Driving and aging.

Driving represents a major tangible representation of independence for the elderly. People tend to think of driving as an inherent right. In fact, it is a complicated and potentially fatal activity that must be regulated and monitored. Although individuals over 70 years of age drive fewer miles, the chance of an accident per mile driven is higher because of the multiple changes related to aging. Those changes include decreased sensory perception, slowed information processing, and changes in motor performance. Most states presently do not require increased frequency of license renewal for the older driver, nor do they include periodic retesting using a written examination and road test. The laws regarding such retesting are in a state of change. Screening tests for driving safety must be revised. They should include vision and motor performance testing that is related to driving performance, based on current and continuing research. A field test should be included for drivers over 70 years of age, with a license renewal every 24 months. The physician is in a powerful position regarding surveillance of unsafe drivers. A difficult ethical decision may arise, however, involving a breach in the confidential physician/patient relationship, which must be weighed against the desire to protect society. Legislation regarding physician immunity needs to be clarified. There are many unsafe older drivers who should have their driving limited or their driver's licenses cancelled. However, we also must protect the rights of the older individuals who are safe drivers.