In-person Renewal Research Articles

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.

The Associations Between Older Driver Licensure Laws with Travel and Passenger Behaviors Among Adults Aged 65 Years or Older (United States, 2003-2017).

Introduction: The aging population has been rapidly growing in the United States (U.S.). In line with this trend, older adults’ mobility and transportation safety are an increasing priority. Many states have implemented driver licensure laws specific to older adults to limit driving among the elderly with driving skill decline. Evaluations of these laws have primarily focused on their safety benefits related to older drivers’ fatal crash rate or injury rate. However, very few studies investigated licensure law effects on older adults’ mobility. Objective: The objective of our study is to evaluate the association between older driver licensure laws and older adult daily traveling and passenger exposure. Methods: The 2003–2017 American Time Use Survey (ATUS) data were linked with statewide driver licensure law provisions. Adults aged 55–64 years were used as the reference group to control for the effects of non-licensure-law factors (e.g., economic trend). We used modified Poisson regressions with robust variance to estimate the relationships between licensure law provisions and the likelihoods of older men and women’s daily traveling and passenger behaviors. Results: Laws requiring a vision test at in-person renewal were associated with increased daily traveling likelihood for women aged 75 years or older, primarily as a passenger. Laws requiring a knowledge test were related to a reduced daily overall traveling likelihood for women aged 75 years or older. Conclusions: In general, licensure law provisions are not strongly related to older adults’ mobility, in particular for older male adults. Older female adults’ daily mobility may be more likely to be influenced by the change of licensure laws than older male adults. The existence of gender-based disparities in responding to licensure laws requires future studies to account for the gender difference in estimating the effects of those traffic policies on older adults’ mobility and traffic safety.

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.

Dementia and motor vehicle crash hospitalizations: Role of physician reporting laws.

To determine the effect of physician reporting laws and state licensing requirements on crash hospitalizations among drivers with dementia. A study of drivers hospitalized because of vehicle crashes, identified from the State Inpatient Databases of the Agency for Healthcare Research and Quality. Multivariable logistic regression was used to examine the effect of mandatory physician reporting of at-risk drivers and state licensing requirement on the prevalence of dementia among hospitalized drivers. Physician reporting laws, mandated or legally protected, were not associated with a lower likelihood of dementia among crash hospitalized drivers. Hospitalized drivers aged 60 to 69 years in states with in-person renewal laws were 37% to 38% less likely to have dementia than drivers in other states and 23% to 28% less likely in states with vision testing at in-person renewal. Road testing was associated with lower dementia prevalence among hospitalized drivers aged 80 years and older. Vision testing at in-person renewal and in-person renewal requirements were significantly related with a lower prevalence of dementia in hospitalized older adults among drivers aged 60 to 69 years. Road testing was significantly associated with a lower proportion of dementia among hospitalized drivers aged 80 years and older. Mandatory physician driver reporting laws lacked any independent association with prevalence of dementia among hospitalized drivers.

Mature Driver Laws and State Predictors of Motor Vehicle Crash Fatality Rates Among the Elderly: A Cross-sectional Ecological Study

Objective: State-level data have indicated that motor vehicle crash (MVC) fatality rates among the elderly vary widely across states. To date, the majority of states have implemented mature driver laws, which often require more frequent license renewals, in-person renewal, and vision testing for drivers above a certain age. We sought to evaluate the impact of mature driver laws on states’ MVC fatality rates among the elderly while examining other state-level determinants of MVC-related deaths.Methods: We performed a cross-sectional ecological study and modeled state MVC fatality rates for the population over age 65 as a function of state transportation policies and demographic, health system, population health, travel, and climate characteristics using a general linear model. Principal component analysis was used to reduce dimensionality of the data and overcome multicollinearity of state predictor variables.Results: Higher average temperature, higher gas prices, and a greater number of emergency medicine physicians to population size were significantly associated with lower MVC fatality rates. Positive predictors of MVC fatality rates were percentage of population overweight or obese and percentage with college degree over the age of 65. Having any restriction on elderly drivers was associated with a higher MVC fatality rate and no individual component of mature driver laws (shortened renewal cycle, in-person renewal, and vision testing) was significantly associated with lower fatality MVC rates for adults over 65.Conclusions: Mature driver laws are not associated with lower state MVC fatality rates among 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.

Review of the Evidence Related to Older Adult Community Mobility and Driver Licensure Policies

A systematic review of literature related to the effects of drivers' license policies and community mobility programs on older adult participation was completed as a part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. The results revealed that states can achieve a goal of reducing traffic crashes, traffic violations, and traffic-related fatalities through relicensing policies requiring in-person renewal and vision testing as well as driving restrictions. Evidence suggests that failure to consider the continued community mobility needs of older adults can result in increasing fatalities among senior citizens using other modes of community mobility. This evidence-based review is informative for occupational therapy practice; however, it does not reveal the association between policy and community mobility interventions and improved engagement and participation. There is a role for occupational therapy in policy development and community mobility programming to promote engagement in occupation to support participation.

