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Driving is a central part of daily life and commerce. The ability to safely navigate a motor vehicle is an extremely complex task that is impacted by the health of the driver and their driving behaviours.

The mission of the Safer Driver Program is to improve driver health and roadway safety through research, evidence-based approaches, and interventions. We are focused on providing individuals, families, companies, insurers, risk managers, policymakers and regulators with solutions designed to improve driver health and roadway safety.

We have established a growing network of stakeholders who are interested in promoting improvements in driver health and roadway safety through a wide range of research efforts including sponsoring and/or participating in research.

The Safer Driver Program also offers a growing number of educational experiences, training opportunities, and interventions to improve driver health and roadway safety.

To learn more about ways about how you or your organization can become members of the Safer Driver Program efforts, or to learn about ways the Safer Driver Program can assist you or your organization contact us at: info@safedriverprogram.com

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Research

The Safer Driver Program is committed to advancing the scientific understanding of how medical conditions and health-related factors affect driving safety. Below you will find a brief summary of peer-reviewed, open-access research from PubMed and PubMed Central (PMC) for several common medical conditions known to impact driving abilities and risky driving behaviours. The links to the peer-reviewed research is also available for each section. The content in this section will update on a regular cadence throughout the year to expand on recent findings and include more medical conditions.

Dementia and Driving Risk

Dementia significantly impairs the cognitive functions essential for safe driving, including attention, visuospatial processing, judgment, and reaction time. Research indicates that drivers with dementia perform worse on standardized road tests and driving simulators compared to age-matched controls. Importantly, crash risk appears to increase substantially in the years preceding a dementia diagnosis. One population-based study found a nearly five-fold increase in motor vehicle crashes during the three years before an index hospitalization for dementia.

Key Research Articles

  • Jun H, Liu Y, Chen E, Becker A, Mattke S. "State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis." JAMA Network Open. 2024;7(4):e248889. PMID: 38662368. Free PMC article.
  • Agimi Y, Albert SM, Engberg J, Steiner CA, Youk A, Documet P. "Physician reporting laws and crash hospitalizations among drivers with dementia." Neurology. 2018. PMID: 29695593. Free PMC article. This study found that physician reporting laws were not independently associated with lower crash rates among drivers with dementia, but vision testing at in-person license renewal was associated with lower crash prevalence.
  • Lam B, Agar M, Chye R, Brannock M. "Diagnosed dementia and the risk of motor vehicle crash among older drivers." Alzheimer Disease & Associated Disorders. 2018. PMC5869102. A population-based study using the Western Australian Data Linkage System found that 43% of drivers with dementia had a crash in the 3 years before diagnosis, compared to 30% of those without dementia. After diagnosis, crash risk dropped 93%.
  • Davis J, Hamann C, Butcher B, Peek-Asa C. "The Medical Referral Process and Motor-Vehicle Crash Risk for Drivers with Dementia." Geriatrics. 2020;5(4):91. PMID: 33202718. Free open-access article. Found that after the license referral process, drivers with dementia who retained their licenses were not at increased crash risk compared to other referred drivers.

Mild cognitive impairment (MCI) represents an intermediate stage between normal cognitive aging and dementia, and it poses important challenges for driving safety. Research consistently shows that drivers with MCI perform worse on road tests and driving simulators than cognitively normal adults, and they demonstrate higher rates of at-fault crashes. Naturalistic driving studies using vehicle dataloggers reveal subtle but meaningful changes in driving behavior among individuals with MCI, including reduced speed, greater headway distance, and altered lane control, suggesting these technologies may be useful for early detection.

Key Research Articles

  • Chen L, et al. "Association of Daily Driving Behaviors with Mild Cognitive Impairment in Older Adults Followed Over 10 Years." PMC12662389. Free PMC article. This longitudinal naturalistic driving study found that datalogger-measured driving behaviors could distinguish between drivers with MCI and those with normal cognition over a 10-year follow-up.
  • Wadley VG, Okonkwo O, Crowe M, et al. "Mild Cognitive Impairment and Everyday Function: An Investigation of Driving Performance." Journal of Geriatric Psychiatry and Neurology. 2009. PMC2832580. Found significant differences between MCI and controls on global driving ratings, with MCI associated with worse performance on measures of complex attention and processing speed.
  • Devlin A, McGillivray J, Charlton J, Lowndes G, Etienne V. "Assessment of Driving Safety in Older Adults with Mild Cognitive Impairment." Journal of Alzheimer’s Disease. 2017. PMC5409039. Demonstrated that driving-specific screening tools were more informative than general neuropsychological tests in predicting on-road test outcomes in MCI.
  • Crowe M, Allman RM, Triebel K, Sawyer P, Martin RC. "Cognitive Decline and Older Driver Crash Risk." Journal of the American Geriatrics Society. 2019. PMC6541224. Found that a 1-unit lower cognitive score was associated with a 26% higher crash risk (IRR=1.26) in older drivers without dementia, followed over an average of 7 years.

Diabetes mellitus affects over 25 million people in the United States, and its impact on driving safety is primarily mediated through hypoglycemia. A meta-analysis estimated that drivers with diabetes have a 12–19% overall increased risk of motor vehicle crashes. Drivers with type 1 diabetes face approximately twice the crash risk of non-diabetic drivers. Severe hypoglycemia is the single most significant risk factor, consistently and strongly related to crashes at all ages. Paradoxically, lower HbA1c levels (indicating tighter blood sugar control) have been associated with increased crash risk, likely because aggressive glycemic management increases the frequency of hypoglycemic episodes. Insulin therapy itself is not independently associated with increased crash risk when diabetes type is controlled for.

Key Research Articles

  • Songer TJ, Dorsey RR. "High Risk Characteristics for Motor Vehicle Crashes in Persons with Diabetes by Age." Annual Proceedings of the Association for the Advancement of Automotive Medicine. 2006;50:335–351. PMC3217477. Found that crash risk remained higher for persons with diabetes throughout the age span, with severe hypoglycemia consistently and strongly related to crashes.
  • Cox DJ, et al. "Diabetes and Driving Safety: Science, Ethics, Legality & Practice." American Journal of the Medical Sciences. 2013;345(4):263–265. PMC3652323. Comprehensive review establishing that people with type 1 diabetes have approximately twice the collision rate of non-diabetic drivers, with hypoglycemia as the primary mechanism.
  • Cox DJ, et al. "Diabetes and Driving." Canadian Journal of Diabetes. 2013;37(2):128–134. PMC3632177. Detailed review of the impact of diabetes on driving with specific emphasis on hypoglycemia recognition and prevention strategies.
  • Redelmeier DA, Kenshole AB, Ray JG. "Motor vehicle crashes in diabetic patients with tight glycemic control: a population-based case-control analysis." PLoS Medicine. 2009;6(12):e1000192. PMID: 19997499. Free PMC article. Found that lower HbA1c was paradoxically associated with increased crash risk due to hypoglycemia.

Obstructive sleep apnea (OSA) is a prevalent condition characterized by repeated upper airway collapse during sleep, resulting in fragmented sleep and excessive daytime sleepiness. Systematic reviews and meta-analyses demonstrate that individuals with OSA have a 2–3 fold increased risk of motor vehicle crashes compared to those without the condition. Among commercial drivers, approximately 50% are estimated to be at risk for sleep apnea. Continuous positive airway pressure (CPAP) treatment has been shown to significantly reduce crash risk. Excessive daytime sleepiness, measured by the Epworth Sleepiness Scale, is a key mediating factor between OSA and crash risk.

