Older Driver Safety
Knowledge Sharing Should Help States Prepare for Increase in Older Driver Population Gao ID: GAO-07-413 April 11, 2007As people age, their physical, visual, and cognitive abilities may decline, making it more difficult for them to drive safely. Older drivers are also more likely to suffer injuries or die in crashes than drivers in other age groups. These safety issues will increase in significance because older adults represent the fastest-growing U.S. population segment. GAO examined (1) what the federal government has done to promote practices to make roads safer for older drivers and the extent to which states have implemented those practices, (2) the extent to which states assess the fitness of older drivers and what support the federal government has provided, and (3) what initiatives selected states have implemented to improve the safety of older drivers. To conduct this study, GAO surveyed 51 state departments of transportation (DOT), visited six states, and interviewed federal transportation officials.
The Federal Highway Administration (FHWA) has recommended practices--such as using larger letters on signs--targeted to making roadways easier for older drivers to navigate. FHWA also provides funding that states may use for projects that address older driver safety. States have, to varying degrees, adopted FHWA's recommended practices. For example, 24 states reported including about half or more of FHWA's practices in state design guides, while the majority of states reported implementing certain FHWA practices in roadway construction, operations, and maintenance activities. States generally do not place high priority on projects that specifically address older driver safety but try to include practices that benefit older drivers in all projects. More than half of the states have implemented licensing requirements for older drivers that are more stringent than requirements for younger drivers, but states' assessment practices are not comprehensive. For example, these practices primarily involve more frequent or in-person renewals and mandatory vision screening but do not generally include assessments of physical and cognitive functions. While requirements for in-person license renewals generally appear to correspond with lower crash rates for drivers over age 85, the validity of other assessment tools is less clear. The National Highway Traffic Safety Administration (NHTSA) is sponsoring research and other initiatives to develop and assist states in implementing more comprehensive driver fitness assessment practices. Five of the six states GAO visited have implemented coordination groups to assemble a broad range of stakeholders to develop strategies and foster efforts to improve older driver safety in areas of strategic planning, education and awareness, licensing and driver fitness assessment, roadway engineering, and data analysis. However, knowledge sharing among states on older driver safety initiatives is limited, and officials said states could benefit from knowledge of other states' initiatives.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-07-413, Older Driver Safety: Knowledge Sharing Should Help States Prepare for Increase in Older Driver Population
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Report to the Special Committee on Aging, U.S. Senate:
April 2007:
Older Driver Safety:
Knowledge Sharing Should Help States Prepare for Increase in Older
Driver Population:
GAO-07-413:
GAO Highlights:
Highlights of GAO-07-413, a report to the Special Committee on Aging,
U.S. Senate
Why GAO Did This Study:
As people age, their physical, visual, and cognitive abilities may
decline, making it more difficult for them to drive safely. Older
drivers are also more likely to suffer injuries or die in crashes than
drivers in other age groups (see fig.) These safety issues will
increase in significance because older adults represent the fastest-
growing U.S. population segment.
GAO examined (1) what the federal government has done to promote
practices to make roads safer for older drivers and the extent to which
states have implemented those practices, (2) the extent to which states
assess the fitness of older drivers and what support the federal
government has provided, and (3) what initiatives selected states have
implemented to improve the safety of older drivers. To conduct this
study, GAO surveyed 51 state departments of transportation (DOT),
visited six states, and interviewed federal transportation officials.
What GAO Found:
The Federal Highway Administration (FHWA) has recommended
practices”such as using larger letters on signs”targeted to making
roadways easier for older drivers to navigate. FHWA also provides
funding that states may use for projects that address older driver
safety. States have, to varying degrees, adopted FHWA‘s recommended
practices. For example, 24 states reported including about half or more
of FHWA‘s practices in state design guides, while the majority of
states reported implementing certain FHWA practices in roadway
construction, operations, and maintenance activities. States generally
do not place high priority on projects that specifically address older
driver safety but try to include practices that benefit older drivers
in all projects.
More than half of the states have implemented licensing requirements
for older drivers that are more stringent than requirements for younger
drivers, but states‘ assessment practices are not comprehensive. For
example, these practices primarily involve more frequent or in-person
renewals and mandatory vision screening but do not generally include
assessments of physical and cognitive functions. While requirements for
in-person license renewals generally appear to correspond with lower
crash rates for drivers over age 85, the validity of other assessment
tools is less clear. The National Highway Traffic Safety Administration
(NHTSA) is sponsoring research and other initiatives to develop and
assist states in implementing more comprehensive driver fitness
assessment practices.
Five of the six states GAO visited have implemented coordination groups
to assemble a broad range of stakeholders to develop strategies and
foster efforts to improve older driver safety in areas of strategic
planning, education and awareness, licensing and driver fitness
assessment, roadway engineering, and data analysis. However, knowledge
sharing among states on older driver safety initiatives is limited, and
officials said states could benefit from knowledge of other states‘
initiatives.