A Brief Look at Driver License Renewal Policies in the United States

Driver license renewal policies in the United States vary from state to state in terms of the length of the renewal cycle, requirements for accelerated renewal for older drivers, and other renewal provisions. This article briefly outlines some of these state-to-state differences and comments on the impact of those differences, particularly for senior citizens. The authors note that 17 states have special renewal provisions for older drivers, including requirements for in-person renewal, vision tests, or other testing or certification (e.g., written and road tests). Few states require physician or other professional reporting of unfit drivers to licensing agencies, although many encourage physician reporting or at least do not forbid it. Based on the outcomes of these special renewal provisions for older drivers, as well as other information available to licensing agencies, agency personnel have several choices: allow the driver to keep his or her license, refuse to renew the license or suspend, revoke or restrict the license (e.g., prohibit night driving), or shorten the renewal cycle. The article concludes by commenting on the lack of research data about how well these policies are doing in reducing crash-related injuries and deaths, particularly among older drivers. This lack of data on the effectiveness of specific renewal provisions, coupled with the expenses of additional testing and review, may explain the variations in policies in different states.

Elderly licensure laws and motor vehicle fatalities.

Little is known about how state-level driver licensure laws, such as in-person renewal, vision tests, road tests, and the frequency of license renewal relate to the older driver traffic fatality rate. To determine whether state driver's license renewal policies are associated with the fatality rate among elderly drivers. Retrospective, longitudinal study conducted January 1990 through December 2000 of all fatal crashes in the contiguous United States identified in the Fatality Analysis Reporting System, which involved either an older (ages 65-74 years, 75-84 years, and > or =85 years) or middle-aged (ages 25-64 years) driver. Two regression approaches were used to study the effect of state laws mandating in-person renewal, vision tests, road tests, and frequency of license renewal on driver fatalities, controlling for state-level factors including the number of licensed elderly drivers, primary and secondary seatbelt laws, maximum speed limit laws, blood alcohol level of 0.08, and administrative license revocation drinking and driving laws, per capita income, and unemployment rate. The first regression approach examined only elderly driver fatalities and the second approach examined daytime elderly driver fatalities and used daytime fatalities among middle-aged drivers as a general control for unobserved variation across states and over time. Older driver fatalities and older and middle-aged daytime driver fatalities. Among individuals aged 85 years or older, there were a total of 4605 driver fatalities and 4179 daytime driver fatalities during the study period. For this age cohort, after controlling for middle-aged daytime driver deaths, states with in-person license renewal were associated with a lower driver fatality rate (incident rate ratio [RR], 0.83; 95% confidence interval [CI], 0.72-0.96). This was the only policy related to older drivers that was significantly associated with a lower fatality risk across both regression models. Thus, state-mandated vision tests, road tests, more frequent license renewal, and in-person renewal (for individuals aged 65-74 years and 75-84 years) were not found to be independently associated with the fatality rate among older drivers in the 2 models. In-person license renewal was related to a significantly lower fatality rate among the oldest old drivers. More stringent state licensure policies such as vision tests, road tests, and more frequent license renewal cycles were not independently associated with additional benefits.

License extensions for clean-record drivers: A 4-year follow-up

Over 4,000,000 of California's 17,000,000 licensed drivers used to come to the California Department of Motor Vehicles (DMV) annually to take written and vision tests in order to renew their driver licenses. In an effort to increase public convenience and reduce costs, extension of the license by mail was implemented for selected groups of drivers with clean records over the life of their previous licenses. Continued implementation of the program was subject to evaluation of its effect on traffic safety. Since clean-record drivers make up about 50% of the renewal population, this program made it possible for some 2,000,000 drivers annually to avoid coming to the DMV for license renewal. Two studies of program safety effects were conducted, one evaluating a 2-year extension (760,000 subjects), and the other a 4-year extension (407,000 subjects). Random assignment to a group offered extension by mail or to a control group undergoing standard renewal testing and procedures was followed by careful tracking of accident and conviction activity. During the 48-month period following mailing of renewal notices or extension offers, the extension group had a slightly higher accident rate than did the in-person renewal group — an increase of 1%, or 13 accidents for every 10,000 extension offers. Although this small increase in accident rate would translate into about 2,500 additional accident involvements per year if applied to the current volume of clean-record drivers eligible for extension, statistical tests of significance indicated that the increase could easily be due to sampling error ( p>.10). A supplemental Bayesian analysis resulted in a .24 probability that there was no true increase. The administrative cost savings attributable to the extension program were conservatively estimated to be $3,000,000 per year.