Key Research Articles

  • Tregear S, Reston J, Schoelles K, Phillips B. "Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis." Journal of Clinical Sleep Medicine. 2009;5(6):573–581. PMID: 20465027. Free PMC article. Found mean crash-rate ratios ranging from 1.21 to 4.89 for individuals with OSA.
  • Gottlieb DJ, Ellenbogen JM, Bianchi MT, Czeisler CA. "Sleep deficiency and motor vehicle crash risk in the general population." Sleep. 2018;41(10). PMID: 30101319. Free PMC article. Established the link between sleep deficiency and crash risk in population-based data.
  • Burks SV, Anderson JE, Bombyk M, et al. "Nonadherence with employer-mandated sleep apnea treatment and increased risk of serious truck crashes." Sleep. 2016;39(5):967–975. PMID: 26951400. Free PMC article. Demonstrated that commercial drivers who did not adhere to CPAP therapy had significantly higher crash rates.

Depression is associated with approximately a two-fold increased risk of motor vehicle crashes (OR=1.90 in meta-analysis). Depressive symptoms impair key cognitive domains that are critical for safe driving including attention, concentration, reaction time, and decision-making—all critical for safe driving. Drivers with depression report higher levels of sleepiness while driving, regardless of medication status. Antidepressant medications can increase crash risk by approximately 40% (OR=1.40), likely due to sedating side effects.

Key Research Articles

  • Wickens CM, Smart RG, Mann RE. "The Impact of Depression on Driver Performance." International Journal of Mental Health and Addiction. 2014;12:524–537. Free open-access article. Comprehensive review demonstrating the multifaceted relationship between depression and impaired driving.
  • Hill LL, Lauzon VL, Bhupinder S, et al. "Depression, antidepressants and driving safety." Injury Epidemiology. 2017;4:10. PMID: 28367591. Free PMC article. Meta-analysis finding that depression approximately doubles crash risk and antidepressants increase risk by approximately 40%.
  • Blanchard EB, Hickling EJ, Taylor AE, et al. "Psychological morbidity associated with motor vehicle accidents." Behaviour Research and Therapy. 1995;33(3):283–290. PMID: 7726804. Found that 39% of motor vehicle accident survivors developed PTSD, with prior depression as a significant risk factor.

Polypharmacy, the use of 5 or more medications daily, poses a significant and underrecognized threat to driving safety, particularly among older adults. Research has found that 68.9% of medically impaired drivers use potentially driver-impairing (PDI) medications, and 80% of older crash-involved drivers used at least one PDI medication before their crash. Specific medication classes carry elevated risks: benzodiazepines increase crash hospitalization risk 5.3-fold (OR=5.3), antidepressants approximately 1.8-fold, and opioid analgesics approximately 1.5-fold. PDI medication use is also associated with higher daytime sleepiness scores.

Key Research Articles

  • Hetland A, Carr DB. "Medications and Impaired Driving: A Review of the Literature." Annals of Pharmacotherapy. 2014;48(4):494–506. PMID: 24473490. Systematic review of specific medication classes and their impact on driving ability.
  • Rudisill TM, Zhu M, Kelley GA, et al. "Medication use and the risk of motor vehicle collisions among licensed drivers." Accident Analysis & Prevention. 2016;96:115–123. PMID: 27560810. Free PMC article. Found that benzodiazepines, opioids, and antidepressants significantly increase crash risk.
  • Lococo KH, Staplin L, Martell CA, Sifrit KJ. "Pedal Application Errors and Fatalities Among Older Drivers: Association With Commonly Prescribed Medications." Traffic Injury Prevention. 2015. PMID: 25789382. Demonstrated the connection between PDI medications and specific crash types in older drivers.

Attention-deficit/hyperactivity disorder (ADHD) is associated with a significantly elevated risk of motor vehicle crashes and driving violations. Meta-analyses report a relative risk of 1.23–1.36 for accidents among drivers with ADHD. A prospective study found a 5% increased crash risk for each unit increase in ADHD symptom severity. Teen drivers with ADHD have a 62% higher crash rate in their first month of licensure compared to teens without ADHD. Drivers with ADHD also demonstrate higher rates of alcohol-related crashes (2.1-fold) and more speeding violations. The effects of ADHD medication on crash risk remain mixed, with some studies showing a protective effect and others showing equivocal results.

Key Research Articles

  • Vaa T. "ADHD and relative risk of accidents in road traffic: A meta-analysis." Accident Analysis & Prevention. 2014;62:415–425. PMID: 24238842. Meta-analysis establishing relative risk of 1.23–1.36 for accidents among drivers with ADHD.
  • Curry AE, Metzger KB, Pfeiffer MR, et al. "Motor vehicle crash risk among adolescents and young adults with attention-deficit/hyperactivity disorder." JAMA Pediatrics. 2017;171(8):756–763. PMID: 28618415. Free PMC article. Found 62% higher crash rate in first month of licensure for teen drivers with ADHD.
  • Chang Z, Quinn PD, Hur K, et al. "Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes." JAMA Psychiatry. 2017;74(6):597–603. PMID: 28493054. Free PMC article. Examined whether ADHD medication use reduces crash risk, finding mixed results.

Individuals with Level 1 autism spectrum disorder (ASD, previously Asperger syndrome) face unique challenges in driving. Research indicates that only about one-third of individuals with ASD obtain a driver’s license by age 21, compared to the general population. Those who do drive tend to endorse lower self-ratings of driving ability and report higher numbers of traffic accidents and citations. Simulator studies reveal that drivers with ASD have particular difficulty with social hazards (e.g., pedestrians) compared to non-social hazards (e.g., other vehicles), and show poorer hazard perception overall. However, some population-based studies have not found significant differences in crash rates between drivers with and without ASD, possibly reflecting self-selection and self-regulation effects.

Key Research Articles

  • Curry AE, Yerys BE, Metzger KB, et al. "Traffic crashes, violations, and suspensions among young drivers with ASD." Pediatrics. 2018;142(5):e20174027. PMID: 30352791. Free PMC article. Found higher rates of traffic violations and crashes among young drivers with ASD.
  • Chee DY, Lee HC, Patomella AH, Falkmer T. "Driving behaviour profile of drivers with autism spectrum disorder (ASD)." Journal of Autism and Developmental Disorders. 2017;47(9):2658–2670. PMID: 28567695. Characterized driving behaviors and self-reported difficulty in drivers with ASD.
  • Bishop HJ, Biasini FJ, Stavrinos D. "Social and Non-Social Hazard Response in Drivers with Autism Spectrum Disorder." Journal of Autism and Developmental Disorders. 2017;47(4):905–917. PMC5346040. Found that drivers with ASD had particular difficulty detecting and responding to social hazards.

Parkinson’s disease (PD) significantly impairs driving ability through motor, cognitive, and visual dysfunction. A systematic review and meta-analysis found that individuals with PD had 6.16 times higher odds of failing on-road driving tests and 2.63 times higher odds of simulator crashes compared to healthy controls. In a clinical driving assessment study of 154 PD patients, 32% were found unsuitable to drive. Longitudinal studies show progressive driving decline: drivers with PD who initially drove comparably to controls showed significantly more safety errors after 2 years, predicted by baseline driving performance and deterioration of cognitive, visual, and functional abilities. Key clinical predictors of on-road failure include the Trail Making Test Part B and contrast sensitivity.

Key Research Articles

  • Thompson T, Poulter D, Miles C, et al. "Driving impairment and crash risk in Parkinson disease: A systematic review and meta-analysis." Neurology. 2018;91(10):e906–e916. PMID: 30076275. The most comprehensive meta-analysis finding 6.16x odds of on-road test failure and 2.63x odds of simulator crashes.
  • Uc EY, Rizzo M, Johnson AM, et al. "Longitudinal decline of driving safety in Parkinson disease." Neurology. 2017. PMID: 29021353. Free PMC article. Prospective study showing that returning drivers with PD showed significantly more driving errors than controls after 2 years.
  • Singh R, Pentland B, Hunter J, Provan F. "Parkinson’s disease and driving ability." Journal of Neurology, Neurosurgery & Psychiatry. 2007. PMC2077772. Free PMC article. Clinical study of 154 PD patients finding that severity of physical disease, age, cognitive impairment, and reaction time were key predictors of fitness to drive.
  • Classen S, et al. "Driving with Parkinson’s disease: Cut points for clinical predictors of on-road outcomes." Canadian Journal of Occupational Therapy. 2018. PMID: 29635922. Identified Trail Making Test Part B and contrast sensitivity as the most predictive clinical screening tools.