Figure: Fatal Crashes by Driver Age Group per 100 Million Vehicles
Miles Traveled (2002):
[See PDF for Image]
Source: GAO analysis of NHTSA and USDOT data.
[End of figure]
What GAO Recommends:
GAO is recommending that the Secretary of Transportation direct the
FHWA and NHTSA Administrators to implement a mechanism to allow states
to share information on older driver safety practices. The Department
of Health and Human Services agreed with the report. The Department of
Transportation provided technical corrections but did not offer overall
comments on the report.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-413].
To view the full product, including the scope and methodology, click on
the link above. To view the e-supplement online, click on
http://www.gao.gov/cgi-bin/getrpt?GAO-07-517SP. For more information,
contact Katherine Siggerud at (202) 512-6570 or siggerudk@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
FHWA Has Recommended Practices and Made Funding Available to Make Roads
Safer for Older Drivers, but States Generally Give Higher Priority to
Other Safety Issues:
More than Half of States Have Implemented Some Assessment Practices for
Older Drivers, and NHTSA Is Sponsoring Research to Develop More
Comprehensive Assessments:
Selected States Have Implemented Coordinating Groups and Other
Initiatives to Promote Older Driver Safety:
Conclusion:
Recommendation for Executive Action:
Agency Comments and Our Evaluation:
Appendixes:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: States' Licensing Requirements for Older Drivers:
Appendix III: Comments from Department of Health and Human Services:
Appendix IV: GAO Contact and Staff Acknowledgments:
Tables:
Table 1: Most Widely Implemented Practices Recommended by FHWA for
Improving Older Driver Safety:
Table 2: Methods Reported by States for Working with Local Governments
to Improve Older Driver Safety:
Table 3: Types of Safety Projects in Which States Report Investing
Resources to a Great or Very Great Extent:
Table 4: Older Driver Safety Coordination Groups' Organizations and
Functions:
Table 5: States with Vision Testing Requirements for Older Drivers:
Table 6: States with Accelerated Renewal Cycles for Older Drivers:
Table 7: States Requiring In-Person Renewals:
Figures Figures:
Figure 1: Drivers in Fatal Crashes per 100,000 Licensed Drivers (1995
to 2005):
Figure 2: Fatal Crashes by Driver Age Group per 100 Million Vehicle
Miles Traveled (2001):
Figure 3: Population Growth of Adults Aged 65 and Older:
Figure 4: Fatal Crashes at Intersections by Driver Age (2004):
Figure 5: Older Driver Improvements at an Intersection:
Figure 6: Examples of Improved Signs and Ability to See Oncoming
Traffic:
Figure 7: Older Driver Improvements at an Intersection with Traffic
Signals:
Figure 8: Examples of Improved Signals and Median Markings:
Figure 9: Older Driver Improvements at an Interchange:
Figure 10: Older Driver Improvements on Curves:
Figure 11: Older Driver Improvements at Railroad Crossings:
Figure 12: State Licensing Practices Related to Older Driver Safety:
Abbreviations:
AAMVA: American Association of Motor Vehicle Administrators:
AASHTO: American Association of State and Highway Transportation
Officials:
AOA: Administration on Aging:
CTRE: Center for Transportation Research and Education:
DHSMV: Department of Highway Safety and Motor Vehicles:
DOT: Department of Transportation:
FADC: Florida At-Risk Driver Council:
FHWA: Federal Highway Administration:
GHSA: Governors Highway Safety Association:
HSIP: Highway Safety Improvement Program:
IDOT: Iowa Department of Transportation:
LTAP: Local Technical Assistance Program:
MAB: Medical Advisory Board:
MDDB: Mature Driver Database:
MPO: Metropolitan Planning Organization:
MUTCD: Manual on Uniform Traffic Control Devices:
NCHRP: National Cooperative Highway Research Program:
NHTSA: National Highway Traffic Safety Administration:
NIA: National Institute on Aging:
OCTS: Older Californian Traffic Safety Task Force:
ODMVS: Oregon Driver and Motor Vehicle Services:
SAFETEA-LU: Safe, Accountable, Flexible, Efficient Transportation
Equity Act: A: Legacy for Users:
SEMCOG: Southeast Michigan Council of Governments:
SHSP: Strategic Highway Safety Plan:
STIP: Statewide Transportation Improvement Program:
April 11, 2007:
The Honorable Herb Kohl:
Chairman:
The Honorable Gordon H. Smith:
Ranking Minority Member:
Special Committee on Aging:
United States Senate:
As people age, their physical, visual, and cognitive abilities may
deteriorate, making it more difficult for them to drive safely.
