Abstract
This research was designed to identify the impact of state driver's license renewal requirements on the driving mobility (i.e., the reduction or cessation of driving) of older (70 years or older) drivers in the United States. Nationally representative data from four waves (1993–2000) of the Asset and Health Dynamics of the Oldest Old study were linked to state policies on relicensing and used in a longitudinal logistic regression analysis. The author assessed the driving behaviors of a sample of 9,638 men and women. The findings demonstrate that the driving mobility of older people is influenced by state relicensing policies. The analysis indicates that five policies—accelerated renewal, mental testing, peripheral vision testing, renewal in person at age 70+ (as opposed to renewal by mail or online), and restricted licensing—have a significant effect on an older driver's decision to reduce or cease driving. The driving patterns of older adults are influenced not only by their health and socioeconomic backgrounds, but also by state relicensing policies. In terms of public policy, this result shows that there is a mechanism for extending the years of independent mobility for older people: restricted licensing.
INTRODUCTION
The increased number of older people in the developed world has profoundly affected the practice and research in transportation and public policy for older people. With this increase has come a growth in the body of scientific literature concerning mobility and transportation for older people and the influence of medical conditions on driving late in life (CitationFonda, Wallace, & Herzog, 2001; CitationSantariano, MacLeod, Cohn, & Ragland, 2004; CitationAAA Foundation for Traffic Safety, 2008).
There are several approaches to analyze state driver's license renewal laws in the United States. One approach suggests that the majority of states have not reacted to the increasing numbers of older drivers or their decreased driving abilities, and thus the license renewal process (or the lack thereof in some states) significantly contributes to the dangers presented by older drivers to themselves and others (CitationBodnar, 1995). This approach recommends that states adopt more standardized and stricter laws to regulate the driver's license renewal process by instituting mandatory road testing for license renewal beginning at age 60. However, several studies have evaluated the safety effects of age-related screening policies and have found that age alone is not a good predictor of driving ability (CitationKelsey, Janke, Peck, & Ratz, 1985; CitationTripodis, 1997). Results suggest that older drivers should not be tested on the basis of their age but on the basis of their observed or reported abilities because the goal is to preserve mobility while ensuring public safety (CitationStaplin & Lococo, 2003; CitationMolnar, Eby, & Dobbs, 2005). In addition, some research has shown that age-based screening policies cause certain subgroups of safe, capable drivers (especially women) to stop driving prematurely (CitationSiren, Hakamies-Blomqvist, & Lindeman, 2004). More recent work proposes that driver diagnostics and screenings can improve safety and be cost-effective if they target subgroups of drivers who have identifiable high-risk factors, such as diagnosed dementia, rather than targeting the general population (CitationHakamies-Blomqvist, Siren, & Davidse, 2004).
Many researchers in the United States have argued that, in general, elderly drivers are aware of their problems and are able to compensate for their impairment by reducing their annual driving and regulating the time and location of their driving (CitationEvans, 1988; CitationEberhard, 1996; CitationSmiley, 1999; CitationRosenbloom & Stahl, 2002). Further gains in safety are believed to be achieved by encouraging older drivers to learn and use compensatory driving strategies when necessary (CitationAAA Foundation for Traffic Safety, 1994; CitationEby, Molnar, Shope, Vivoda, & Fordyce, 2003). CitationRoenker, Cissell, Ball, Wadley, and Edwards (2003) and CitationEdwards et al. (2009) have found that training drivers to improve the speed of their cognitive processing might protect against declines in driving mobility. However, older drivers most at risk for crashes proved unable to compensate adequately (CitationRoss et al., 2009).