Aging is associated with progressive declines in sensory, motor, and cognitive functions that can impair driving ability. Older adults aged 80 and above have the highest rate of fatal crash involvement per miles driven of any age group. A large cohort study found that a 1-unit lower cognitive score was associated with a 26% higher crash risk (IRR=1.26) in older drivers without dementia, followed over an average of 7 years. Age-related declines in vision, contrast sensitivity, visual processing speed, and executive function contribute to reduced driving safety. Many older adults self-regulate their driving by avoiding difficult situations, reducing mileage, and limiting nighttime driving, which may partially offset increased per-mile crash risk. However, this self-regulation may not always sufficient, and formal assessment becomes important when cognitive or physical decline is suspected.

Key Research Articles

  • Crowe M, et al. "Cognitive Decline and Older Driver Crash Risk." Journal of the American Geriatrics Society. 2019. PMC6541224. Free PMC article. Found that poorer cognitive function (CASI-IRT score) was associated with greater crash risk in older drivers without dementia.
  • Toups R, Chirles TJ, Ehsani JP, et al. "Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety." Innovation in Aging. 2022;6(1):igab051. PMID: 35028434. Free PMC article. Comprehensive review of driving performance measures and their application to older adult safety.
  • Falkenstein M, Karthaus M, Brüne-Cohrs U. "Age-Related Diseases and Driving Safety." Geriatrics. 2020;5(4):80. Free open-access article. Review of multiple age-related diseases and their compounding effects on driving safety.

Glaucoma causes progressive peripheral visual field loss that can significantly impair driving safety. As the most common cause of irreversible blindness worldwide, it affects approximately 3% of adults over age 40 and becomes increasingly prevalent with age. Driving is a visually intensive task that relies heavily on peripheral vision for hazard detection, lane keeping, and intersection navigation. Each of these aspects of vision can be impaired by glaucoma-related visual field loss.

Research consistently demonstrates that drivers with moderate to advanced glaucoma have elevated crash risk and poorer on-road driving performance, though the relationship between glaucoma and driving safety is more nuanced than a simple linear correlation. The severity and location of visual field defects, divided attention capacity, and contrast sensitivity all contribute to crash risk independently. Importantly, many drivers with glaucoma engage in self-regulatory behaviors (avoiding night driving, highways, and adverse weather), which may partially offset crash risk at the population level but are insufficient as a standalone safety strategy.

Key findings from the research literature include the following: patients with moderate or advanced glaucoma demonstrate a 4.1-fold greater risk of unsafe driving on standardized on-road evaluations; visual field defects in the worse eye (moderate defects OR=3.6, severe defects OR=4.4) are significantly associated with motor vehicle collision involvement; intersection errors (at traffic lights and give-way/yield situations) are the most common problem area for drivers with glaucoma; divided attention metrics (UFOV and driving simulator reaction times) are more predictive of future crashes than standard visual field indices alone; and glaucoma patients show steeper increases in driving risk under adverse conditions such as fog. However, some studies have found that glaucoma patients who actively self-regulate their driving may have overall crash rates comparable to or even lower than age-matched controls, highlighting the complexity of this relationship.

Key Research Articles

Wood JM, Black AA, Mallon K, Thomas R, Owsley C (2016). Glaucoma and Driving: On-Road Driving Characteristics. PLoS One, 11(7), e0158318. PMID: 27472221 | PMCID: PMC4966939 | https://pubmed.ncbi.nlm.nih.gov/27472221/

This landmark on-road driving study of 75 drivers with glaucoma and 75 age-matched controls found that glaucoma patients made significantly more driving errors overall (p=0.034), particularly at intersections with traffic lights and give-way (yield) signs. The errors at intersections have the most serious safety consequences as they involve multiple road users. This was the first study to identify intersections as a particular performance problem for drivers with glaucoma on real roads, and demonstrated that standard visual field measures alone do not fully capture driving risk.

McGwin G Jr, Xie A, Mays A, Joiner W, DeCarlo DK, Hall TA, Owsley C (2005). Visual Field Defects and the Risk of Motor Vehicle Collisions Among Patients with Glaucoma. Invest Ophthalmol Vis Sci, 46(12), 4437-4441. https://pubmed.ncbi.nlm.nih.gov/16303931/

Using the AGIS (Advanced Glaucoma Intervention Study) scoring system, this study found that patients with moderate visual field defects in the worse eye had 3.6 times the odds of MVC involvement (OR=3.6, 95% CI 1.4-9.4), and those with severe defects had 4.4 times the odds (OR=4.4, 95% CI 1.6-12.4), compared to those with no visual field defects. Importantly, only severe defects in the better eye approached statistical significance, suggesting the worse eye’s visual field plays a critical role in crash risk.

Gracitelli CPB, Tatham AJ, Boer ER, Rosen PN, Medeiros FA (2015). Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study. PLoS One, 10(10), e0138288. https://pubmed.ncbi.nlm.nih.gov/26426342/

A prospective cohort study of 117 drivers with glaucoma followed for an average of 2.1 years found that 9.4% experienced an MVC during follow-up. Divided attention metrics—specifically UFOV divided attention (HR=1.98 per 1 SD worse, p=0.022) and low contrast reaction time on driving simulator (HR=2.19 per 1 SD slower, p=0.003)—were significantly predictive of MVC, while standard visual field indices (SAP) in either eye were not. The driving simulator model was a substantially better predictor of MVC than UFOV alone (R²=0.41 vs R²=0.18).

McGwin G Jr, Mays A, Joiner W, DeCarlo DK, McNeal S, Owsley C (2004). Is Glaucoma Associated with Motor Vehicle Collision Involvement and Driving Avoidance?. Invest Ophthalmol Vis Sci, 45(11), 3934-3939. https://pubmed.ncbi.nlm.nih.gov/15505039/

In a counterintuitive finding, patients with glaucoma were actually less likely to be involved in collisions overall (RR=0.67, 95% CI 0.47-0.97) than those without glaucoma, with no difference in at-fault crash rates (RR=1.22, 95% CI 0.67-2.22). However, glaucoma patients had significantly higher levels of driving avoidance: night driving (OR=2.06), fog (OR=3.80), rain (OR=2.99), rush hour (OR=2.24), highways (OR=2.81), and high-density traffic (OR=2.88). This suggests that self-regulatory driving behavior may substantially offset population-level crash risk in glaucoma.

Age-related macular degeneration (AMD) is the leading cause of central vision loss in older adults, affecting approximately 11 million Americans. AMD exists in two forms: dry AMD (geographic atrophy, ~85-90% of cases) involves gradual deterioration of the macula, while wet AMD (~10-15%) involves abnormal blood vessel growth (choroidal neovascularization) that can cause rapid, severe central vision loss. Both forms progressively impair the detailed central vision needed for reading road signs, recognizing traffic signals, detecting pedestrians, and identifying hazards at a distance.

The relationship between AMD and crash risk is complex and varies significantly by disease severity. Research has shown that drivers with early to intermediate AMD may actually have lower crash rates than those with normal eye health, likely because awareness of their visual limitations leads to extensive self-regulatory driving behavior. However, drivers with advanced AMD show increased crash risk and significantly impaired on-road driving performance. Motion sensitivity, not visual acuity or contrast sensitivity, has emerged as the strongest predictor of driving safety in AMD, which makes sense given that the driving environment is inherently dynamic.

