Because available tests exhibit limitations, efforts are being made to further expand driving competence evaluations beyond the written formats and existing road examinations. Suggestions for improvement include the utilization of visuo-spatial tests, mazes and technologically based solutions. One of the most fascinating technological tests in development is the Global Position Satellite (GPS) model (Porter and Whitton, 2002). This procedure involves outfitting the elderly person's vehicle with a GPS receiver and a dash-mounted camcorder for a specified duration of time. The GPS receiver provides the physical location of the vehicle, thereby providing the driver's position with respect to intersections, roads and heavy traffic areas. Visual data from the camcorders, coupled with the GPS location data, can later be reviewed to provide information about the exact events of the driving test as they occurred. Oncoming traffic flow, pedestrian activity and road hazards can all be considered in the evaluation of the elderly driver. The GPS test would also address discontinuity of testing standards in vehicle test administrators.
While intelligence testing and mental status examination tools may suggest the presence or absence of driving difficulties in a cognitive sense, they do not include substantial information as to the physical and operational abilities of the elderly individual when driving. Physical faculties must be pristinely functioning in order to successfully operate a vehicle. Deficits in sight and hearing, arthritic conditions, muscular degenerative conditions, connective tissue diseases, and Parkinson's disease all may render an individual unable to operate a vehicle with the precision necessary for safe driving.
Medicinal treatments of physical impairments come with their own inherent set of problems. Certain medications may actually interfere with safe vehicle operation. Statistically, older drivers are far more likely to be on medications than any other driver age bracket (McGregor, 2002). Medications that commonly affect driving ability are hypnotic anxiolytics, narcotics, antipsychotics, sedatives, antidepressants, anti-inflammatory agents, muscle relaxants and ophthalmic drugs. While many drivers are able to function normally on medications, the additional factor of multiple physical maladies and comorbidities may create a decisive impairment in driving ability.
Current legal thinking suggests that responsibility for this problem must be shared between the DMV and the health care system. The American Medical Association's Council on Ethical and Judicial Affairs opines that the physician has an ethical duty to report patients who may suffer from dementia or related deficits (Howe, 2000). In 1988, California adopted a law that requires physicians to submit reports on all patients diagnosed with Alzheimer's disease or related cognitive disorders to the Health Department. In turn, these reports are sent to the local DMV office so that a driver's test can be administered immediately. However, a recent study suggested "more than 28% of all geriatricians do not know how to report patients with dementia who are potentially dangerous drivers" (Cable et al., 2000). The DMV, while mandated to make administrative decisions regarding driving privileges, has no enforcement ability. Enforcement falls to the police, who may have little time or interest in tracking down elderly drivers who are operating their vehicles with revoked licenses.
Since a single individual or instrument cannot examine elements of cognition, physical ability and psychological well-being, some investigators have proposed new solutions. Fitten (2003) suggested the implementation of graduated driver licensing programs in order to provide for a better system of screening. Fitten argued that age-appropriate testing is a necessity. He advocated a program with action plans and resources to respond to issues such as confidentiality, post-driving cessation education, and alternative transportation options. Fitten opined that it is in the interest of the greater good "to identify impaired elderly drivers through scientifically derived and health-related screening methods."
Taking an opposing stance is Fain (2003) who proposed that the perceived threat of the elderly driver is indicative of societal bias with respect to age. She argued that the rights of the elderly are being trampled upon to avoid inconvenience to the general populace. Fain also called attention to the fact that national studies of morbidity rates and crash data are designed to average accident information, but do not give any consideration to the percentage of capable elderly drivers who maintain spotless driving records. She suggested that the data reflects an unfair bias toward the elderly in that it proposes restrictions on both problematic drivers and capable drivers alike. Essentially, Fain proposed a return to examinations based solely on driving history and functional performance, regardless of age.
The arguments on both sides have merit and both also miss the point--we propose to reframe the issue. We take no specific position on whether the elderly should be permitted to drive, because this is up to the will of society. Essentially, we are speaking of a balance between personal (an individual's right to drive) versus collectivity (society's right to be protected from harm) autonomy. Similar to the sexually violent predator (SVP) statutes (which derived out of several notorious cases; e.g., Kansas v Hendricks, 1996), we perceive that society now wants to impose a liberty limitation on the elderly driver (also as a result of a few tragic instances). If this is the case, let us then, as a society, be honest about this desire. Let us cease to lay the responsibility into the laps of the DMV, the physician and the family, because these parties do not currently have legal guidance as to what society wants and do not have enforcement power. If, as we suspect, society no longer wants many elderly people to drive, specific guidelines for making the determination of driving incapacity must be legislated (in a similar manner to how SVP legislation was enacted), and we should then put our energies toward intelligently dealing with the resulting fallout.
Until legislative guidelines can be enacted to further address the issue of driving in the elderly, improvements can be undertaken to reduce the rate of accident occurrence. Efforts are being directed toward three key areas: the driver, the roadway and the vehicle (Fain, 2003). Current training programs are now offered for the elderly driver to improve driving performance and refresh knowledge of driving laws. Recognizing that drivers vary in operational ability in later years, engineers are also designing automobiles with additional safety features and driver assist capabilities. Car companies promise such features as automatic braking and proximity alert devices. Roadway improvements are focused on lessening turning gradients, increasing sign visibility and introducing reflective pavements.