In addition to research on driver-level interventions, research has examined the effect of driver's license renewal laws on fatal traffic crashes among older people (CitationGrabowski & Morrisey, 2001; CitationGrabowski, Campbell, & Morrisey, 2004; CitationKelsey, Janke, Peck, & Ratz, 1985, CitationNelson, Sacks, & Chorba, 1992; CitationLevy, Vernick, & Howard, 1995). The results have been mixed. The Nelson and Levy studies compared persons living in different states that have different regulations. They found that mandatory vision testing, adjusted for the driver's license renewal period, was associated with reductions in the risk of fatal crashes for older drivers. CitationKelsey et al. (1985) conducted a randomized study of older, clean-record drivers in California and found that over the 4-year follow-up, the renewal-by-mail group and the control group, which underwent annual written and vision renewal tests, had similar crash rates. Nevertheless, CitationGrabowski et al. (2004) suggested that the only policy associated with lower fatality rates was the in-person renewal of driver's licenses for the oldest category (85 years and older). CitationNasvadi and Wister (2009) reported that the “daylight-only” driving restriction prolonged the safe driving of older adults in British Columbia, Canada.
However, no research exists to date regarding the impact of state driver's license renewal requirements on the driving mobility of older Americans. The present study attempts to address this gap in the literature by identifying the impact of state driver's license renewal policies on the driving patterns (i.e., driving short or long trips or ceasing to drive) of older drivers (70 years and older) in the United States. This study also compares the demographic, socioeconomic, health-related, and functioning characteristics of three types of drivers: (1) individuals who over time stop driving, (2) individuals who restrict their driving to short trips, and (3) individuals who continue to drive on long trips.
METHODS
Theory
This study uses a rational choice framework to explain why older people reduce or stop driving. Drivers receive utility from driving or from what driving allows them to do, and they weigh the costs and benefits of driving and either renew their driver's licenses or drive illegally. By self-regulating instead of abstaining from driving, older drivers seek to maximize the utility of driving. Restricted licenses impose limits customized to compensate for a driver's particular limitations. Thus, restricted driving may extend the period of time in which a person with particular impairments is able to drive safely.
The advantage of restrictive relicensing policies is that the policies keep people on the road for as long as they can drive without presenting a danger to other drivers. The restricted license provides an option for drivers to continue driving under restrictions. For example, the “restricted license” may allow driving only during the daytime (e.g., to a medical appointment or to a grocery store); for states without this policy option, license revocation may be implemented. An order to surrender one's license results in the abrupt, often traumatic, cessation of driving, compared to a gradual period of restricted licensure. Such an abrupt transition to driving cessation may in turn cause a sharp decline in an older person's quality of life, increase depressive symptoms, and exacerbate the risk of clinical depression (CitationMarottoli et al., 2000; CitationFonda et al., 2001). Therefore, it is desirable to avoid premature driving cessation that lacks a transitional stage of restricted driving. For older drivers, the restricted license is a safety measure analogous to the graduate drivers' license issued to the new, inexperienced, usually young drivers.
Licensing policies and procedures vary across the United States. Most states regulate drivers regardless of age, but several states have additional age-specific policies ().
TABLE 1 Driver's License Renewal Policies by StateFootnote a
There is no agreement in the literature and among state policy makers on the age at which a driver should be considered old (CitationColey, 2001). The youngest age at which a state changes its license renewal provisions is 50 (Oregon) and the oldest is 81 (Illinois). The data used in this study, the Asset and Health Dynamics of the Oldest Old (AHEAD), determined the age of respondents for this study as 70 years and older.
As previous research has shown (CitationFreund & Szinovacz, 2002), the socioeconomic and demographic characteristics of drivers (e.g., income, employment, family status, ethnicity, age, and gender) influence their driving mobility. A higher income can lead to having a safer car and can make driving expenses less of a burden for older drivers. Thus, a higher income should be positively linked with continued driving.
Additionally, having a job often necessitates driving. Employed persons may be more likely to drive because public transportation may not be available or convenient in many locations. The cost-benefit analysis of driving for this person is expected to result in his or her continued driving. Thus, the “work” variable is expected to be positively associated with continued driving.
People who live alone are more likely to drive than those who live with a partner despite the restrictive costs of driving or their physical difficulties. The “marriage status” variable was used to distinguish between those respondents who live alone (coded 1) and those who live with a partner (coded 0). Therefore, we expected the “marriage status” variable to be positively associated with continued driving among older persons.
An educated person is likely to improve his or her driving skills through driving improvement courses for older drivers and to self-regulate his or her driving. Therefore, the “college education” variable was expected to positively influence continued driving. Driving cessation is a process that is strongly related to a driver's self-assessment of health and vision and, in particular, to the actual existence of certain medical conditions. Personal observations can reflect either real or perceived changes in health status. Usually, self-perceived deterioration in health leads to the reduction or cessation of driving.