Key findings include: drivers with AMD made more errors requiring instructor intervention (critical errors) than age-matched controls on standardized on-road assessments, even at early and intermediate disease stages; central motion sensitivity was the only visual function measure significantly associated with driving safety ratings in AMD; drivers with intermediate AMD showed paradoxically reduced MVC rates compared to normal-eye-health controls (RR=0.34), likely reflecting extensive self-regulation; self-regulatory strategies alone are insufficient to fully compensate for AMD-related driving impairment at the population level; AMD is strongly associated with driving cessation (RR=2.21, 95% CI 1.47-3.31 in meta-analysis); and anti-VEGF treatment for wet AMD, by preserving or improving visual function, may help maintain driving ability, though direct evidence on crash outcomes is limited.

Key Research Articles

Wood JM, Black AA, Mallon K, Kwan AS, Owsley C (2018). Effects of Age-Related Macular Degeneration on Driving Performance. Invest Ophthalmol Vis Sci, 59(1), 273-279.

PMID: 29340641 | PMCID: PMC5770181: https://pubmed.ncbi.nlm.nih.gov/29340641/

This on-road driving study compared 33 older drivers with early/intermediate AMD to 50 age-matched controls. Drivers with AMD had significantly lower driving safety ratings and made more critical errors requiring instructor intervention. Notably, neither central visual acuity nor contrast sensitivity were significantly associated with driving safety ratings. Instead, central motion sensitivity was the only visual function measure significantly associated with driving safety, suggesting that standard clinical measures may underestimate AMD-related driving risk.

McGwin G Jr, Mitchell B, Searcey K, Albert MA, Feist R, Mason JO 3rd, Thomley M, Owsley C (2013). Examining the Association Between Age-Related Macular Degeneration and Motor Vehicle Collision Involvement: A Retrospective Cohort Study. Br J Ophthalmol, 97(9), 1173-1176. https://pubmed.ncbi.nlm.nih.gov/23832967/

This retrospective cohort study pooling four previous studies examined MVC rates across AMD severity levels. MVC rate was highest among those with normal eye health and progressively declined among those with early and intermediate disease, with drivers with intermediate AMD showing significantly lower MVC rates (RR=0.34, 95% CI 0.13-0.90). MVC rates increased again for those with advanced AMD. The paradoxical finding in intermediate AMD likely reflects heightened self-regulatory driving behavior as patients become aware of their visual limitations.

Owsley C, McGwin G Jr (2008). Driving and Age-Related Macular Degeneration. J Vis Impair Blind, 102(10), 621-635.

PMID: 20011117 | PMCID: PMC2799941: https://pubmed.ncbi.nlm.nih.gov/20011117/

This comprehensive review examined the research literature on driving and AMD, including crash risk, driving performance, driving difficulty, self-regulation, and interventions. Key conclusions: drivers with AMD report significantly more driving difficulty and restrict their driving more than those without AMD; simulator studies show slower braking response times, slower driving speeds, and more lane crossings in AMD; self-regulatory strategies (avoiding night driving, unfamiliar routes, heavy traffic) are common but have never been proven effective as a standalone strategy for enhancing safety; and evidence-based guidance on interventions such as bioptic training programs remains limited.

Nguyen H, Di Tanna GL, Coxon K, Brown J, Ren K, Ramke J, et al. (2023). Associations Between Vision Impairment and Vision-Related Interventions on Crash Risk and Driving Cessation: Systematic Review and Meta-Analysis. BMJ Open, 13(8), e065210.

PMID: 37567751 | PMCID: PMC10423787: https://pubmed.ncbi.nlm.nih.gov/37567751/

This systematic review and meta-analysis synthesized evidence across all major vision conditions. For AMD specifically, driving cessation was strongly associated with the condition (RR=2.21, 95% CI 1.47-3.31, p<0.001). The meta-analysis also found that visual field defects (RR=1.51), contrast sensitivity loss (RR=1.40), and visual acuity loss (RR=1.21) each independently increased crash risk across all vision conditions. Evidence for cataract surgery as an intervention showed the strongest support for reducing crash risk among vision-related interventions.

Cataracts are the most common cause of impaired vision worldwide, present in approximately half of adults aged 65 and older. Cataracts cause progressive clouding of the eye’s natural lens, resulting in reduced visual acuity, impaired contrast sensitivity, increased glare sensitivity, and diminished color perception. All of these visual deficits are directly relevant to driving safety, affecting the ability to read road signs, detect hazards, maintain lane position, and drive safely at night or in bright sunlight.

The evidence linking cataracts to increased crash risk is substantial and consistent. Research demonstrates that older drivers with cataracts are approximately twice as likely to have been involved in at-fault crashes compared to those without cataracts, with contrast sensitivity impairment, rather than visual acuity or glare sensitivity, serving as the primary visual risk factor. This finding is particularly important because driver licensing requirements worldwide are based primarily on visual acuity, potentially missing the most relevant predictor of driving safety in cataract patients.

Critically, cataract surgery is one of the most well-documented and effective interventions for improving driver safety. Multiple studies including a landmark population-based study of over 559,000 patients have demonstrated that cataract surgery reduces crash rates by approximately 50%, with improvements in sign recognition, hazard detection, and overall driving performance. A systematic review found cataract surgery associated with an 88% reduction in driving-related difficulties. On driving simulators, crash/near-crash rates decreased 36% after first-eye surgery and 47% after second-eye surgery. These findings position cataract surgery as perhaps the most impactful medical intervention for driving safety currently available.

Key Research Articles

Schlenker MB, Thiruchelvam D, Redelmeier DA (2018). Association of Cataract Surgery With Traffic Crashes. JAMA Ophthalmol, 136(9), 998-1007. PMID: 29955857 | PMCID: PMC6142973 | https://pubmed.ncbi.nlm.nih.gov/29955857/

This population-based study of 559,546 patients aged 65+ in Ontario, Canada (2006-2016) used a self-matched exposure-crossover design. The crash rate decreased from 2.36 per 1,000 patient-years before surgery to a lower rate after surgery, with the reduction observed across diverse demographic, ophthalmologic, and medical characteristics. The reduction did not extend to control analyses where the patient was a passenger or pedestrian, supporting a causal association with improved driving ability. The absolute risk reduction corresponds to a number needed to treat of approximately 5,000 to prevent one serious traffic crash within one year.

Owsley C, McGwin G Jr, Sloane M, Wells J, Stalvey BT, Gauthreaux S (2002). Impact of Cataract Surgery on Motor Vehicle Crash Involvement by Older Adults. JAMA, 288(7), 841-849.

PMID: 12186601 | DOI: 10.1001/jama.288.7.841. https://pubmed.ncbi.nlm.nih.gov/12186601/

This prospective cohort study of 277 cataract patients aged 55-84 years with 4-6 years follow-up found that patients who underwent cataract surgery had approximately half the rate of crash involvement (rate ratio=0.47, 95% CI 0.23-0.94) compared to those who did not have surgery, adjusting for race and baseline driving exposure. This was one of the first studies to provide direct evidence that cataract surgery improves driver safety, not just visual function.

Owsley C, Stalvey BT, Wells J, Sloane ME, McGwin G Jr (2001). Visual Risk Factors for Crash Involvement in Older Drivers with Cataract. Arch Ophthalmol, 119(6), 881-887.

PMID: 11405840 | DOI: 10.1001/archopht.119.6.881https://pubmed.ncbi.nlm.nih.gov/11405840/

This cross-sectional analysis of 274 older drivers with cataract found that contrast sensitivity—not visual acuity or disability glare—was the visual function most strongly associated with at-fault crash involvement. Drivers with serious contrast sensitivity deficits were 8 times more likely to have been crash-involved in the worse eye (OR=7.86, 95% CI 1.55-39.79) and nearly 4 times in the better eye (OR=3.78, 95% CI 1.15-12.48). Even a severe contrast sensitivity deficit in only one eye was significantly associated with crash involvement (OR=2.70, 95% CI 1.16-6.51).

Meuleners LB, Fraser ML, Ng J, Morlet N (2021). Changes in Driving Performance After First and Second Eye Cataract Surgery: A Driving Simulator Study. Accid Anal Prev, 162, 106393.