Furthermore, older drivers are more likely to suffer injuries or die in
accidents than drivers in most other age groups, in part because of the
greater frailty that comes with age. Older driver safety issues will
become increasingly significant in the future because older adults
represent the fastest-growing segment of the U.S. population--by 2030
the number of licensed drivers aged 65 and older is expected to nearly
double to about 57 million. Consequently, efforts to build safer roads
and develop better methods of assessing driver fitness are keys to
helping older people continue to drive safely and maintain their
mobility, independence, and health.
Concerned about the safety of older drivers, you requested that we
review steps being taken by both the federal and state governments to
support older driver safety initiatives. Accordingly, this report
addresses (1) what the federal government has done to promote practices
to make roads safer for older drivers and the extent to which states
have implemented those practices, (2) the extent to which states assess
the fitness of older drivers and what support the federal government
has provided, and (3) what initiatives selected states have implemented
to improve the safety of older drivers.
To determine what the federal government has done to promote practices
to make roads safer for older drivers, we reviewed documents and
interviewed officials from the Federal Highway Administration (FHWA)
within the U.S. Department of Transportation (DOT). To obtain
information on the extent to which states are implementing these
practices, we surveyed and received responses from DOTs in each of the
50 states and the District of Columbia.[Footnote 1] This report does
not contain all the results from the survey. The survey and a more
complete tabulation of the results can be viewed at [Hyperlink,
http://www.gao.gov/cgi-bin/getrpt?GAO-07-517SP]. To determine the
extent to which states assess the fitness of older drivers and what
support the federal government has provided, we reviewed documents and
interviewed officials from the National Highway Traffic Safety
Administration (NHTSA) within the U.S. DOT, the National Institute on
Aging (NIA) and the Administration on Aging (AOA) within the U.S.
Department of Health and Human Services (HHS), and the American
Association of Motor Vehicle Administrators (AAMVA)--a nongovernmental
organization that represents state driver licensing agencies. To obtain
information on initiatives that selected states have implemented, we
conducted case studies in six states-- California, Florida, Iowa,
Maryland, Michigan, and Oregon--that transportation experts identified
as progressive in their efforts to improve older driver safety. The
scope of our work focused on older driver safety. Prior GAO work
addressed the associated issue of senior mobility for those who do not
drive.[Footnote 2] We conducted our work from April 2006 through April
2007 in accordance with generally accepted government auditing
standards. (For details of our objectives, scope, and methodology, see
app. I.)
Results in Brief:
To make roads safer for older drivers, FHWA has recommended practices-
-such as using larger letters on signs, placing advance street name
signs before intersections, and improving intersection layouts--for the
design and operation of roadways that make them easier for older
drivers to navigate. FHWA is also continuing research to demonstrate
the effectiveness of these practices. While these practices are
designed to address older drivers' needs, their implementation can make
roads safer for all drivers. States have, to varying degrees,
incorporated FHWA's older driver safety practices into their design
standards, implemented the practices in roadway operation and
maintenance activities, trained technical staff in applying the
practices, and coordinated with local agencies to promote the use of
the practices. Following are the actions taken by the 51 DOTs we
surveyed in the states and District of Columbia:
* 24 states reported including about half, most, almost all, or all of
FHWA's practices in their state design guides.
* 51 states reported implementing advance traffic control warning
signage on approaches to intersections.
* 12 states reported they had trained about half, most, almost all, or
all of their technical staff.
* 38 states reported they had held sessions on older driver issues with
local governments.
FHWA also provides federal highway funding that states may use to
implement projects that address older driver safety. While older driver
safety projects are eligible for federal highway funding, state DOTs
generally place a higher priority on and commit more of their limited
resources to other projects--such as railway/highway intersection
safety projects, roadside hazard elimination or mitigation projects,
road intersection safety projects, and roadway departure projects--that
more broadly affect all drivers. Although older driver safety is not
the primary focus of these projects, the projects may incorporate
FHWA's recommended practices to improve older driver safety.
More than half of the states have implemented assessment practices to
support licensing requirements for older drivers that are more
stringent than requirements for younger drivers. These requirements
generally involve more frequent renewals (16 states), mandatory vision
screening (10 states), in-person renewals (5 states), and mandatory
road tests (2 states) for older drivers. In addition, all states accept
physician reports and third-party referrals of concerns about drivers,
while 36 states use medical advisory boards to assist licensing
agencies in assessing driver fitness. However, assessment of driver
fitness in all states is not comprehensive because cognitive and
physical functions are generally not evaluated to the same extent as
visual functions. Furthermore, the effectiveness of assessment
practices used by states is largely unknown. For example, research
indicates that in-person license renewal is associated with lower
accident rates for older drivers--particularly for those aged 85 and
older--but vision screening, road tests, and more frequent license
renewal cycles are not always associated with lower older driver
fatality rates. Because there is insufficient evidence on the validity
and reliability of driver fitness assessments, states may have
difficulty discerning which assessments to implement. Recognizing the
need for better assessment tools, NHTSA is developing more
comprehensive practices to assess driver fitness and intends to provide
technical assistance to states in implementing these practices.