The women in the studied cohorts were expected to cease or reduce their driving sooner than the men. Historical, socioeconomic, and cultural factors explain this relationship. The people in the studied cohorts came of age at a time when women drove less than men. Now, from a lack of confidence in their own driving and to avoid potentially stressful traffic situations, they sometimes stop driving before the objective conditions would warrant such a decision. Among current older couples, the male partner is generally the principal driver when both partners drive.
Hypothesis
State driver's license renewal requirements for older drivers are public policies that affect an older driver's decision to reduce or cease driving.
Sample
The study used data from the four waves (1993, 1995, 1998, and 2000) of the AHEAD survey, which was conducted by the Institute for Social Research at the University of Michigan. Data collected by this national panel study include information on older adults' health status, financial resources, health care, formal and informal support, and driving status. AHEAD is based on a representative community sample of the continental United States. This survey included community-dwelling individuals aged 70 years and older and a substantial sample of the oldest (age 85 and older) in the elderly population (CitationMyers, Juster, & Suzman, 1997; CitationSoldo, Hurd, Rogers, & Wallace, 1997). The youngest participant was 70 and the oldest was 97.
All of the respondents in the analysis were able to drive at the beginning of each wave. Throughout the waves of the study, the same respondents provided information about their driving patterns (i.e., whether they took short or long trips or stopped driving). An individual's participation was conditional on his or her surviving until each wave's final interview. The total number of observations was larger than the total number of participants because each respondent could be interviewed once, twice, or three times depending on his or her “vital status” in each wave. The sample size was 9,638.
Measures
Dependent variable
For the dependent variable, we used a 3-category variable that distinguished among the participants who drive long distances, those who drive short distances, and those who stopped driving. The dependent variable was constructed from the answers to two questions about driving involvement: “Are you able to drive?” and “Do you limit your driving to nearby places, or do you also drive on longer trips?” The dependent variable was coded as “stop driving” = 0, “short trips” = 1, and “long trips” = 2.
Independent variables
Policy variables
The central tool of law available to guide the self-regulatory behavior of all drivers is the license renewal process. Reporting laws, licensing, and renewal requirements vary across state jurisdictions. The AHEAD study did not contain information about state policies. Therefore, we generated the policy variables through a qualitative document analysis of state policies on driving relicensing and linked them with the AHEAD study.
A search of the regulations of all 50 states and the District of Columbia revealed 13 different driver's license renewal policies (). The policies considered were implemented before the respondents were surveyed. A policy enacted by a state was coded as “1,” and the absence of a specific policy was coded as “0.” An individual respondent's data were linked to his or her state policy variables to make the policy variables the individual-level variables. All the respondents in a state had the same values. For individuals who moved to another state between the interviews, the license regulations of the state where they lived at the time of the initial interview for each wave were applied.
The original policy sources, identified by reviewing the state laws in each state, reported laws on driver's licensing and driver's license renewal statutes in each of the 50 states and the District of Columbia as of 1993, 1995, and 1998. The state license renewal requirements that regulate drivers of all ages and those that specifically affect older drivers were examined. Further information was obtained from the Web sites of the Department of Motor Vehicles (DMV) in each state, the Insurance Institute for Highway Safety, and the National Highway Traffic Safety Administration. In several states where documented regulations were unclear, we conducted telephone interviews with the representatives of the DMV Medical Units to help clarify the regulations. For example, people age 65 and older may choose a 2-year renewal cycle in Connecticut. It was not clear why a driver would choose to renew the license for 2 years when a 6-year option was available. A DMV representative explained that the 2-year license was cheaper than the 6-year license, which is why older people often choose to renew their licenses for only 2 years. We compared the 1992, 1996, and 1998 State Motor Laws and found no changes among the regulations affecting licensing practices during these years. Most laws have remained the same until now. Therefore, the values of the policy variables remained constant for all years of the study. The five policy variables identified in the preliminary analysis (results not shown) that had a significant impact on the decision of an older driver to stop or reduce driving were included in this model.