PMID: 34399910 | DOI: 10.1016/j.aap.2021.106393 https://pubmed.ncbi.nlm.nih.gov/34399910/

This prospective cohort study of 44 older drivers with bilateral cataract assessed driving simulator performance before first-eye surgery, after first-eye surgery, and after second-eye surgery. Crash/near-crash rates decreased significantly by 36% after first-eye surgery (IRR=0.64, 95% CI 0.47-0.88, p=0.01) and 47% after second-eye surgery (IRR=0.53, 95% CI 0.35-0.78, p<0.001). Better contrast sensitivity was associated with fewer crashes (IRR=0.69, 95% CI 0.48-0.90) and less speeding, reinforcing the importance of timely bilateral cataract surgery.

Chronic pain, defined as pain persisting for more than three months, affects approximately 1 in 5 U.S. adults (roughly 50 million people), with about 1 in 14 experiencing high-impact chronic pain that limits daily activities. Chronic pain impacts driving through multiple mechanisms: direct effects of pain on attention, reaction time, and physical mobility; cognitive interference from pain processing that reduces available attentional resources for driving; fatigue and sleep disturbance commonly associated with chronic pain conditions; and the pharmacological effects of pain medications, particularly opioids, on central nervous system function.

The research literature on chronic pain and driving reveals a dual-edged risk profile. On one hand, untreated or undertreated pain itself impairs driving-relevant cognitive and psychomotor functions including attention, reaction time, and decision-making. On the other hand, the medications most commonly used to treat chronic pain, especially opioid analgesics, carry their own risk of driving impairment through sedation, drowsiness, and delayed reaction times. A 2022 systematic review identified that drivers with chronic pain engage in various self-regulatory strategies but that significant barriers and variability exist in their application, and that chronic pain may independently increase crash risk.

The opioid-driving relationship is particularly complex. The evidence suggests that illicit opioid use, initiation of opioid therapy, dose increases, and opioid use combined with other psychoactive medications are the contexts most clearly associated with driving impairment. However, patients on stable, long-term opioid regimens may demonstrate driving performance comparable to healthy controls in some studies, likely reflecting tolerance to sedative effects. A 2022 systematic review of 14 observational studies found that 8 studies reported increased MVC risk with prescription opioid use. Population-level data from fatal crash analyses show that prescription opioid use is associated with significantly increased risk of crash initiation, particularly due to failure to maintain proper lane position.

Key research articles

Vaezipour A, Horberry T, Baumgartner J, Zohrabi N, Esterman A, Sterling M (2022). Impact of Chronic Pain on Driving Behaviour: A Systematic Review. Pain, 163(3), e401-e416.

PMID: 34174040 | DOI: 10.1097/j.pain.0000000000002404 https://pubmed.ncbi.nlm.nih.gov/34174040/

This systematic review of 22 studies assessed driving behavior and motor vehicle crash risk in drivers with chronic pain using a framework based on the Michon model of driving behavior. Findings suggest that drivers with chronic pain engage in risk-compensatory strategies (avoiding certain driving situations, reducing exposure) that are positive from a precautionary perspective, but considerable variability exists across different patient samples. The review provided evidence that chronic pain could independently increase crash risk and change driving behavior at strategic, tactical, and operational levels of the driving task.

Cameron-Burr KT, Conicella A, Neavyn MJ (2021). Opioid Use and Driving Performance. J Med Toxicol, 17(3), 289-308. PMID: 33403571 | PMCID: PMC8206443 | DOI: 10.1007/s13181-020-00819-y | https://pubmed.ncbi.nlm.nih.gov/33403571/

This comprehensive review categorized the opioid-driving literature by study context. Among key findings: 52% of all studies favored the conclusion that opioids impair driving or driving-related neurocognitive performance; illicit use, initiation of therapy, and opioid use combined with other psychoactive medications were contexts most clearly associated with impairment; some data suggest patients on stable, chronic opioid regimens may not show increased risk compared to healthy controls; and 69% of forensic toxicology studies supported an association between positive opioid findings and crash involvement. The review concluded that individual risk assessment is essential.

Leon SJ, Trachtenberg A, Briscoe D, Ahmed M, Hougen I, Askin N, et al. (2022). Opioids and the Risk of Motor Vehicle Collision: A Systematic Review. J Pharm Technol, 38(1), 54-62.

PMID: 35141728 | PMCID: PMC8820048 | DOI: 10.1177/87551225211059926 |https://pubmed.ncbi.nlm.nih.gov/35141728/

This systematic review identified 14 observational studies assessing prescribed opioid use and MVCs. Of these, 8 studies found increased MVC risk among those with a concomitant opioid prescription at the time of the crash. Three studies found no significant increase in culpability for fatal MVCs. The review highlighted that current published literature lacks detailed information about opioid dosages, chronicity of use, and specific opioid types, making it difficult to precisely quantify risk. New opioid use and frequent dispensations were both associated with approximately 2-fold increased odds of single-vehicle crashes.

Li G, Chihuri S (2019). Use of Prescription Opioids and Initiation of Fatal 2-Vehicle Crashes. JAMA Netw Open, 2(5), e193571. PMID: 31074821 | PMCID: PMC6484610 | DOI: 10.1001/jamanetworkopen.2019.3571 https://pubmed.ncbi.nlm.nih.gov/31074821/

Using a pair-matched design analyzing 18,321 fatal 2-vehicle crashes (36,642 drivers), prescription opioid use (detected by toxicological testing) was significantly associated with increased risk of crash initiation, due in large part to failure to keep in proper lane. Drivers younger than 35 and those 65 and older were at heightened risk. The prevalence of prescription opioids detected in fatally injured drivers has increased markedly in the past two decades, underscoring the growing public health significance of opioid-impaired driving.

This Education section is intended to supply drivers, caregivers, healthcare providers, and families with information focused on understanding how medical conditions and driving behaviors affect road safety, and what steps can be taken to reduce risk. For each condition and risky driving behavior the current medical guidelines (as related to driving) are provided as are monitoring/mitigation strategies. This section also includes tips on how to discuss possible driving issues with your physician and family, and provides tips for considering alternative modes of transportation when driving is no longer possible.

Dementia

Current Guidelines: The American Academy of Neurology (AAN) 2010 Practice Parameter on the Evaluation and Management of Driving Risk in Dementia recommends the Clinical Dementia Rating (CDR) as the strongest tool for identifying patients at increased risk of unsafe driving. A CDR score of 1.0 or higher indicates significant driving risk. The consensus across guidelines (AAN, AMA, Swedish National Road Administration) is that moderate to severe dementia precludes driving.

Mitigation Strategies: Regular cognitive screening at primary care visits, especially for patients over age 65; use of the CDR, Trail Making Test Part B, and UFOV (Useful Field of View) as screening tools; referral for comprehensive driving evaluation when cognitive concerns arise; engagement of family members in monitoring driving behaviors; planned, gradual transition to non-driving status when appropriate; and exploration of alternative transportation early in the disease course.

Current Guidelines: The AAN recommends that patients with MCI be monitored for driving safety, though no single cognitive test reliably predicts crash risk. The National Highway Traffic Safety Administration (NHTSA) Clinician’s Guide to Assessing and Counseling Older Drivers (3rd edition, 2016) recommends the use of driving-specific assessments for patients with suspected cognitive impairment.

Mitigation Strategies: Regular reassessment every 6–12 months as MCI can progress to dementia; use of driving-specific screening tools (DriveSafe, Multi-D battery) rather than relying solely on general cognitive tests; referral for on-road driving evaluation when performance concerns emerge; consideration of in-vehicle technology (dataloggers, GPS tracking) to monitor driving patterns; self-regulation education (avoiding rush hour, nighttime driving, unfamiliar routes); and cognitive training programs that target processing speed and attention.

