Assessing the fitness to drive

Practices in European countries governing the licensing of older drivers vary. Some countries require renewal of the driving licence at a certain age, others do not. Those countries that do, often require some sort of medical examination (See box on licensing procedures). Increasingly, researchers recognise that age-based mandatory assessment programmes targeting older drivers are unlikely to produce safety benefits and may have counter-productive results. One of the few evaluations of existing driver testing programmes has compared Finnish and Swedish licensing practices [48]. Finland requires regular medical check-ups in conjunction with licence renewal starting at age 70, whereas Sweden has no such age-related control. A comparison of Finland and Sweden shows no apparent reduction in crashes as a result of the Swedish programme. However, Finland had a higher rate of fatalities among unprotected older road users than Sweden, arguably the result of an increase in the number of older pedestrians who had lost their driving licence. An Australian study reached a similar conclusion. Although the state of Victoria has no age-related licensing controls, its crash statistics for older drivers are no worse than those of other states with established testing programmes [112].

Given the variation in older-driver licensing programmes in European countries, it is understandable that evidence relating to the effectiveness of age-related controls is inconclusive. However, one outcome is clear: many drivers (especially women) voluntarily stop driving rather than undergo a medical examination or a driving test [66][47] . Some give up their licences for health reasons or owing to difficulties in driving, although it remains to be established whether these factors are severe enough to warrant cessation of driving [81].

Licensing procedures in some European countries

Practices in European countries governing the licensing of older drivers vary. The results of an OECD survey show some of the differences in medical requirements for licence renewal. In addition to the medical requirements for renewal of the driving licence, some countries also require older drivers to pass driving tests.

Country	Renewal procedure	Renewal interval	Medical requirements for renewal
Belgium	No	No renewal required	None
Denmark	Yes	At age 70, issued for four years At age 71, issued for three years At ages 72-79, issued for two years At ages 80+, issued for one year If ill, shorter terms possible.	Doctor’s certificate required
United Kingdom	Yes	From age 70, mandatory renewal for three-year periods	Self-declaration of ability to meet vision standard required. Any medical condition that could affect driving must be reported to the Licensing Agency
Finland	Yes	At age 45, renewal every five years As of age 70, renewal period depends on the physician.	After age 45, medical review every five years, covering general health status and vision. Renewal requires medical examination and verification of ability by two people.
France	No	No renewal required	None
Germany	No	Renewal not determined by age	None
Ireland	Yes	Annual renewal regardless of age	At 70, a certificate of medical fitness is required
Italy	Yes	Ten-year renewal up to age 50 Five-year renewal after age 50 Three-year renewal at age 70.	Medical test required with renewal
Netherlands	Yes	At age 70, medical review required every five years	Depending on physical condition, medical review may be more frequent, vision test required
Portugal	Yes	At age 70, renewed every two years	At age 70, a medical exam is required every two years
Sweden	No	No renewal required	None

Source: OECD, 2001

Consultation of doctors

When a health problem has been identified, the question of whether to continue driving depends not on a medical diagnosis, but on the functional consequences of the illness. Moreover, a given condition may affect an individual’s fitness to drive in different ways and to varying degrees [81][55].

Although medical assessment seldom provides sufficient grounds for an absolute assessment of driving ability, it does play a role when there are genuine reasons to question older drivers’ functional capabilities. Physicians, especially those working in primary care, represent an important first contact and information source and are in a position to make judgements and give advice to the patient about fitness to drive. In addition to assessing specific conditions and disabilities, physicians also need to advise on the effects of any prescribed drugs on driving [81].

Knowledge

Assessing the fitness to drive

Licensing procedures for older drivers

Consultation of doctors