Identifying & Managing Health Risks in Aging Drivers

Driving related health risks can be categorized into five categories: sight, hearing, mental, physical, and medication/substance induced. This guide covers how to deal with these risks effectively.

1. Sight

A. Common Vision Difficulties

Most peoples eyesight typically begins deteriorate in their mid-40’s and worsens with age. Here are the most common reasons, many of which are not correctable with glasses:

  • Presbyopia: or the ability to focus on things close to us, such as words on instruments and maps.
  • Focus speed:  A decrease in speed of focal length changes between far and near objects.
  • Reduced field of vision: Glaucoma can cause a decrease in a person’s field of vision, making it difficult to see objects and people in their periphery.
  • Night-vision:  The ability to see in the dark diminishes (e.g. reduced “rod” function, and pupils decreased ability to shrink).
  • Glare:  A decreased ability to adjust between dark and light situations is common. More than twice the time can be needed for older people to adjust from a light to a dark environment making recovery from glare delayed. Some adults choose to drive in daylight hours.
  • Central vision loss: Macular degeneration can reduce a persons central vision and can reduced a persons ability to make out details. Generally, degeneration worsens with time.
  • Fuzzy/blurriness: Cataracts can make road signs and signals appear blurred or fuzzy, while colors are diminished. Cataracts worsen with time, and in some cases, cataracts can cause glaucoma and blindness, but glasses, and in severe cases, a relatively safe surgery can be performed.
  • Lazy eye: This is when the brain causes one eye does most of the work, and if vision ever deteriorates in the weak eye, this can cause an unnoticed reduction in ability to read road signs in certain circumstances. Vision and DMV tests can monitor this over time.

Solution: Reduction or even prevention of certain diseases can be reduced with early detection, therefore, regular screenings and eye exams should be used.

B. Safe Vision Driving Tips

  • Eye exam: Prevent Blindness recommends that adults between 40 and 64 get an eye exam every 2 to 40 years, while 65+ should get an exam every 1 to 2 years, but more often if you have a family history of glaucoma or other inheritable diseases. Additionally, and new difficulties with vision that appear between these intervals should be checked as they arise.
  • Increase brightness: on the instrument cluster for night driving.
  • Windshield wipers: should be checked every few months.
  • Clean optical surfaces: All transparent surfaces such as glasses, windshields (both inside and out), mirrors, headlights, cameras and optical sensors should be kept clean.
  • Avoid or limit low-light driving: If a driver has difficult with night driving, they should avoid such, and may still be able to drive during the daytime.
  • Glass/sunglasses choice: Be careful in selection of glasses and sunglasses that they do not impede peripheral vision.
  • Elevate seating: If a driver is short, they may opt to use a booster seat of some kind such as a pillow, cushion, or other raised object, being careful to ensure they can still reach the pedals.
  • Scan more often: Practice turning head side to side more often to compensate for a decreasing field of vision.

2. Hearing

A. Common Hearing Difficulties

Most people underestimate the need for hearing well while driving. According to a study by the University of North Carolina, UFOV (Useful Field of View) tests show that “Individuals with moderate or greater hearing impairment performed poorly on the UFOV, indicating increased risk for adverse driving events.”  Here are some common challenges and symptoms with hearing:

  • Reduced ability to hear quieter sounds: Being able to hear sirens of emergency vehicles or other vehicles honking their horns to alert for danger.
  • High-pitched frequency loss:  Or a “sloping” hearing loss, may cause difficulty in hearing people or animals. This can also cause other issues listed below.
  • Hearing words but not understanding: even at increased volumes.
  • Unable to differentiate foreground noise: from background noise

B. Safe Hearing Driving Tips

  • Increase the frequency of using mirrors and checking to both sides and behind can help offset minor hearing loss as it increases dependence on visual clues.
  • Audiologists recommend getting screened (a basic hearing test) every three to five years as part of a patients annual physical, especially because its gradual nature often goes unnoticed. Setting a baseline can monitor changes over time.
  • Consider getting hearing aids when recommended by a doctor.

3. Mental / Cognitive Function

A. Common Mental Alertness

According to the Tennessee Highway Safety office, a driver makes approximately 20 major decisions per mile driven, and response times of less than one-half a second are needed in order to prevent a collision.

