The safety benefits of older drivers attending an in-person licence renewal

Highlights

• Literature on safety benefits of older drivers attending an in-person licence renewal was systematically reviewed.

• Five studies published between 1986 and 2011 met the inclusion criteria.

• Review did not identify any suitable screening tools for inclusion in a population-based in-person licence renewal process.

• Inconclusive evidence regarding the safety benefits associated with in-person licence renewal policies.

• Population-based controlled research study is needed to investigate the efficacy of in-person licence renewal polices.

Abstract

Introduction

This study systematically reviewed the literature on key issues relating to the safety benefits of older drivers attending an in-person licence renewal. This included identifying: 1) screening tools that are suitable for inclusion in a populationbased in-person licence renewal process for drivers aged 75 years and older which: a) can be administered by non-health professionals (or via a computer terminal/smart device), and b) are compatible with Australian fitness to drive requirements; 2) the evidence that in-person licence renewal policies are associated with safety benefits, as defined by: a) a reduction in motor vehicle crash risk, or b) on-road driving test outcomes.

Methods

This review was registered with PROSPERO 2019: CRD42019120809. A systematic search of public health, psychology and transport databases was conducted on March 20th 2019.

Results

Five studies published between 1986 and 2011 met the inclusion criteria. The review did not identify any suitable screening tools for inclusion in a population-based in-person licence renewal process for older drivers. There was inconclusive evidence regarding the safety benefits associated with in-person licence renewal policies for older drivers. Two studies reported that these policies were associated with a reduced crash risk. However, two studies reported that these policies were not associated with a reduced crash risk, and a third study provided inconclusive evidence. It is important to note that the included studies were conducted across different licensing jurisdictions, with different in-person licence renewal policies – both with and without vision and cognitive testing, which limit the generalisability of the findings.

Conclusions

It is recommended that a population-based controlled research study in multiple licensing jurisdictions is conducted to specifically investigate the safety benefits of in-person licence renewal policies, as well as the efficacy of different components (including screening by health professionals prior to renewal), as a means to reduce road trauma.

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:

• What available screening tools are suitable for inclusion in a population-based IPLR process for ODs aged 75 years and older which:

  • Can be administered by non-health professionals (or computer/smart device), and

  • Comply with Australian fitness-to-drive (AFTD) requirements (Austroads, 2016)?

• What is the evidence that IPLR policies are associated with safety benefits, defined as:

  • Reduction in crash risk, and/or

  • On-road driving test outcomes (pass/fail)?