A key initiative implemented in five of the six states we visited was
their use of coordination groups to assemble a broad range of
stakeholders--including public agencies, academic institutions, medical
professionals, and partner nongovernmental organizations--to develop
strategies and implement efforts to improve older driver safety.
Specific efforts under way in the states we visited were generally in
areas of strategic planning, education and awareness, licensing and
driver fitness assessment, engineering, and data analysis. Following
are examples:
* Florida promotes education and public awareness through the Florida
GrandDriver® Program that reaches out to older drivers by providing Web-
based information related to driver safety courses and alternative
transportation; provides training to medical, social service, and
transportation professionals on older driver issues; sponsors safety
talks at senior centers; and holds events to help older drivers
determine if they need to make adjustments to better fit in their cars.
* Michigan conducted a demonstration program, funded jointly by state,
county, and local government agencies, along with AAA Michigan, that
made low-cost improvements at over 300 high-risk, signal-controlled
intersections in the Detroit area; an evaluation of 30 of these
intersections indicated that the injury rate for older drivers was
reduced by more than twice as much as for drivers aged 25 to 64 years.
However, according to officials we spoke with in these six states,
knowledge sharing among states on older driver safety practices is
limited, and the general consensus of these officials is that states
could benefit from knowledge of other states' initiatives to address
older driver safety issues. According to these officials, sharing this
information could help them make decisions about whether to implement
new practices and identifying the research basis for practices could
assist them in assessing the benefits to be derived from implementing a
particular practice. To facilitate this transfer of knowledge between
stakeholders in all states, we are recommending that the Secretary of
Transportation implement a mechanism that would allow states to share
information on leading practices for enhancing the safety of older
drivers. This mechanism could also include information on other
initiatives and guidance, such as FHWA's research on the effectiveness
of road design practices and NHTSA's research on more effective driver
assessment practices.
We provided a draft of this report to the Department of Health and
Human Services and to the Department of Transportation for review and
comment. The Department of Health and Human Services agreed with the
report and offered technical suggestions which we have incorporated, as
appropriate. (See app. III for the Department of Health and Human
Services' written comments.) The Department of Transportation did not
offer overall comments on the report or its recommendation. The
department did offer several technical comments, which we incorporated
where appropriate.
Background:
Driving is a complex task that depends on visual, cognitive, and
physical functions that enable a person to:
* see traffic and road conditions;
* recognize what is seen, process the information, and decide how to
react; and:
* physically act to control the vehicle.
Although the aging process affects people at different rates and in
different ways, functional declines associated with aging can affect
driving ability. For example, vision declines may reduce the ability to
see other vehicles, traffic signals, signs, lane markings, and
pedestrians; cognitive declines may reduce the ability to recognize
traffic conditions, remember destinations, and make appropriate
decisions in operating the vehicle; and physical declines may reduce
the ability to perform movements required to control the vehicle.
A particular concern is older drivers with dementia, often as a result
of illnesses such as Alzheimer's disease. Dementia impairs cognitive
and sensory functions causing disorientation, potentially leading to
dangerous driving practices. Age is the most significant risk factor
for developing dementia--approximately 12 percent of those aged 65 to
84 are likely to develop the condition while over 47 percent of those
aged 85 and older are likely to be afflicted. For drivers with the
condition, the risk of being involved in a crash is two to eight times
greater than for those with no cognitive impairment. However, some
drivers with dementia, particularly in the early stages, may still be
capable of driving safely.
Older drivers experience fewer fatal crashes per licensed driver
compared with drivers in younger age groups; however, on the basis of
miles driven, older drivers have a comparatively higher involvement in
fatal crashes. Over the past decade, the rate of older driver
involvement in fatal crashes, measured on the basis of licensed
drivers, has decreased and, overall, older drivers have a lower rate of
fatal crashes than drivers in younger age groups (see fig. 1). Older
drivers' fatal crash rate per licensed driver is lower than
corresponding rates for drivers in younger age groups, in part, because
older drivers drive fewer miles per year than younger drivers, may hold
licenses even though they no longer drive, and may avoid driving during
times and under conditions when crashes tend to occur, such as during
rush hour or at night. However, on the basis of miles traveled, older
drivers who are involved in a crash are more likely to suffer fatal
injuries than are drivers in younger age groups who are involved in
crashes. As shown in figure 2, drivers aged 65 to 74 are more likely to
be involved in a fatal crash than all but the youngest drivers (aged 16
to 24), and drivers aged 75 and older are more likely than drivers in
all other age groups to be involved in a fatal crash.
Figure 1: Drivers in Fatal Crashes per 100,000 Licensed Drivers (1995
to 2005):
[See PDF for image]
Source: GAO analysis of NHTSA and FHWA data.