Accelerated renewal
Fifteen states and the District of Columbia had a requirement for older people to renew their drivers' licenses more often than younger people; the remaining 35 states did not. For example, in Illinois, drivers aged 21 through 80 were issued licenses that were valid for 4 years. Drivers aged 81 through 86 were issued licenses that were valid for 2 years, and drivers of age 87 and older were required to renew their licenses annually.
Renewal in-person at age 70 or older
Seven states do not allow drivers older than 70 to renew their licenses by mail; the remaining 43 states and the District of Columbia do.
Peripheral vision testing
Twenty-four states have a requirement for a driver to be tested to be able to see “out of the corner of the eye.” This ensures that a driver can see cars on both sides of him or her while the eyes are on the road ahead. Twenty-six states and the District of Columbia do not require the peripheral vision (perception of angular movement) test. The states' requirements for passing the peripheral fields' vision test varies from 70 to 120 degrees.
Restricted licensing
A typical restriction allows driving only during daylight hours, requires the vehicle to have additional equipment (e.g., wide-angle and planar rear-view mirrors and the extension or relocation of controls), or restricts driving to specified places or activities (e.g., visiting the hospital or doctor, shopping, and attending church services) or to a limited distance from the driver's residence. These restrictions can also limit driving to 40 miles per hour and/or no interstate driving. In 15 states, the DMV can issue restricted or limited driver's licenses to individuals who have disabilities or a reduced driving ability in all types of traffic conditions. The other 35 states and the District of Columbia do not issue restricted licenses.
Mental testing
Twenty-four states and the District of Columbia have an optional policy that requires drivers to perform a mental test; the other 26 states do not. The policy includes certain mental requirements, such as the proper integration and interpretation of sensory input, focus of attention, proper associations of thought, and appropriate judgment. However, the mere existence of a certain mental or physical condition is not sufficient to support the DMV revoking drivers' licenses. For this action to be justified, there must be a poor driving record or proof of accidents, if any. A mental test may be requested at the discretion of an examiner or may be performed if other people, laws, or doctors require it.
Demographic and Socioeconomic Controls
The analysis controlled for a respondent's background characteristics, including age, gender, race, marital status, income, education, and residence (urban or rural). Race was coded into three dummy variables: Black, Hispanic, and White. The “White” variable served as a reference category. The household income was log transformed to reduce its originally skewed distribution. Education was a dummy variable with two categories: no college and college.
Health-Related and Functioning Controls
The AHEAD surveys included measures of the health conditions and functioning statuses that affect driving in old age; 10 of these measures were used in this study. To assess the impact of health on driving, 7 medical conditions (angina, arthritis, high blood pressure, insulin-dependent diabetes, psychiatric problems, stroke, and poor vision) that a person could have experienced during the 12 months prior to the study or between two waves of the study were included in the analysis as dummy variables.
As a proxy measurement for physical limitations and mobility tasks, we used the “not walk” variable to indicate whether a respondent reported having difficulty walking several blocks. The variable was dummy coded “0” for “not having difficulty walking several blocks” and “1” for “having difficulty walking several blocks.”
Prior research has shown that the “fall incidents” variable, which was included in this study, affects driving patterns. Studies have reported that a history of falls is associated with reduced or diminished driving ability or increased accident risk (CitationForrest, Bunker, Songer, Coben, & Cauley, 1997). The use of prescription drugs was the final dummy variable.
The definitions and mean values of all the explanatory variables that describe the drivers in the first wave of the AHEAD study are reported in . These variables reflect the status of the individuals at the time of the baseline interview in 1993.
TABLE 2 Sample Means and Standard Deviations for Baseline Model (n = 4,207)
Analysis
A trinomial logistic regression model was used for this longitudinal analysis. The model included the short- and long-trip drivers in all four waves of the AHEAD study. The drivers who took long trips were the reference category for the model. Therefore, the model produced the effects of independent variables on stopping driving versus continuing to drive long distances and on switching to driving short trips versus continuing to drive long distances. All the independent and control variables were simultaneously included in the regressions. The log odds are shown in to present a more intuitive interpretation of the results.
