Every morning in America, millions of senior citizens pick up their car keys and drive to doctors’ appointments, grocery stores, and social events. For many, these everyday drives help them stay independent and connected to others. However, there is a serious issue: nearly one in six older drivers has mild cognitive impairment. Our healthcare system does not have a reliable way to decide who should no longer be driving.
Based on the most recent data, which comes from 2020, there were 48 million licensed drivers aged 65 and older in the United States. Approximately 17% of seniors are affected by mild cognitive impairment, presenting a significant challenge to ensuring road safety while maintaining their independence. A recent analysis conducted by researchers at Brigham and Women’s Hospital indicates that the healthcare system must enhance its efforts to monitor and assess older adults who continue to hold driving licenses. The data reveal a sobering reality: in 2020, motor vehicle crashes resulted in 7,480 fatalities and nearly 150,000 non-fatal injuries among drivers over the age of 65.
As the research notes, “With approximately 17% of people older than 65 years (roughly 8.2 million people) experiencing mild cognitive impairment and at increased risk of motor vehicle crashes, it is critical to have a health care system that appropriately evaluates and addresses driving safety among older adults.”
Primary care physicians face a challenging dilemma when tasked with evaluating an older patient’s driving capabilities. Existing cognitive screening tests are inadequate, and even specialists struggle with these assessments. Making an incorrect decision can lead to serious repercussions: revoking someone’s driver’s license prematurely may lead to depression and social isolation, while failing to identify genuinely dangerous drivers poses a risk to everyone on the road.
Specialized driving evaluation programs provide a valuable solution for assessing driving competence. These assessments involve direct observations—often on-road—of a patient’s driving skills, conducted by occupational therapists or other qualified professionals in clinical settings. Instead of relying solely on cognitive tests conducted in an office, these programs focus on evaluating real-world performance, resulting in concrete data about an individual’s ability to navigate traffic safely.
These essential assessments face a significant barrier: cost. In Massachusetts, comprehensive driving evaluations, including road tests, range from $500 to $800. Without Medicare coverage, many seniors cannot afford this potentially life-saving service.
The researchers note, “without Medicare coverage, private driving assessments can be prohibitively expensive for many.”
The stakes go beyond individual safety. In 2016, annual Medicare expenses for traumatic brain injuries were estimated to exceed $19 billion, with motor vehicle crashes being a significant source of these injuries among older adults. By implementing proper driving assessments, we could potentially reduce these costs while safeguarding both seniors and other road users.
Major patient advocacy groups, like AARP and the Alzheimer’s Association, recommend that drivers who may be at risk receive thorough driving evaluations from qualified specialists. These assessments help identify individuals who cannot drive safely. They also suggest limitations, strategies to compensate for driving challenges, or training for those with less serious issues.
Medicare covers fall risk assessments by occupational therapists because preventing falls saves lives and money. This logic should also apply to driving safety. Like falls, car crashes are preventable sources of injury and death among seniors. Current policies create an artificial barrier between safety assessments, leaving a dangerous gap in preventive care.
While concerns exist about standardization in driving assessments, there is broad agreement on dangerous behaviors such as crossing into oncoming traffic or ignoring signals. Advancements in GPS technology and driving simulations may provide cost-effective screening options in the future.
Changing Medicare policy requires congressional action, but the cost of inaction—both in lives and healthcare expenses—far exceeds the investment needed for this coverage. We cannot wait for a perfect system while potentially impaired drivers remain on the roads without proper evaluations.
“Driving is a multifaceted activity that requires learned skills and the coordination of complex cognitive and physical functions. As we age, we are vulnerable to declines in our cognitive, visual and motor skills that can impact our ability to drive safely,” says corresponding author Kirk Daffner, in a statement. “Therefore, it is imperative to support programs in our healthcare system that can evaluate driving safety of at-risk individuals in a manner analogous to Medicare’s coverage of a fall risk assessment.”
Just as we wouldn’t permit pilots to operate commercial aircraft without routine safety evaluations, we cannot leave the assessment of at-risk drivers to randomness or financial limitations. It is essential for Medicare to understand that driving safety transcends transportation—it is a vital public health issue that warrants coverage within our national healthcare system.
Methodology
The authors conducted an informal survey of 8 driving assessment programs in Massachusetts in March 2024 to determine current costs. They reviewed existing literature and policies regarding driving assessment methods, Medicare coverage, and statistics about older drivers and motor vehicle crashes. The paper presents a viewpoint synthesizing this information to argue for Medicare coverage of driving assessments.
Key Results Breakdown
The research revealed that approximately 15% of patients with mild cognitive impairment fail driving evaluations. With about 8.2 million older Americans experiencing mild cognitive impairment, this suggests over 1.2 million potentially unsafe drivers on the roads. Current assessment costs range from $500-$800 in Massachusetts, making them prohibitively expensive for many seniors without insurance coverage.
Study Limitations
The cost survey was limited to Massachusetts programs and may not represent national averages. The paper also acknowledges ongoing debate about the most effective methods for driving assessment and the lack of standardization across programs.
Discussion and Key Takeaways
The authors argue that driving safety evaluations are analogous to currently covered preventive services like fall risk assessments. They emphasize that impaired drivers pose risks not only to themselves but to the public, making this a unique public health issue. The paper suggests that covering these assessments could actually save money by preventing costly accidents and injuries.
Funding and Disclosures
The authors reported no conflicts of interest or external funding sources for this paper.
Publication Information
This viewpoint article was published online in JAMA Neurology on August 12, 2024, authored by Kirk R. Daffner, MD and Margaret O’Connor, PhD from the Department of Neurology at Brigham and Women’s Hospital, Harvard Medical School.