Current Guidelines: The American Diabetes Association (ADA) Position Statement on Diabetes and Driving recommends that all drivers with diabetes check their blood glucose before driving and carry fast-acting glucose in the vehicle at all times. The Federal Motor Carrier Safety Administration (FMCSA) has specific guidelines for commercial drivers with diabetes.

Mitigation Strategies: Check blood glucose before every drive and do not drive if below 90 mg/dL without first treating; keep fast-acting glucose (glucose tablets, juice) readily accessible in the vehicle; use a continuous glucose monitor (CGM) for real-time alerts of hypoglycemia; avoid driving for at least 45 minutes after treating a low blood sugar episode; discuss hypoglycemia awareness with your physician; adjust driving duration and frequency if experiencing recurrent hypoglycemia; and ensure regular eye exams to monitor for diabetic retinopathy, which can impair driving vision.

Current Guidelines: The American Academy of Sleep Medicine (AASM) recommends screening for OSA in all commercial drivers and in individuals with excessive daytime sleepiness. The FMCSA requires that commercial drivers with OSA demonstrate treatment compliance (minimum 4 hours of CPAP use per night for at least 70% of nights).

Mitigation Strategies: Consistent use of CPAP or other prescribed therapy every night; monitoring treatment adherence through machine data downloads; avoiding driving when feeling sleepy, regardless of treatment status; scheduling regular sleep study follow-ups; maintaining a regular sleep schedule; recognizing the signs of drowsy driving (lane drifting, frequent yawning, difficulty keeping eyes open); and pulling over to a safe location for a 15–20 minute nap if drowsiness occurs while driving.

Current Guidelines: The American Psychiatric Association (APA) Practice Guideline for the Treatment of Major Depressive Disorder recommends that clinicians assess the functional impact of depression, including driving ability. The AMA Physician’s Guide to Assessing and Counseling Older Drivers recommends screening for depression as part of driving fitness evaluations.

Mitigation Strategies: Open discussion with your prescriber about the sedating effects of antidepressant medications on driving; timing medication doses to minimize daytime sedation (e.g., taking sedating medications at bedtime); monitoring for changes in attention, concentration, and reaction time; avoiding driving during acute depressive episodes when concentration is significantly impaired; regular sleep hygiene to reduce fatigue; and gradual return to driving as symptoms improve with treatment.

Current Guidelines: The American Geriatrics Society Beers Criteria (updated 2023) identifies potentially inappropriate medications for older adults, including many that impair driving. The AMA’s Physician Guide to Assessing and Counseling Older Drivers recommends regular medication review with attention to potentially driver-impairing drugs.

Mitigation Strategies: Request a comprehensive medication review from your physician or pharmacist, specifically asking about medications that may impair driving; ask about non-sedating alternatives for medications in high-risk classes (benzodiazepines, opioids, sedating antihistamines, anticholinergics); avoid alcohol when taking any potentially impairing medications; be especially cautious when starting a new medication or changing dosages; use a medication management system to ensure proper timing; and report any symptoms of dizziness, drowsiness, or blurred vision to your physician promptly.

Current Guidelines: The American Academy of Pediatrics (AAP) guidelines on ADHD recommend discussion of driving risks with adolescents and families. The CHADD (Children and Adults with ADHD) organization provides specific driving safety guidelines for individuals with ADHD.

Mitigation Strategies: Ensure ADHD medication is active during driving times; minimize in-vehicle distractions (phones, complex audio controls, multiple passengers for teens); use graduated driver licensing programs fully before independent driving; consider supplemental driver training programs; practice routes before driving them independently; avoid driving during times of peak inattention; use vehicle technology that provides alerts for lane departure and following distance; and maintain regular follow-up with ADHD treatment provider.

Current Guidelines: There are no specific national clinical guidelines for driving with ASD; however, the American Occupational Therapy Association (AOTA) recommends individualized driving evaluation and training for individuals with developmental conditions that may affect driving.

Mitigation Strategies: Seek specialized driving instruction from certified driving rehabilitation specialists (CDRS) familiar with ASD; extended practice periods before independent driving; gradual exposure to increasingly complex driving environments; use of visual supports and structured routines for driving tasks; practice with social hazard recognition (pedestrians, cyclists, school zones); consider vehicle technology that assists with hazard detection; avoid driving in overstimulating environments until comfortable; and regular reassessment as skills develop.

Current Guidelines: The NHTSA/American Occupational Therapy Association Consensus Statements on Driving in People with Parkinson’s Disease (Classen et al., 2014) recommend comprehensive driving evaluation for all persons with PD who wish to continue driving, including clinical screening with the Trail Making Test Part B and contrast sensitivity testing.

Mitigation Strategies: Regular comprehensive driving evaluations (at least annually) by a CDRS; clinical screening with Trail Making Test Part B and contrast sensitivity testing; vehicle modifications (hand controls, steering wheel knobs, left foot accelerator) as motor symptoms progress; timing driving to coincide with peak medication effectiveness (“on” periods); avoiding driving during medication wearing-off periods; monitoring for sudden onset of sleep, a side effect of some dopaminergic medications; and planned transition to non-driving status with involvement of the care team.

Current Guidelines: The AGS/NHTSA Clinician’s Guide to Assessing and Counseling Older Drivers (3rd edition, 2016) provides a comprehensive framework for assessing driving fitness in older adults, including the Assessment of Driving-Related Skills (ADReS) tool. The CDC also provides resources through its Older Adult Driver Safety program.

Mitigation Strategies: Annual vision and hearing exams; regular medication reviews; strength and flexibility exercises to maintain physical driving ability; occupational therapy assessment for adaptive equipment needs; self-regulation of driving exposure (avoiding nighttime, rush hour, bad weather, and unfamiliar routes); consideration of refresher driving courses; discussion of driving concerns with primary care physician; and proactive planning for eventual driving cessation.

Causes: Distracted driving encompasses visual, manual, and cognitive distractions. The most common causes include cell phone use (texting, calling, social media), eating or drinking, adjusting GPS or entertainment systems, interacting with passengers, and external distractions. Texting while driving is especially dangerous because it combines all three types of distraction simultaneously.

Impacts: The NHTSA reports that distracted driving claimed 3,308 lives in 2022 alone. Sending a text takes a driver’s eyes off the road for approximately 5 seconds—at 55 mph, that is equivalent to driving the length of a football field blindfolded. Distracted driving is a contributing factor in approximately 8–9% of all fatal crashes.

Reduction Strategies: Enable “Do Not Disturb While Driving” features on smartphones; place phones out of reach while driving; use hands-free systems only when necessary; set GPS and audio before beginning the trip; pull over to a safe location for any activity requiring sustained attention; model distraction-free driving for teen passengers; and consider apps that block notifications while the vehicle is in motion.

Causes: Speeding is driven by time pressure, risk tolerance, traffic conditions, road design, and driver temperament. Young drivers (ages 16–25) are disproportionately represented in speed-related crashes. Environmental factors such as wide, straight roads may encourage higher speeds.

Impacts: Speed was a contributing factor in 29% of all traffic fatalities in 2022 (NHTSA). Higher speeds reduce the time available to react to hazards, increase stopping distance, and exponentially increase crash severity. The risk of a fatal crash doubles for every 10 mph increase over 50 mph.

Reduction Strategies: Allow adequate travel time to reduce urgency; use cruise control on highways to maintain consistent speed; be aware of speed limits, especially in construction zones and school zones; use vehicle speed alert features if available; for parents of teen drivers, set speed alerts in telematics monitoring devices; and recognize that the time saved by speeding is typically minimal (5 mph over the limit on a 30-minute commute saves approximately 2 minutes).

Causes: Hard cornering occurs when a driver enters a curve too fast, requiring a sharp steering correction. Contributing factors include excessive speed, inattention to road curvature, unfamiliar roadways, drowsiness, and impaired reaction time from medical conditions or medications.

Impacts: Hard cornering increases the risk of rollover, loss of vehicle control, and run-off-road crashes. Vehicles with higher centers of gravity (SUVs, trucks) are particularly vulnerable. Hard cornering can also indicate broader patterns of aggressive or impaired driving.

