Mandatory cognitive tests for older drivers help prevent car crashes caused by men but not women, according to new research. In Japan, those over 75 reapplying for their licence have to have a cognitive test and can have their licence withdrawn if they have dementia or Alzheimer's.
This led to an increase in the number of accidents involving elderly pedestrians and cyclists, as they find alternative ways of getting around. The findings are based on an analysis of police-reported data on over 70s in Japan from July 2012 to December 2019.
Corresponding author Dr Haruhiko Inada, of Johns Hopkins Bloomberg School of Public Health, Baltimore, said: "Safety measures need to be strengthened for older cyclists and pedestrians. We should also provide older people with necessary care to prepare for driving cessation and safe, alternative transport means."
The study in the Journal of the American Geriatrics Society found motor vehicle collisions just fell among male drivers after the program was implemented. But more pedestrians and cyclists were injured as mentally impaired individuals used bikes, or walked, instead.
As of March 2017, over 75s who screen positive are required to see a physician. If diagnosed with dementia, their driving licenses may be suspended or revoked. Following the policy, there were around 3,670 fewer collisions than would have been expected among male motorists.
There were roughly 959 more injuries for pedestrians and cyclists of both sexes, mainly affecting men aged 80 to 84 and women over 80. Dr Inada said: "After March 2017, the number of motor vehicle collisions per population decreased among older men but not among women."
Previous studies have shown mixed results for the association between the introduction of cognitive testing for driver's license renewal among older drivers and the incidence of motor vehicle collisions involving them. Dr Inada said: "Using a robust study design with large national data, we revealed that such a cognitive screening for drivers aged 75 years or older from March 2017 was associated with decreased motor vehicle collisions per population in Japan.
"This study also confirmed that the cognitive screening was associated with increased road injuries per population among older pedestrians and cyclists."
There were a total 602,885 collisions for drivers during the period and 196,889 injuries for pedestrians and cyclists."
Japan has one of the fastest ageing societies in the world - with one in five citizens aged 70 or older. It is also a nation of drivers and car lovers, with nearly 80 million vehicles on the road.
Keeping traffic accidents down as people get older is a growing problem. A recent survey in the UK found more than half of motorists over the age of 60 would back retests every five years after they reach 70.
Under current rules, they have to renew their driving licence every three years. But that process simply requires drivers to fill out a form and a medical declaration. There are no checks to find out whether the driver is competent behind the wheel.
Being able to drive can provide older people with independence - and respect. Discussions with older family members about giving up their car can be difficult - and affect their dignity. Losing licences can hit elderly people in rural areas - where older populations are biggest and public transport can be limited - especially hard. Without a car, they cannot survive.
They cannot go shopping or see their friends. To enjoy life, a car is necessary. Some are aware of their impaired driving skills, but need to keep driving for their daily life. Dr Inada said: "Older drivers garner increasing attention as populations age and the share of motor vehicle collisions that involve them increases.
"In addition, many people have a negative image of older drivers and believe they are risky."
In Japan in 2019, 41 fatal collisions were attributed to mistakenly pressing the accelerator instead of the brake. Of these, 28 (68%) were caused by drivers aged 75 or older. Dr Inada said: "In addition, older drivers are proneto medical conditions that increase the risk of collisions and may also affect public perceptions of older drivers.
"To prevent motor vehicle collisions among olderdrivers, some countries and areas, including Denmark,Japan, Ontario, and Taiwan, conduct cognitive screening tests at license renewal."
In 2018, the proportion of fatal traffic accidents in Japan caused by drivers 75 or older rose to 15 percent, up from less than nine percent in 2008. According to a Japanese government report in June, they caused more than double the number of fatal accidents than younger drivers.
Vehicle manufacturers are making changes intended to improve safety by reducing collisions caused by errors that older drivers are prone to committing. But the technology has not been fully evaluated. Dr Inada said: "For example, since November 2021, all new model four-wheeled motor vehicles produced and sold in Japan are required to have automatic emergency brakes.
"In addition, in May 2022, Japan introduced a driver's license restricted to partially autonomous vehicles. More broadly, it is necessary to position safety measures for older drivers in the context of social systems that enable older people to age in place.
"However, we still have limited evidence to effectively integrate extending 'driving life expectancy' and securing transportation after driving cessation into multi-sectoral strategies to extend healthy life expectancy.
"Whether older drivers with pre-clinical to mild dementia have a safety profile comparable to their healthy counterparts and may be allowed to continue driving is an area of active research. However, those with moderate to severe dementia should stop driving."
He added: "We need to seek for effective strategies to provide older people with necessary care to prepare for driving cessation and alternative transport means.
"In conclusion, following the amendment of a law requiring cognitive screening at license renewal for older drivers, motor vehicle collisions for older drivers decreased and road injuries of older pedestrians and cyclists increased in Japan."