[End of figure]
Figure 2: Fatal Crashes by Driver Age Group per 100 Million Vehicle
Miles Traveled (2001):
[See PDF for image] - graphic text:
Source: GAO analysis of NHTSA and USDOT data.
Note: 2001 is the most recent year for which age based data on vehicle
miles traveled is available.
[End of figure] - graphic text:
Older drivers will be increasingly exposed to crash risks because older
adults are the fastest-growing segment of the U.S. population, and
future generations of older drivers are expected to drive more miles
per year and at older ages compared with the current older-driver
cohort. The U.S. Census Bureau projects that the population of adults
aged 65 and older will more than double, from 35.1 million people (12.4
percent of total population) in 2000 to 86.7 million people (20.7
percent of total population) in 2050 (see fig. 3).
Figure 3: Population Growth of Adults Aged 65 and Older:
[See PDF for image] - graphic text:
Source: GAO presentation of U.S. Census Bureau data.
[End of figure] - graphic text:
Intersections pose a particular safety problem for older drivers.
Navigating through intersections requires the ability to make rapid
decisions, react quickly, and accurately judge speed and distance. As
these abilities can diminish through aging, older drivers have more
difficulties at intersections and are more likely to be involved in a
fatal crash at these locations. Research shows that 37 percent of
traffic-related fatalities involving drivers aged 65 and older occur at
intersections compared with 18 percent for drivers aged 26 to
64.[Footnote 3] Figure 4 illustrates how fatalities at intersections
represent an increasing proportion of all traffic fatalities as drivers
age.
Figure 4: Fatal Crashes at Intersections by Driver Age (2004):
[See PDF for image] - graphic text:
Source: GAO analysis of NHTSA data.
[End of figure] - graphic text:
DOT--through FHWA and NHTSA--has a role in promoting older driver
safety, although states are directly responsible for operating their
roadways and establishing driver licensing requirements. FHWA focuses
on roadway engineering and has established guidelines for designers to
use in developing engineering enhancements to roadways to accommodate
the declining functional capabilities of older drivers. NHTSA focuses
on reducing traffic-related injuries and fatalities among older people
by promoting, in conjunction with nongovernmental organizations,
research, education, and programs aimed at identifying older drivers
with functional limitations that impair driving performance. NHTSA has
developed several guides, brochures, and booklets for use by the
medical community, law enforcement officials, older drivers' family
members, and older drivers themselves that provide guidance on what
actions can be taken to improve older drivers' capabilities or to
compensate for lost capabilities. Additionally, NIA supports research
related to older driver safety through administering grants designed to
examine, among other issues, how impairments in sensory and cognitive
functions impact driving ability. These federal initiatives support
state efforts to make roads safer for older drivers and establish
assessment practices to evaluate the fitness of older drivers.
The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A
Legacy for Users (SAFETEA-LU),[Footnote 4] signed into law in August
2005, establishes a framework for federal investment in transportation
and has specific provisions for older driver safety. SAFETEA-LU
authorizes $193.1 billion in Federal-Aid Highway Program funds to be
distributed through FHWA for states to implement road preservation,
improvement, and construction projects, some of which may include
improvements for older drivers. SAFETEA-LU also directs DOT to carry
out a program to improve traffic signs and pavement markings to
accommodate older drivers. To fulfill these requirements, FHWA has
updated or plans to update its guidebooks on highway design for older
drivers, plans to conduct workshops on designing roads for older
drivers that will be available to state practitioners, and has added a
senior mobility series to its bimonthly magazine that highlights
advances and innovations in highway/traffic research and technology.
Additionally, SAFTEA-LU authorizes NHTSA to spend $1.7 million per year
(during fiscal years 2006 through 2009) in establishing a comprehensive
research and demonstration program to improve traffic safety for older
drivers.[Footnote 5]
FHWA Has Recommended Practices and Made Funding Available to Make Roads
Safer for Older Drivers, but States Generally Give Higher Priority to
Other Safety Issues:
FHWA has recommended practices for designing and operating roadways to
make them safer for older drivers and administers SAFETEA-LU funds that
states--which own and operate most roadways under state or local
government authority--may use for road maintenance or construction
projects to improve roads for older drivers. To varying degrees, states
are implementing FHWA's older driver practices and developing plans and
programs that consider older drivers' needs. However, responses to our
survey indicated that other safety issues--such as railway and highway
intersections and roadside hazard elimination--are of greater concern
to states, and states generally place a higher priority on projects
that address these issues rather than projects targeted only towards
older drivers.
FHWA Has Recommended Road Design and Operating Practices and Funds
Programs to Improve Older Driver Safety:
FHWA has issued guidelines and recommendations to states on practices
that are intended to make roads safer for older drivers, such as the
Highway Design Handbook for Older Drivers and Pedestrians.[Footnote 6]
The practices emphasize cost-effective construction and maintenance
measures involving both the physical layout of the roadway and use of
traffic control devices such as signs, pavement markings, and traffic
signals.[Footnote 7] The practices are specifically designed to improve
conditions at sites--intersections, interchanges, curved roads,
construction work zones, and railroad crossings--known to be unsafe for
older drivers. While these practices are designed to address older
drivers' needs, implementation of these practices can make roads safer
for all drivers.
