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Chapter 5: Driving Reduction and Cessation Issues for Older Road Users

As in the United States, the issue of driving cessation is one federal and state governments in Australia struggle with to maintain a balance between public safety and individual mobility. The public perception is that older drivers are hazards to other road users and should be removed from driving. This perception is reinforced when high-profile older driver crashes receive significant media attention. Crash data, however, generally do not support this perception. In general, agencies do not want to remove drivers from their vehicles prematurely because it creates a travel mode shift to walking, which has a higher risk for injury, and because driving cessation has negative health consequences as former drivers become socially isolated. During the scan study, radically different approaches to the problem were observed.

Licensing and Assessment

In New South Wales, the RTA mandates annual driver retesting beginning at age 85. (37) Beginning at age 80, an annual medical certification is required. This recent change to the policy has prompted a strong response from the community and motoring clubs. (38) The RTA also maintains an anonymous tip line for family members, law enforcement, and the general public to report unsafe drivers who may need to be retested.

In contrast, the state of Victoria has conducted research that shows no benefit of mass age-based driver retesting and cannot justify the cost of these tests. (39) It allows mail renewals every 3 years for those over age 75. Victoria does provide many self-assessment aids, offered by several agencies, that encourage drivers and families to be aware of potential age-related declines in driving ability. As part of the RoadSafe community road safety program (funded through VicRoads), Wiser Driver courses (developed by Hawthorn Community Education Centre) are offered in the community and supporting information is provided to health-care providers and family members. (40)

The state of Queensland is reevaluating its driver licensing policy and expects changes to come in the next version of its strategic safety plan. It now has a mandatory selfreporting requirement for certain medical conditions and a medical evaluation system. Some older driver medical conditions such as eye disease and dementia are covered by this system. Drivers over 75 must have a medical evaluation every 2 years. (41)

In Japan, the law is scheduled to change in 2009 to require driver retesting at age 75. The Tokyo government announced a new incentive program to encourage drivers over 65 to voluntarily surrender their driving privileges. The program partners with local businesses to provide discounts to those who give up their licenses. (42)

Training and Education

The scan team's conversations with researchers and transportation officials in Australia indicated that for the most part they believe older drivers limit their driving to low-risk situations as they age. Training programs and educational materials, therefore, are often geared toward helping drivers and their families assess their fitness to drive and providing information on high-risk driving situations. These training programs do not focus on driving skills, but rather on understanding risks and adapting driving exposure and behavior to mitigate those risks.

As seen in the strategic safety plans, partnerships are crucial in senior driver training and education. The automobile clubs play an important role. The Royal Automobile Club of Victoria offers a road safety program for seniors on safe driving, driving skill, and assessing fitness to drive. (43) The 1-hour Years Ahead program is offered at senior centers, community clubs, and retirement villages. The same program is offered by National Roads and Motorists' Association (NRMA) motoring clubs in New South Wales. (44) In addition, they offer information on choosing vehicles with advanced safety features that provide more protection to frail seniors in the event of a crash. (45) Some clubs offer refresher behind-the-wheel driver training with a professional driving instructor. (46) These sessions can serve as an objective assessment of fitness to drive as well as preparation for mandatory age-based retesting. In addition, the clubs offer study materials for driver's reexamination. (47, 48)

A pilot program in Queensland, being evaluated by the local university, (49) provides peer-to-peer education programs for those considering driving cessation. The classes include self-assessment of fitness to drive, as well as information on using the transit system and accessing home delivery services. Officials have found that peer education is particularly effective for these topics. The evaluation will assess quality of life and mental health outcomes for participants. The hope is that by learning about mobility options, participants will get out of their homes more often. These trips have been linked to positive mental health in previous studies.

A similar program, called Mobility Advisor, (50) is being tested in Victoria in cooperation with the Monash University Accident Research Centre. The state Parliamentary Road Safety Committee initiated the program after public hearings and research on older road user safety. (51) The project will specially train state home health-care workers on mobility advice such as transit use. The project will measure performance by assessing physical and mental health and travel patterns throughout the study. It does not feature the peer education component of the Queensland program.

VicRoads provides a one-stop Web site for advice on transportation options after driving cessation for former drivers and their family members. (52) It provides information on driving cessation decisionmaking, public transport, and links to community alternative transportation programs. This Web site, along with several of the presentations the scan team saw throughout Australia, also promotes the use of delivery services for groceries, bill paying, postal services, and other common trip generators for older people.

Motoring clubs also offer members support for mobility after driving cessation. (53) While that may seem ironic, club officials report that these services help retain members who may use other travel and insurance products the club offers. In addition, the motoring clubs believe they have a role to play in representing not just the motoring interests of drivers, but also the mobility interests of citizens in general, including nondrivers. The clubs believe that community prosperity and well-being depend on having efficient transport and mobility services in place.

Community-Based Mobility Options

If drivers elect to stop driving, their transportation needs must be met by other means. Traveling in personal vehicles remains the dominant form of transportation for many elderly people who have stopped driving. This is accomplished through direct requests of family or friends and through community rideshare groups. Being dependent on others for rides can be stressful for older people. Research in Japan has shown that it is more stressful for the elderly person making the request than it is for the person being asked. (54) In the countries visited, as in the United States, there is a shortage of mobility options to serve all the trip needs of older citizens. This is particularly true in rural areas, where routine trips such as medical appointments or shopping can require traveling long distances.

The scan team observed a community-based program in Queensland offered by the Transport Development and Solution Alliance, a nonprofit organization that provides support to communities to develop and coordinate transportation services. (55) The representative from this group noted that the majority of trips are for medical care. With the growth in outpatient surgery, the number of trips is increasing as more follow-up appointments are required. These multiple trips often use up an individual's transportation budget for the month. The alliance sponsors a biannual conference among local governments, including those in rural areas, to share ideas for alternative transportation. The alliance has found that the cost of owning and maintaining a vehicle limits the success of many community-based programs. Some innovative vehicle use programs that have been tried in rural Queensland include the use of school buses for midday trips, the use of church buses during weekdays, and even the use of the local hearse as a transport vehicle for intercity trips in rural areas.

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