Some of the causes of an individual’s cognitive impairment are:

  • Dementia (e.. Alzheimer’s disease or other dementia)
  • Seizure disorder (lapse of consciousness condition)
  • Sleep disorders (insomnia. narcolepsy, sleep apnea)
  • Difficulties in maintaining, or unknowingly losing, consciousness
  • Parkinson’s disease
  • Stroke or brain aneurism
  • Dizziness or vertigo
  • Brain tumors

Although the science is less clear in mental health, it is generally believed that engaging the mind regularly is helpful to increase its long term ability to function well.  Even something as simple as playing games and puzzles may help sharpen focus and awareness.

B. Safe Mental Health Driving Tips

Generally, most brain functioning issues worsen with time, therefore, greater monitoring and vigilance is required when any of these conditions are present in a driver.

Screening for reduced mental function is available:

  • Clinical Dementia Rating (CDR) scale: This tests for mild to average level of dementia, and strong evidence suggests that the CDR can help identify unsafe drivers. However, many people who score low or average (0.5 or 1) can still drive safely.
  • Mini-Mental State Examination (MMSE): This tests memory, language, and spatial ability, but the evidence for unsafe driving ability is lower with this test as its score may not be correlated with risk.
  • Neuropsychological tests: These tests focus on thinking ability, but like the MMSE, the evidence is not as strong.
  • Working with a specialist that focuses on dementia can help create a plan for drivers at risk.

Some states’ DMVs require that upon receiving a diagnosis or referral for someone with a cognitive impairment, the DMV requires that reported individual to complete a driver test.

4. Physical / Body

A. Common Physical Challenges

As people get older, their general functioning ability tends to decline. Task that were once simple, such as pressing the gas, turning the car, or looking over your shoulder can become difficult or impossible for some.

Focusing on physical health and exercise can reduce the rate of impairment. Moderate or light exercise is valuable for all age groups, and the benefits far exceed driving needs. Simple at-home exercise can be performed such as using a stepper, lifting light objects around the house, and moving arms and legs in various motions. Your physician or occupational therapist may have specific recommendations for you if you do not have other sources. Common exercises may include:

  • Walking
  • Yoga or stretching
  • Light aerobics
  • Water exercise/aerobics
  • Dancing
  • Light weight lifting (useful to prevent osteoarthritis too)
  • Cleaning or gardening
  • Shopping
  • Community programs (e.g. senior centers, community centers, doctors office)

There are many other activities that can improve your health, strength and flexibility. Finding an enjoyable activity is a useful way to stay motivated.  The benefits are not limited to just driving, but all aspects of living as it generally slows the progress of aging, disease, and death. If unsure about which activities are safe, your physician can recommend activities.

Over time, our body’s muscles tend to weaken, our bones become more fragile, and our range of motion decreases.

B. Safe Driving Tips with Physical Weakness

  • Stiff/arthritic joints or osteoporosis can make head turning difficult.
    • Use additional side mirrors or large, panoramic rear-view mirrors.
    • Turn at the waist instead of the neck to look over your shoulder.
  • Muscle weakness:
    • Your vehicle should include power features such as power steering, brakes, and windows.
    • An automatic requires less strength (and distraction) than some stick shifts.
    • A turning knob can be put on a steering wheel to make it easier to turn. 
  • Broken bones, even after healed, can slow reflexes.
    • Alternative braking devices may be available from your doctor. Muscle atrophy from broken bones, bone replacements, and metal pins, is common.

5. Medications:  Over the Counter and Prescription Medication

All medication labels/guides should be carefully read to determine safety while driving.

When in doubt, a pharmacist is the most qualified (not a physician) to interpret and convey medication risks. Common medications that impair cognitive function include medications that treat for:

  • Depression
  • Pain
  • Anxiety
  • Sleep aids
  • Diabetes
  • And others

Common over-the-counter (OTC) medications cause drowsiness, decrease coordination, impair judgment, and slow response times while driving. In many cases, the effects are similar to driving while intoxicated (e.g. drugs and alcohol). Common OTC medications may include:

  • Cold & flu
  • Allergy & antihistamines
  • Sleeping aid medications
  • And others

6. Other Safety Tips

  • Only drive when not upset. 6% of senior car accidents with known-causes occur due to aggressive driving, and 2% due to an emotionally upset driver.
  • Driver sober. Our body’s ability to tolerate alcohol decreases with time. Likewise, 3% of such accidents are caused by DUI/DWI.
  • Do not drive when sleepy or fatigued. Similarly, 4% of crashes are due to falling asleep at the wheel, and 3% due to fatigue.
  • Long trips may require breaks in driving.


Next in this series: Self Assessment Driving Tools & Worksheets for Older Drivers

Return to main page: Senior Driving Safety