TABLE 3 Effects of State Policies on Driving Restriction/Cessation: Multinomial Logistic Regression, Fixed Effect Model (AHEAD Waves I–IV, 1993–2000, n = 9,638)
RESULTS
This study's findings on the impact of state policies on driving reduction and cessation are consistent with the theory that certain state policies give older adults the opportunity to continue driving to meet their basic mobility needs (). The results indicate that driving reduction and cessation were strongly linked to the mental testing, peripheral vision testing, and restricted licensing policy variables. The accelerated renewal and renewal in person at age 70 or older variables were significant for reduction but not for cessation of driving.
The restricted licensing policy encouraged driving longer trips instead of shorter trips (p < .05); it also encouraged individuals to continue driving instead of ceasing (p < .1). The accelerated renewal policy promoted driving reduction (p < .05), while the renewal in person at age 70 or older policy encouraged driving longer trips instead of shorter trips (p < .05). These results suggest that the renewal in person at age 70 or older policy reduced the likelihood of driving reduction, and the restricted licensing policy reduced both the reduction and cessation of driving. The mental testing policy promoted driving reduction (p < .001) and cessation (p < .05), although the peripheral vision testing policy decreased the reduction (p < .05) and cessation (p < .001) of driving. The policies that were analyzed appeared to correct for premature driving cessation and premature driving reduction while encouraging the reduction or abstention from driving when necessary.
In addition to the hypothesized effects, we examined the impact of the control variables on driving patterns (). Age was strongly associated with driving cessation and reduction (p < .001) versus continuing to drive long distances. Blacks (as opposed to Whites) were more likely to stop driving or to reduce their driving to short distances (p < .001). Hispanics (as opposed to Whites) were more likely to stop driving and to change their driving patterns from long trips to short trips, but the data and model did not provide sufficiently significant statistical evidence. Consistent with previous research (CitationFreund & Szinovacz, 2002), this study demonstrated that non-White older people have different driving patterns compared to older White drivers.
We also assessed the impact of gender on driving patterns. As expected, the results showed that women were 3 times more likely than men to stop driving (p < .001) and 2.5 times more likely to reduce their driving (p < .001) rather than to continue driving on long trips.
We expected that people who live alone are more likely to drive, despite their health and physical difficulties, than those who live with a partner. The analysis revealed that living alone increased the likelihood of driving for short rather than long distances (p < .05). In other words, those who live alone may be more likely to reduce driving than to cease driving completely, compared to those who live with a partner, regardless of their health and physical difficulties.
Older people with no college education were more likely than their college-educated peers to stop driving altogether or to restrict their driving to short distances (p < .001). Being employed and having a higher income promoted increased driving (p < .001). The analysis also found that a person who does not have a car will likely not drive (p < .001).
As expected, a driver's self-reported vision status and several medical conditions had a statistically significant impact on driving modifications. High blood pressure, insulin-dependent diabetes, psychiatric problems, stroke, and poor vision increased the likelihood of driving reduction and cessation (p < .001). On the other hand, angina and arthritis were not significantly associated with driving reduction and cessation. Surprisingly, our analysis did not show that prescription drug use had a significant impact on driving behavior. However, a self-reported history of falls was associated with driving cessation (p < .01). As also expected, having difficulty walking several blocks significantly increased driving reduction and cessation (p < .001). The availability of public transportation (captured by the variable “urban residence”) appeared not to have a significant impact on driving cessation and reduction.
DISCUSSION
This study built on previous research findings that in-person license renewals reduced fatality rates among the oldest drivers (85 years and older) (CitationGrabowski et al., 2004) and that mandatory vision testing, adjusted for the driver's license renewal period, was associated with a lower fatal crash risk for older drivers (CitationNelson et al., 1992; CitationLevy et al., 1995). This paper demonstrates that state driver's license renewal requirements made a significant difference in the driving mobility of older Americans. Driving decisions are not independent of licensing policies. This research complements the existing literature by providing empirical evidence that the driving mobility of older people is influenced not only by their health and socioeconomic characteristics, but also by state relicensing policies. We showed that the policy requirements, including accelerated renewal, mental testing, peripheral vision testing, renewal in person at age 70 or older, and restricted licensing, have a significant effect on an older driver's decision to reduce or cease driving. These results are consistent with our theory that the states with restrictive relicensing policies allow older people to continue driving to meet their basic mobility needs.