Reduction Strategies: Reduce speed before entering a curve, not during the turn; use the “slow in, fast out” technique; stay alert for curve warning signs; maintain proper tire inflation and tread depth; for drivers with medical conditions affecting motor control, consider vehicle stability control systems; and monitor for patterns of hard cornering using telematics devices.

Causes: Hard braking occurs when a driver must brake forcefully and suddenly, typically because of late hazard detection, following too closely (tailgating), distraction, or impaired reaction time. Medical conditions affecting vision, attention, or processing speed increase the likelihood of hard braking events.

Impacts: Hard braking events significantly increase the risk of rear-end collisions (both being rear-ended and striking the vehicle ahead). They indicate reduced situational awareness and are strongly associated with crash risk. Frequent hard braking is one of the most reliable telematics indicators of unsafe driving.

Reduction Strategies: Maintain a following distance of at least 3–4 seconds; scan the road ahead for potential hazards; avoid distractions that delay hazard recognition; adjust following distance in adverse weather conditions; use forward collision warning systems; for older drivers or those with slowed reaction times, increase following distance to 5–6 seconds; and address underlying vision or cognitive concerns that may be contributing.

Causes: Hard acceleration involves rapid increases in speed, often from a stop or during lane changes. It is frequently associated with aggressive driving, impatience, running late, or trying to merge quickly. In some cases, it may indicate pedal confusion in older drivers.

Impacts: Hard acceleration increases fuel consumption, tire wear, and the risk of loss of vehicle control. When combined with other aggressive driving behaviors, it significantly increases crash risk. In older drivers, unintended acceleration events can be catastrophic.

Reduction Strategies: Practice smooth, gradual acceleration from stops; allow adequate time for trips to reduce urgency; use eco-driving modes available in many modern vehicles; for older drivers experiencing pedal confusion, consider left-foot braking training or vehicle modifications; and use telematics feedback to identify and reduce hard acceleration patterns.

Causes: Lane drift occurs when a vehicle unintentionally moves out of its travel lane without the use of turn signals. Primary causes include drowsiness, distraction, visual impairment, cognitive impairment (especially executive function deficits), medication side effects, and impaired motor control. Lane drift is a key indicator of drowsy driving and cognitive impairment.

Impacts: Lane drift is a leading cause of head-on collisions, sideswipe crashes, and run-off-road crashes. Run-off-road crashes account for a significant proportion of fatal crashes, especially on rural roads. Lane drift events detected by telematics are strongly associated with future crash risk.

Reduction Strategies: Ensure adequate sleep before driving; take breaks every 2 hours or 100 miles on long trips; use lane departure warning and lane keeping assist systems; address underlying conditions causing drowsiness or inattention; ensure eyeglass prescriptions are current; discuss medication timing with your physician if drowsiness is a side effect; and pull over immediately if you notice yourself drifting from the lane.

Talking to your doctor about driving safety is an important step in protecting yourself and others on the road. Many drivers feel uncomfortable raising this topic, but physicians can provide valuable guidance, assessment, and referrals.

When to Talk to Your Doctor About Driving: If you have been diagnosed with any condition that may affect driving (dementia, MCI, diabetes, sleep apnea, depression, Parkinson’s disease, ADHD, ASD); if you have started a new medication or changed dosages; if family or friends have expressed concerns about your driving; if you have had a recent crash or near-miss; if you notice changes in your vision, reaction time, or ability to concentrate while driving; or if you find yourself getting lost on familiar routes.

What to Ask Your Doctor: Ask specifically how your medical condition(s) may affect driving safety; ask whether any of your medications can impair driving and whether alternatives are available; request referral for a comprehensive driving evaluation if you have concerns; ask about cognitive screening and what the results mean for your driving; and ask about adaptive equipment or vehicle modifications that could help.

What to Expect: Your doctor may conduct brief in-office screening tests (vision, cognition, motor function); may refer you to a certified driving rehabilitation specialist (CDRS) for an on-road evaluation; may recommend adjustments to your medication timing or type; may provide a letter to the Department of Motor Vehicles if licensing review is warranted; or may work with you on a graduated plan for reducing driving exposure.

Conversations about driving safety with a loved one can be challenging but are essential when you notice concerning driving behaviors or a decline in driving-related abilities.

Preparing for the Conversation: Choose a calm, private setting; focus on specific observations rather than general accusations (e.g., “I noticed you ran that stop sign” rather than “you’re a terrible driver”); express your concerns in terms of safety and caring, not criticism; have information ready about alternatives (rides, transit, delivery services); consider having the conversation with another trusted family member present; and be prepared for emotional reactions, as driving cessation represents a major loss of independence.

Practical Tips: Suggest a voluntary driving evaluation as a “check-up”; offer to accompany the person to their physician to discuss driving; frame the conversation around mutual safety; provide concrete alternatives and offer to help arrange transportation; involve the person in planning their transportation needs; be patient—the conversation may need to happen more than once; and consult resources from The Hartford Financial Services Group (“At the Crossroads” guide) and AARP.

When driving is no longer safe, maintaining mobility and independence requires planning and awareness of available alternatives.

Public Transportation: Contact your local transit authority for routes, schedules, and accessibility options. Many cities offer paratransit services (door-to-door transportation) for individuals with disabilities under the Americans with Disabilities Act (ADA). In Baton Rouge, CATS (Capital Area Transit System) provides fixed-route and paratransit services.

Ride-Sharing and On-Demand Services: Services like Uber, Lyft, and GoGoGrandparent (which allows booking rides by phone without a smartphone) provide flexible transportation options. Some services offer discounted rates for seniors and people with disabilities.

Community and Volunteer Programs: Many communities have volunteer driver programs through local senior centers, faith-based organizations, and Area Agencies on Aging. The Eldercare Locator (1-800-677-1116) can help identify local transportation resources. ITNAmerica provides affordable transportation for older adults and people with visual impairment.

Healthcare Transportation: Medicaid and many Medicare Advantage plans cover non-emergency medical transportation (NEMT). Contact your insurance provider to learn about covered transportation benefits for medical appointments.

Planning Ahead: Begin exploring alternatives before driving cessation becomes necessary; build a personal transportation network of family, friends, and services; consider relocating to areas with walkable amenities and public transit access; explore grocery and meal delivery services to reduce the need for transportation; and use telehealth options for medical appointments when available.

The Training section provides information on publicly available programs and resources designed to help drivers of all ages and abilities improve their driving skills and driving safety.

Training for Teen Drivers

NHTSA’s “Parents Are the Key” Program: A free comprehensive resource kit from the National Highway Traffic Safety Administration that guides parents through the graduated driver licensing (GDL) process with a structured practice plan. Available at nhtsa.gov/road-safety/teen-driving.

AAA Teen Driver Safety Program: AAA offers a range of resources including the “Teaching Your Teens to Drive” guide, online practice tests, and interactive tools. Available at TeenDriving.AAA.com.

Keys2Drive (National Safety Council): The National Safety Council provides a free online defensive driving course for teens that covers hazard recognition, space management, and distraction avoidance. Available at nsc.org.

B.R.A.K.E.S. (Be Responsible And Keep Everyone Safe): A free, hands-on defensive driving program for teens taught by professional driving instructors at locations across the country. Teens experience skid control, panic braking, and distraction avoidance on a closed course. Information at putonthebrakes.org.

Steer Clear (State Farm): A free safe driving course for drivers under 25, available online, that covers common crash scenarios, road hazards, and decision-making. Completion may qualify drivers for insurance discounts.

AARP Smart Driver Course: The nation’s most widely recognized refresher course for older drivers, available online and in person. Covers changes in driving ability that come with age, adaptive driving strategies, and updates on traffic laws and vehicle technology. Completion may qualify participants for an insurance premium reduction in many states. Available at aarp.org/auto/driver-safety.