* Intersections--Recognizing that intersections are particularly
problematic for older drivers, FHWA's top priority in its Highway
Design Handbook for Older Drivers and Pedestrians is intersection
improvements. Practices to improve older drivers' ability to navigate
intersections include using bigger signs with larger lettering to
identify street names, consistent placement of lane use signs and arrow
pavement markings, aligning lanes to improve drivers' ability to see
oncoming traffic, and using reflective markers on medians and island
curbs at intersections to make them easier to see at night. See figures
5 through 8 for these and additional intersection improvement
practices.
Figure 5: Older Driver Improvements at an Intersection:
[See PDF for image] - graphic text:
Source: GAO.
[End of figure] - graphic text:
Figure 6: Examples of Improved Signs and Ability to See Oncoming
Traffic:
[See PDF for image] - graphic text:
Source: Michigan DOT, FHWA, and GAO.
[End of figure] - graphic text:
Figure 7: Older Driver Improvements at an Intersection with Traffic
Signals:
[See PDF for image] - graphic text:
Source: GAO.
[End of figure] - graphic text:
Figure 8: Examples of Improved Signals and Median Markings:
[See PDF for image] - graphic text:
Sources: Iowa DOT, FHWA, and GAO.
[End of figure] - graphic text:
* Interchanges--Practices to aid older drivers at interchanges include
using signs and pavement markings to better identify right and wrong
directions of travel and configuring on-ramps to provide a longer
distance for accelerating and merging into traffic. See figure 9 for
these and additional interchange improvement practices.
Figure 9: Older Driver Improvements at an Interchange:
[See PDF for image] - graphic text:
Source: GAO.
[End of figure] - graphic text:
* Road curves--Practices to assist older drivers on curves include
using signs and reflective markers--especially on tight curves--to
clearly delineate the path of the road. See figure 10 for these and
additional curve improvement practices.
Figure 10: Older Driver Improvements on Curves:
[See PDF for image] - graphic text:
Source: GAO.
[End of figure] - graphic text:
* Construction work zones--Practices to improve older driver safety in
construction work zones include increasing the length of time messages
are visible on changeable message signs; providing easily discernable
barriers between opposing traffic lanes in crossovers; using properly
sized devices (cones and drums) to delineate temporary lanes; and
installing temporary reflective pavement markers to make lanes easier
to navigate at night.
* Railroad crossings--Practices to help older drivers are aimed at
making the railroad crossing more conspicuous by using reflective
materials on the front and back of railroad crossing signs and
delineating the approach to the crossing with reflective posts. See
figure 11 for these and additional railroad crossing improvement
practices.
Figure 11: Older Driver Improvements at Railroad Crossings:
[See PDF for image] - graphic text:
Source: GAO.
[End of figure] - graphic text:
FHWA is continuing to research and develop practices to make roads
safer for older drivers. FHWA also promotes the implementation of these
practices by sponsoring studies and demonstration projects, updating
its Highway Design Handbook for Older Drivers and Pedestrians, and
training state and local transportation officials. For example, FHWA is
supporting a research study--to be conducted over the next 3 to 5
years--on the effectiveness of selected low-cost road improvements in
reducing the number and severity of crashes for all drivers.[Footnote
8] With the findings of this and other studies, FHWA plans to update
its guidelines to refine existing or recommend new practices in
improving older driver safety. In addition, FHWA is considering changes
to its MUTCD--to be published in 2009--that will enhance older driver
safety by updating standards related to sign legibility and traffic
signal visibility.
Under SAFETEA-LU, FHWA provides funding that states may use to
implement highway maintenance or construction projects that can enhance
older driver safety.[Footnote 9] However, because projects to enhance
older driver safety can be developed under several different SAFETEA-LU
programs, it is difficult to determine the amount of federal funding
dedicated to highway improvements for older drivers. While older driver
safety is generally not the primary focus of projects funded through
SAFETEA-LU programs, improvements made to roads may incorporate
elements of FHWA's older driver safety practices. For example, under
SAFETEA-LU's Highway Safety Improvement Program (HSIP), states submit a
Strategic Highway Safety Plan (SHSP)[Footnote 10] after reviewing crash
and other data and determining what areas need to be emphasized when
making safety improvements. If older driver safety is found to be an
area of emphasis, a state may develop projects to be funded under the
HSIP that provide, for example, improved traffic signs, pavement
markings, and road layouts consistent with practices listed in FHWA's
Highway Design Handbook for Older Drivers and Pedestrians.
