The safety benefits of older drivers attending an in-person licence renewal
Introduction
There is international support for older adults to maintain independent vehicular mobility, however their safety is a serious concern (Langford and Koppel, 2006). The United Nations identified Sustainable Development Goals (SDGs) for road safety, including OD safe mobility (UN General Assembly, 2015). For example, to reduce road deaths and injuries by 50 percent by 2020, and to provide safe, affordable, accessible and sustainable transport by 2030, with special attention to older road users. Currently ODs (ODs) are involved in few crashes (absolute numbers), but are over-represented in both crash-related deaths and serious injuries per distance travelled (Koppel et al., 2011). This over-representation has been attributed to their greater frailty and injury susceptibility (Li et al., 2003), plus increases in age-related functional impairments (Janke, 1994), medical conditions and medication use (Marshall, 2008).
OD's heightened crash risk has prompted licensing jurisdictions to implement policies whereby ODs must demonstrate their fitness-to-drive (Grabowski et al., 2004; Levy et al., 1995; McGwin et al., 2008; Tefft, 2014), including in-person licence renewal (IPLR) (i.e., presenting in-vivo to a driver licensing authority (DLA) for the purpose of licence renewal vs. mail/online). IPLR advocates suggest that this policy facilitates identification of unsafe/unfit drivers for the purpose of referral for further evaluation (i.e., medical review, driving assessment) or licence withdrawal (Grabowski et al., 2004). IPLR critics suggest that this policy can result in safe ODs surrendering their licences prematurely (Oxley et al., 2003) which can be associated with negative psychosocial and health consequences (Edwards et al., 2009; Fonda et al., 2001; Marottoli et al., 2000). However, few studies have specifically examined the safety benefits associated with these policies.
This review evaluated the evidence on key issues relating to the safety benefits of ODs attending an IPLR including:
- 1.
What available screening tools are suitable for inclusion in a population-based IPLR process for ODs aged 75 years and older which:
- a.
Can be administered by non-health professionals (or computer/smart device), and
- b.
Comply with Australian fitness-to-drive (AFTD) requirements (Austroads, 2016)?
- a.
- 2.
What is the evidence that IPLR policies are associated with safety benefits, defined as:
- a.
Reduction in crash risk, and/or
- b.
On-road driving test outcomes (pass/fail)?
- a.
Section snippets
Protocol and registration
The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Liberati et al., 2009; Moher et al., 2009). The protocol was registered with PROSPERO in May 2019 (see CRD42019120809).
Definition and scope
Safety benefits were defined as: 1) crash risk [involvement in motor vehicle crashes that resulted in an injury or fatality (WHO, 2016)], or 2) on-road driving test outcome (pass/fail).
IPLR was defined as the driver (not a delegate) presenting
Study selection
The review process is summarised in Fig. 1. Altogether, five studies met the inclusion criteria and were reviewed/assessed (Table 2, Table 3).
Study characteristics
Included studies were conducted between 1986 and 2011; All studies adopted cross-sectional/cohort study designs. Authors provided limited details regarding study samples (e.g., only two reported sample size) and none reported participant mean age or gender distribution. Four studies were conducted in the U.S. and one in Japan.
Risk of bias
Table 2 summarises the risk
Summary of evidence
This review evaluated the evidence on key issues relating to the safety benefits of ODs attending an IPLR defined as: a) a reduction in crash risk, and/or b) on-road driving test outcomes. Five studies were identified that investigated the relationship between IPLR and crash risk, while no studies were identified that investigated the relationship between IPLR and about on-road test outcomes.
The review suggested there is inconclusive evidence on the safety benefits of IPLR. Two studies (
Funding
This systematic review was funded by VicRoads (Melbourne, Australia).
CRediT authorship contribution statement
Sjaan Koppel: Data curation, Writing - original draft, Writing - review & editing. Lyndal Bugeja: Data curation, Writing - original draft. Amanda Stephens: Data curation, Writing - original draft. Anna Cartwright: Data curation, Writing - original draft. Rachel Osborne: Data curation, Writing - original draft. Gabrielle Williams: Data curation, Writing - original draft. Marilyn Di Stefano: Data curation, Writing - original draft, Writing - review & editing. Judith L. Charlton: Data curation,
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