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The main goal of the Clinician’s Guide
remains helping healthcare practitioners
prevent motor vehicle crashes and injury to
older adults. Motor vehicle injuries persist
as the leading cause of injury-related deaths
among 65- to 74-year-olds and are the
second leading cause (after falls) among 75-
to 84-year-olds. While traffic safety programs
have had partial success in reducing crash
rates for all drivers, the fatality rate for drivers
over age 65 has consistently remained high.
Increased comorbidities and frailty associated
with aging make it far more difficult to survive
a crash, and the expected massive increase
in the number of older adults on the road
is certain to lead to increased injuries and
deaths unless we can successfully intervene
to prevent harm
The Clinician’s Guide to Assessing and Counseling Older Drivers, 4th Edition is published by the American Geriatrics Society (AGS) as a service to healthcare providers involved in the care of older adults. This 4th edition is an update of the 3rd edition to the current state of the literature, with a continued focus on the interprofessional nature of the team caring for an older adult driver. This edition is the result of a cooperative agreement between AGS and the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA).
The Clinician’s Guide is available in two formats, a digital text accessed through your browser and a downloadable PDF.
Older drivers may have age-related and medical conditions that affect their driving performance.
More than 90% of car crashes are caused by human error. In older adults, age-related changes of decreased vision, cognitive decline, slowed reaction time, and decreased grip strength increase the risk of common driving errors, including straying from driving lanes, failing to observe speed limits, and overlooking traffic signs.
The risk of dying in a car crash is 2.5 times higher for drivers aged 75 to 79 years and 5 times higher for those aged 80 years or older compared with younger drivers.
A systematic review was conducted to determine the effectiveness and economic efficiency of multicomponent programs with community mobilization for reducing alcohol-impaired driving. The review was conducted for the Guide to Community Preventive Services (Community Guide). Six studies of programs qualified for the review. Programs addressed a wide range of alcohol-related concerns in addition to alcohol-impaired driving. The programs used various crash-related outcomes to measure their effectiveness. Two studies examined fatal crashes and reported declines of 9% and 42%; one study examined injury crashes and reported a decline of 10%; another study examined crashes among young drivers aged 16-20 years and reported a decline of 45%; and one study examined single-vehicle late-night and weekend crashes among young male drivers and reported no change. The sixth study examined injury crashes among underage drivers and reported small net reductions. Because the actual numbers of crashes were not reported, percentage change could not be calculated. According to Community Guide rules of evidence, the studies reviewed here provided strong evidence that carefully planned, well-executed multicomponent programs, when implemented in conjunction with community mobilization efforts, are effective in reducing alcohol-related crashes. Three studies reported economic evidence that suggests that such programs produce cost savings. The multicomponent programs generally included a combination of efforts to limit access to alcohol (particularly among youth), responsible beverage service training, sobriety checkpoints or other well-defined enforcement efforts, public education, and media advocacy designed to gain the support of both policymakers and the general public for reducing alcohol-impaired driving.
