BALTIMORE — Mandatory cognitive tests for older drivers help prevent car crashes involving men, but not women, a new study finds. In Japan, those over 75 reapplying for their license have to take a cognitive test and can lose their license if they have dementia or Alzheimer’s. However, this increases the number of accidents involving elderly pedestrians and cyclists, as they find alternative ways of getting around.
The findings are based on an analysis of police-reported data on people over 70 in Japan from July 2012 to December 2019.
“Safety measures need to be strengthened for older cyclists and pedestrians,” says corresponding author Dr. Haruhiko Inada from the Johns Hopkins Bloomberg School of Public Health, according to a statement from SWNS. “We should also provide older people with necessary care to prepare for driving cessation and safe, alternative transport means.”
The study in the Journal of the American Geriatrics Society found motor vehicle collisions only fell among male drivers after the implementation of the program. However, more pedestrians and cyclists were injured as cognitively impaired individuals used bikes or walked instead of driving.
Japan has one of the oldest populations worldwide
As of March 2017, people over 75 in Japan who test positive for cognitive impairment must see a physician. If diagnosed with dementia, their driving licenses may be suspended or revoked.
Following the policy, there were around 3,670 fewer collisions than expected among male motorists. There were roughly 959 more injuries involving pedestrians and cyclists of both sexes, mainly affecting men between 80 and 84, and women over 80.
“After March 2017, the number of motor vehicle collisions per population decreased among older men but not among women,” Dr. Inada tells SWNS.
Previous studies have shown mixed results regarding the association between the introduction of cognitive testing for driver’s license renewal among older drivers and the incidence of motor vehicle collisions involving them.
“Using a robust study design with large national data, we revealed that such a cognitive screening for drivers aged 75 years or older from March 2017 was associated with decreased motor vehicle collisions per population in Japan,” Dr. Inada continues. “This study also confirmed that the cognitive screening was associated with increased road injuries per population among older pedestrians and cyclists.”
There was a total of 602,885 driving collisions during the study period and 196,889 injuries involving pedestrians and cyclists. Japan is one of the fastest aging societies in the world, with one in five citizens over the age of 70. It is also a nation of drivers and car lovers, with nearly 80 million vehicles on the road. Keeping traffic accidents down as people get older is a growing problem.
Older drivers cause twice as many fatal accidents
A recent survey in the United Kingdom found more than half of motorists over the age of 60 would back testing drivers every five years after they reach 70. Under current rules, U.K. drivers have to renew their driving license every three years, but that process simply requires drivers to fill out a form and a medical declaration. There are no checks to find out whether the driver is still competent behind the wheel.
Being able to drive can provide older people with independence and respect. Discussions with older family members about giving up their car can be difficult and affect their dignity.
Losing licenses can significantly impact elderly people in rural areas, where older populations are bigger and public transport can be limited. Without a car, many cannot survive. They cannot go shopping or see their friends. To enjoy life, a car is a necessity for many people. Some older adults are aware of their impaired driving skills, but they need to keep driving for their daily life.
“Older drivers garner increasing attention as populations age and the share of motor vehicle collisions that involve them increases,” Dr. Inada says, according to SWNS. “In addition, many people have a negative image of older drivers and believe they are risky.”
In Japan in 2019, 41 fatal collisions were attributed to drivers mistakenly pressing the accelerator instead of the brake. Of these, 28 were caused by motorists 75 or older.
“In addition, older drivers are prone to medical conditions that increase the risk of collisions and may also affect public perceptions of older drivers,” the study author continues. “To prevent motor vehicle collisions among older drivers, some countries and areas, including Denmark, Japan, Ontario, and Taiwan, conduct cognitive screening tests at license renewal.”
In 2018, the proportion of fatal traffic accidents in Japan caused by drivers 75 or older rose to 15 percent, up from less than nine percent in 2008. According to a Japanese government report, these older drivers caused more than double the number of fatal accidents than younger drivers.
Can car makers do something?
Vehicle manufacturers are making changes intended to improve safety by reducing collisions caused by errors that older drivers are prone to committing. However, the technology has not been fully evaluated.
“For example, since November 2021, all new model four-wheeled motor vehicles produced and sold in Japan are required to have automatic emergency brakes,” Dr. Inada explains. “In addition, in May 2022, Japan introduced a driver’s license restricted to partially autonomous vehicles. More broadly, it is necessary to position safety measures for older drivers in the context of social systems that enable older people to age in place. However, we still have limited evidence to effectively integrate extending ‘driving life expectancy’ and securing transportation after driving cessation into multi-sectoral strategies to extend healthy life expectancy.”
“Whether older drivers with pre-clinical to mild dementia have a safety profile comparable to their healthy counterparts and may be allowed to continue driving is an area of active research. However, those with moderate to severe dementia should stop driving,” Inada tells SWNS. “We need to seek for effective strategies to provide older people with necessary care to prepare for driving cessation and alternative transport means.”
“In conclusion, following the amendment of a law requiring cognitive screening at license renewal for older drivers, motor vehicle collisions for older drivers decreased and road injuries of older pedestrians and cyclists increased in Japan.”
South West News Service writer Mark Waghorn contributed to this report.