A decrease in driving mobility is an important characteristic of older drivers as a group (CitationHakamies-Blomqvist, Johansson, & Lundberg; 1996; CitationRoss et al., 2009). However, self-regulation (by reducing driving) is not the only explanation for a reduction in driving mobility among older drivers. As they age, people may have less need to drive or simply prefer not to drive (CitationBlanchard & Myers, 2010). In contrast, those who have responsibilities that require them to drive will do so. This research showed that having a job is a significant predictor of extended driving mobility for older Americans; working men and women are less likely to stop or reduce their driving. Additionally, in some cases, self-regulation can result in more driving. For instance, avoiding the freeway and left-hand turns may lead to more driving because these strategies force the driver to take indirect routes.
The development of state relicensing policies is a necessary condition to solve the mobility problem for older people, but it cannot be the sole solution, particularly for the oldest individuals in the elderly population. Our analysis is consistent with findings from previous studies that show that there is no substantial increase in the use of alternatives, such as fixed-route public transit, flexible paratransit services, taxis, or walking, when people can no longer drive themselves (CitationFonda et al., 2001; CitationDonorfio, Mohyde, Coughlin, & D'Ambrosio, 2008). This finding can be explained by the limitations of traditional public transportation and the operational limitations of special services that cannot substitute for the mobility and freedom a private car provides (CitationRosenbloom, 1993; CitationCobb & Coughlin, 1998). Another reason for the no car substitution effect is the tendency of older people, even those in relatively good health, to have medical conditions that limit walking and, consequently, the use of public transportation, even before they are forced to stop driving (CitationOrganisation for Economic Co-operation and Development, 2001). The current study also showed that men and women who have difficulty walking several blocks are almost 3 times more likely to stop driving than those who do not have this difficulty.
Some of the existing literature argues that public transit will become increasingly important to communities of older people (CitationU.S. Department of Transportation, 2003), while other studies disagree with this projection. These studies suggest that public transportation intrinsically does not meet the needs of older people and, therefore, spending money on public transportation for them is not a wise use of public resources (CitationBurkhardt, 2000). Moreover, given current fiscal constraints, state governments are unlikely to have funds for such projects. Therefore, there is a need for transportation that is tailored to the functional limitations of those who stop driving. Many of this population would require “door to door” or even “door through door” transportation. This kind of transportation is the only acceptable alternative to driving a private car for older people who, for various reasons, can no longer drive (CitationEberhard, 2008). To date, there are several states (California, Florida, Maine, Maryland, Missouri, and Kansas) that have developed and begun to implement a transportation policy for older adults that includes both relicensing and alternatives to private driving. Another innovative solution to seniors' mobility needs is the Independent Transportation Network (ITN), which provides rides that replicate the comfort and convenience of a private car (CitationITNAmerica, 2010).
This study suggests that providing the option of restricted driving may be a way to meet the mobility needs of some community-dwelling older drivers. Restricted licenses impose limits that are customized to compensate for a driver's particular limitations. Thus, restricted driving can extend the period of time in which a person with particular impairments is able to drive. In public policy terms, this finding shows that there is a potential mechanism for extending the years of independent mobility for older people. However, when driving is no longer safe, alternative transportation programs to maintain or even increase mobility should be considered (CitationRoss et al., 2009; CitationWindsor & Anstey, 2006).
This study was limited because we did not address how the state policies were implemented. Conducting corresponding data collection was not feasible within the scope of the current project. We had to assume that across (and within) different states the effectiveness of the same policy was equal. Only the presence or absence of license renewal policies in state laws was recorded. In the future, additional analyses can be conducted using new measurement technologies to examine the safety and mobility benefits of extending driving through restricted licenses. Further research will also benefit from studying the impact of auto insurance companies' policies on the driving mobility of older adults.
The author is grateful to Anna Amirkhanyan, Vernon Greene, Gwendolyn Stewart, Douglas Wolf, the editor, and the reviewers for their helpful comments on earlier versions of this paper.
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