Hospitalized drivers aged 60 to 69 in states with in-person renewal laws were 38% less likely to have dementia than drivers in states without such laws.
New evidence shows that mandating physicians to report dementia patients to state driver's license bureaus does not reduce hospitalizations from motor vehicle crashes.
Instead, a new study from the University of Pittsburgh Graduate School of Public Health shows that in-person license renewal laws and vision testing dramatically cut crashes involving drivers with dementia.
The results, published today in Neurology, suggest that physician reporting laws – mandated or legally protected – either aren't working or lack any observable safety benefits.
"This was surprising, as we know that older drivers stop driving based on the advice of their physicians and, if reported to licensing authorities, few regain driving privileges," said lead author Yll Agimi, a health data scientist who did the research while a doctoral student at Pitt Public Health.
"Physicians are required to ensure the well-being of patients with dementia by also monitoring their driving competence," Agimi said. "That leads us to conclude that other licensing requirements may act as the principal means of identifying at-risk older drivers, before physicians identify and report a patient with a medical impairment, such as dementia."
The study analyzed the crash-related hospital admissions from the states reporting data between 2004 and 2009. Among 136,987 hospitalized older drivers, 5,564 had a diagnosis of dementia.
Hospitalized drivers aged 60 to 69 in states with in-person renewal laws were 38% less likely to have dementia than drivers in states without such laws and 23% to 28% less likely in states with vision testing at in-person renewal.
However, physician reporting laws were not associated with a lower likelihood of dementia among hospitalized drivers. These findings held even after the researchers accounted for other factors that could influence crash rates, ranging from police enforcement of safe driving to inclement weather, the study showed.
At the time of the study, Pennsylvania, Oregon and California required physicians to report drivers with dementia to licensing authorities. Twenty-seven states provided legal protection to physicians who report their patients, regardless of whether such reporting is required by law.
Only five states do not require that drivers present in-person – which allows licensing personnel to assess driving fitness – for license renewal at least once within two or three renewal cycles. Two states require road testing at licensing renewal, and 36 states require vision testing.
"The results of our study point to age-based licensing requirements as an effective way to improve safety," said co-author Steven M. Albert, chair of the Department of Behavioral and Community Health Sciences at Pitt.
"But such requirements also may cause social isolation and depression, and may be seen as ageist and discriminatory," Albert said. "So it is very important that our findings spur further study to determine the best approach to ensure safe driving for all on the road while avoiding a negative impact on the mental health of older adults."
John Commins is a senior editor at HealthLeaders.