Some States Have Implemented FHWA's Recommended Practices and
Considered Older Drivers in Highway Safety Plans and Programs, but
Other Safety Issues Generally Receive Greater Priority:
State DOTs have, to varying degrees, incorporated FHWA's older driver
safety practices into their design standards; implemented the practices
in construction, operations, and maintenance activities; trained
technical staff in applying the practices; and coordinated with local
agencies to promote the use of the practices. The states' responses to
our survey indicate the range in states' efforts.
Design standards. Nearly half of the states have incorporated about
half or more of FHWA's practices into their design standards, as
follows:[Footnote 11]
* 24 state DOTs reported including about half, most, almost all, or all
of the recommendations.
* 20 reported including some of the recommendations.
* 6 reported including few or none of the recommendations.
Construction, operations, and maintenance activities. Even though most
state DOTs have not incorporated all FHWA practices into their design
standards, the majority of states have implemented some FHWA practices
in construction, operations, and maintenance activities, particularly
in the areas of intersections and work zones (see table 1).
Table 1: Most Widely Implemented Practices Recommended by FHWA for
Improving Older Driver Safety:
FHWA practice: Advance "STOP AHEAD," "YIELD AHEAD," and "SIGNAL AHEAD"
signs on approaches to intersections when existing signs or signals are
not visible soon enough for drivers to respond appropriately;
Number of states that have implemented the practice: 51.
FHWA practice: Channelizing devices such as traffic cones, tubular
markers, striped panel signs, drums, or temporary barriers to separate
opposing traffic in construction zones to provide conspicuous and
unambiguous traffic control;
Number of states that have implemented the practice: 48.
FHWA practice: Dashed turn path pavement markings in intersections
where evidence suggests that older drivers may have difficulty
negotiating turns;
Number of states that have implemented the practice: 41.
FHWA practice: Overhead lane control signs at intersections with
traffic signals where drivers may have trouble positioning themselves
in the correct lane;
Number of states that have implemented the practice: 40.
FHWA practice: Reflective devices on medians and island curbs at
intersections to make them more obvious;
Number of states that have implemented the practice: 39.
Source: State DOT responses to GAO survey.
Note: In our questionnaire, we asked state officials whether they had
implemented 14 specific recommendations. Six of those recommendations
were selected from the 136 recommendations found in FHWA's Highway
Design Handbook for Older Drivers and Pedestrians (2001). The 8
remaining recommendations were chosen from the 35 similar
recommendations cited in FHWA's Travel Better, Travel Longer: A Pocket
Guide to Improve Traffic Control and Mobility for Our Older Population
(2003).
[End of table]
Training. Nearly one-fourth of state DOTs have provided training on
FHWA practices to half or more of their technical staff, as follows:
* 12 state DOTs reported having trained about half, most, almost all,
or all of their technical staff.
* 32 have trained some of their technical staff.
* 7 have trained few or none of their technical staff.
Coordination with local agencies. Because state transportation agencies
do not own local roads--which may account for the majority of roads in
a state[Footnote 12]--coordination with local governments is important
in promoting older driver safety in the design, operation, and
maintenance of local roads. The states reported using a variety of
methods in their work with local governments to improve older driver
safety (see table 2).
Table 2: Methods Reported by States for Working with Local Governments
to Improve Older Driver Safety:
Method used: Holding sessions at statewide conferences;
Number of states using method: 38.
Method used: Offering training in road design and traffic control;
Number of states using method: 32.
Method used: Developing programs with the Local Technical Assistance
Program[A] (LTAP);
Number of states using method: 29.
Method used: Developing programs with Metropolitan Planning
Organizations[B] (MPO);
Number of states using method: 21.
Source: State DOT responses to GAO survey.
[A] LTAP is an FHWA program that enables local highway agencies to
access technology designed to help them meet growing demands placed on
local roads, bridges, and public transportation systems. Through LTAP,
a nationwide system of technology transfer centers--placed in locations
such as universities and state highway agencies--has been established
to facilitate information sharing. Sources of funding for LTAP include
FHWA, state DOTs, local agencies, and universities.
[B] An MPO is a transportation policy-making organization made up of
representatives from local government and transportation authorities.
Federal highway and transit statutes require, as a condition for
spending federal highway or transit funds in urbanized areas, the
designation of MPOs that are responsible for planning, programming, and
coordinating federal highway and transit investments.
