease should also be undertaken. The sex difference in long-term survival is intriguing and needs to be addressed in further studies.

Simulation Framework for Analysis of Elderly Mobility Policies

The population in developed countries is aging. Literature has paid minimal attention to the effects that population aging may have on transport demand and sustainability. These effects are believed to be more pronounced in urban areas. A policy framework is presented. It can be used as a template for the development and evaluation of policies that directly or indirectly relate to the effect of population aging on transport in urban areas and thereby inform the planning process. A component of the proposed policy development framework is an urban transport simulation model that is used to simulate policy scenarios over time. Integrated Model for Population Aging Consequences on Transportation (IMPACT) is a conventional transport simulation model coupled with a powerful demographic model that has the potential to project the population of traffic analysis zones over time, as it takes into account vital statistics (births, deaths) and migration rates. Two types of policies were investigated. The first regards elderly driver's license renewal; the second is related to new housing development policies. The results indicate that such a system can produce results that can inform policy regarding elderly automobility.