AAA Roadwise Driver Course: A free online course designed for older drivers that covers age-related changes in vision, hearing, and reaction time, and provides strategies for safer driving. Available at seniordriving.aaa.com.

CarFit Program: An educational program developed by AAA, AARP, and the American Occupational Therapy Association that helps older drivers check how well they “fit” their vehicles. Trained technicians assess mirrors, seatbelt positioning, pedal reach, and steering wheel height. Information at car-fit.org.

The Hartford Financial Services – Driving Resources: The Hartford provides free publications including “At the Crossroads: Family Conversations About Alzheimer’s Disease, Dementia & Driving” and “We Need to Talk: Family Conversations with Older Drivers.” Available at thehartford.com/resources/mature-market-excellence.

Certified Driving Rehabilitation Specialists (CDRS): Occupational therapists or other professionals certified through ADED (the Association for Driver Rehabilitation Specialists) who provide individualized driving assessment and training for persons with disabilities and medical conditions. Find a specialist at aded.net.

Adaptive Driving Programs at Rehabilitation Centers: Many hospitals and rehabilitation centers offer driver evaluation and training programs for individuals recovering from stroke, traumatic brain injury, or living with progressive neurological conditions like Parkinson’s disease. Contact your local rehabilitation hospital for availability.

BrainHQ Cognitive Training: The Double Decision exercise within BrainHQ (developed by Posit Science) is the only cognitive training program demonstrated in the ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) randomized trial to reduce at-fault crash risk. BrainHQ is available online at brainhq.com.

National Safety Council Defensive Driving Course: Available online and in-person, this course covers hazard recognition, space management, speed management, and distraction avoidance. Completion may qualify for insurance discounts and traffic ticket dismissal in some jurisdictions. Available at nsc.org/safety-training/defensive-driving.

Smith System Driver Improvement Institute: A professional driver training program focused on the “Five Keys to Space Cushion Driving”: aim high in steering, get the big picture, keep your eyes moving, leave yourself an out, and make sure they see you. Originally for fleet drivers but applicable to all. Information at smith-system.com.

State DMV Practice Tests and Resources: Every state’s Department of Motor Vehicles website offers free practice tests, updated driver’s manuals, and information on traffic laws. These are excellent resources for reviewing rules of the road.

Tire Rack Street Survival School: A one-day hands-on driving course for teen and adult drivers that focuses on car control skills in real-world emergency situations, including ABS braking, oversteer/understeer recovery, and emergency lane changes. Information at streetsurvival.org.

Types of Adaptive Equipment: Hand controls for brake and accelerator (for individuals with lower extremity impairment); steering wheel spinner knobs (for one-handed driving or limited grip); left-foot accelerator pedals; pedal extensions for shorter drivers; swivel seats and transfer aids for easier entry/exit; wide-angle mirrors and backup cameras; and voice-activated controls for GPS and audio systems.

Finding Adaptive Equipment: The National Mobility Equipment Dealers Association (NMEDA) maintains a directory of qualified dealers who can install adaptive driving equipment. Available at nmeda.com. Your CDRS can recommend specific modifications based on your individual assessment.

Advanced Driver Assistance Systems (ADAS): Many new vehicles come equipped with features that can significantly enhance safety: automatic emergency braking, lane departure warning and lane keeping assist, blind spot monitoring, adaptive cruise control, rear cross-traffic alert, and parking assistance. Consult with your dealership about the ADAS features available on your vehicle and how to use them effectively.

The following publicly available resources provide valuable information for individuals with medical conditions affecting driving, their families and caregivers, and healthcare providers. Resources are organized by source type.

Federal Agencies

National Highway Traffic Safety Administration (NHTSA) – Comprehensive resources on teen driving, older driver safety, distracted driving, and drowsy driving. The Clinician’s Guide to Assessing and Counseling Older Drivers is a key resource for healthcare providers.

NHTSA Older Driver Safety: https://www.nhtsa.gov/road-safety/older-drivers

NHTSA Teen Driving: https://www.nhtsa.gov/road-safety/teen-driving

NHTSA Distracted Driving: https://www.nhtsa.gov/risky-driving/distracted-driving

Centers for Disease Control and Prevention (CDC) – Older adult driver safety program, transportation and health resources, and motor vehicle crash data.

CDC Older Adult Drivers: https://www.cdc.gov/transportationsafety/older_adult_drivers/index.html

CDC Motor Vehicle Safety: https://www.cdc.gov/transportationsafety/index.html

Federal Motor Carrier Safety Administration (FMCSA) – Regulations and guidelines for commercial drivers, including specific requirements for drivers with diabetes, sleep apnea, and other medical conditions.

FMCSA Medical Programs: https://www.fmcsa.dot.gov/medical

National Institute on Aging (NIA) – Information on aging and driving, including how to talk to older adults about driving safety.

NIA Older Drivers: https://www.nia.nih.gov/health/older-drivers

Louisiana Department of Transportation and Development (DOTD) – Louisiana-specific driving safety information, road conditions, and construction zones.

Louisiana DOTD: https://www.dotd.la.gov

Louisiana Office of Motor Vehicles (OMV) – Licensing information, vision and medical requirements, and driver’s license renewal procedures.

Louisiana OMV: https://www.expresslane.org

State Highway Safety Offices – Each state has a Governor’s Highway Safety Office that coordinates traffic safety programs. Contact your state’s office for local resources.

GHSA Directory: https://www.ghsa.org/about/shsos

American Academy of Neurology (AAN) – Practice parameter on evaluation and management of driving risk in dementia; clinical resources for neurologists.

AAN Practice Parameters: https://www.aan.com/Guidelines/home/ByTopic?topicId=16

American Occupational Therapy Association (AOTA) – Resources on driving and community mobility, including the Driving and Community Mobility webpage and information on finding a CDRS.

AOTA Driving Resources: https://www.aota.org/practice/practice-essentials/driving

American Diabetes Association (ADA) – Position statement on diabetes and driving, clinical guidelines, and patient resources.

ADA Diabetes and Driving: https://www.diabetes.org

American Academy of Sleep Medicine (AASM) – Clinical guidelines for sleep apnea diagnosis and treatment, including resources on drowsy driving.

AASM Sleep Education: https://sleepeducation.org

Association for Driver Rehabilitation Specialists (ADED) – Directory of certified driving rehabilitation specialists nationwide.

ADED Find a Specialist: https://www.aded.net

AARP Driver Safety – Smart Driver course, CarFit program, and resources for older drivers and their families.

AARP Driver Safety: https://www.aarp.org/auto/driver-safety

AAA Foundation for Traffic Safety – Research reports, educational materials, and safety resources for drivers of all ages.

AAA Foundation: https://aaafoundation.org

Alzheimer’s Association – Information on dementia and driving, including safety guidelines and when to stop driving. 24/7 Helpline: 1-800-272-3900.

Alzheimer’s Association: https://www.alz.org

National Safety Council (NSC) – Defensive driving courses, safe driving resources, and employer safety programs.

NSC: https://www.nsc.org

The Michael J. Fox Foundation for Parkinson’s Research – Patient resources including information on driving with Parkinson’s disease.

MJFF: https://www.michaeljfox.org

CHADD (Children and Adults with ADHD) – Resources on ADHD and driving, including practical tips for teens and adults.

CHADD: https://chadd.org

The Arc – Resources for individuals with intellectual and developmental disabilities, including autism and driving.

The Arc: https://thearc.org

ITNAmerica – Affordable, community-based transportation for older adults and people with visual impairment.

ITNAmerica: https://www.itnamerica.org

The Hartford Financial Services – Free publications on older driver safety, caregiver conversations, and driving transition planning.

The Hartford: https://www.thehartford.com/resources/mature-market-excellence

National Mobility Equipment Dealers Association (NMEDA) – Directory of dealers providing adaptive vehicle equipment and modifications.

NMEDA: https://www.nmeda.com