[End of table]
States also varied in their efforts to consult stakeholders on older
driver issues in developing highway safety plans (defined in the state
SHSP) and lists of projects in their Statewide Transportation
Improvement Programs:
(STIP).[Footnote 13] According to our survey, 27 of the 51 state DOTs
have established older driver safety as a component of their SHSPs, and
our survey indicated that, in developing their SHSPs, these states were
more likely to consult with stakeholders concerned about older driver
safety than were states that did not include an older driver component
in their plans. Obtaining input from stakeholders concerned about older
driver safety--from both governmental and nongovernmental
organizations--is important because they can contribute additional
information, and can sometimes provide resources, to address older
driver safety issues. For example, elderly mobility was identified by
the Michigan State Safety Commission to be an emerging issue and, in
February 1998, funded the Southeast Michigan Council of Governments
(SEMCOG) to convene a statewide, interdisciplinary Elderly Mobility and
Safety Task Force. SEMCOG coordinated with various stakeholder groups-
-Michigan DOT, Michigan Department of State, Michigan Office of Highway
Safety Planning, Michigan Department of Community Health, Office of
Services to the Aging, University of Michigan Transportation Research
Institute, agencies on aging, and AAA Michigan among others--in
developing a statewide plan to address older driver safety and mobility
issues.[Footnote 14] This plan--which outlines recommendations in the
areas of traffic engineering, alternative transportation, housing and
land use, health and medicine, licensing, and education and awareness-
-forms the basis for the strategy defined in Michigan's SHSP to address
older drivers' mobility and safety.
Even though 27 state DOTs have reported establishing older driver
safety as a component of their SHSPs, only 4 state DOTs reported
including older driver safety improvement projects in their fiscal year
2007 STIPs. However, state STIPs may contain projects that will benefit
older drivers. For example, 49 state DOTs reported including funding
for intersection improvements in their STIPs. Because drivers are
increasingly more likely to be involved in an intersection crash as
they age, older drivers, in particular, should benefit from states'
investments in intersection safety projects,[Footnote 15] which
generally provide improved signage, traffic signals, turning lanes, and
other features consistent with FHWA's older driver safety practices.
Although older driver safety could become a more pressing need in the
future as the population of older drivers increases, states are
applying their resources to areas that pose greater safety concerns. In
response to a question in our survey about the extent to which
resources--defined to include staff hours and funds spent on research,
professional services, and construction contracts--were invested in
different types of safety projects, many state DOTs indicated that they
apply resources to a great or very great extent to safety projects
other than those concerning older driver safety (see table 3).[Footnote
16] Survey responses indicated that resource constraints are a
significant contributing factor to limiting states' implementation of
FHWA's older driver safety practices and development of strategic plans
and programs that consider older driver concerns.
Table 3: Types of Safety Projects in Which States Report Investing
Resources to a Great or Very Great Extent:
Type of safety project: Roadside hazard elimination or mitigation
projects;
Number of states investing to a great or very great extent: 36.
Type of safety project: Road intersection safety projects;
Number of states investing to a great or very great extent: 36.
Type of safety project: Safety projects at railway/highway
intersections;
Number of states investing to a great or very great extent: 35.
Type of safety project: Roadway departure projects;
Number of states investing to a great or very great extent: 35.
Type of safety project: Older driver safety projects;
Number of states investing to a great or very great extent: 2.
Source: State DOT responses to GAO survey.
[End of table]
More than Half of States Have Implemented Some Assessment Practices for
Older Drivers, and NHTSA Is Sponsoring Research to Develop More
Comprehensive Assessments:
More than half of state licensing agencies have implemented assessment
practices to support licensing requirements for older drivers that are
more stringent than requirements for younger drivers.[Footnote 17]
These requirements--established under state licensing procedures--
generally involve more frequent renewals (16 states), mandatory vision
screening (10 states), in-person renewals (5 states) and mandatory road
tests (2 states). However, assessment of driver fitness in all states
is not comprehensive because cognitive and physical functions are
generally not evaluated to the same extent as visual function.
Furthermore, the effectiveness of assessment practices used by states
is largely unknown. Recognizing the need for better assessment tools,
NHTSA is developing more comprehensive practices to assess driver
fitness and intends to provide technical assistance to states in
implementing these practices.
Over Half of the States Have More Stringent Licensing Requirements for
Older Drivers, but Assessment Practices Are Not Comprehensive:
Over half of the states have procedures that establish licensing
requirements for older drivers that are more stringent than
requirements for younger drivers. These requirements generally include
more frequent license renewal, mandatory vision screening, in-person
renewals, and mandatory road tests. In addition, states may also
consider input from medical advisory boards, physician reports, and
third-party referrals in assessing driver fitness and making licensing
decisions. (See fig. 12 and app. II for additional details.)
* Accelerated renewal--Sixteen states have accelerated renewal cycles
for older drivers that require drivers older than a specific age to
renew their licenses more frequently. Colorado, for example, normally
requires drivers to renew their licenses every 10 years, but drivers
aged 61 and older must renew their licenses every 5 years.
* Vision screening--Ten states require older drivers to undergo vision
assessments, conducted by either the Department of Motor Vehicles or
their doctor, as part of the license renewal process. These assessments
generally test for visual acuity or sharpness of vision.[Footnote 18]
For example, the average age for mandatory vision screening is 62, with
some states beginning this screening as early as age 40 (Maine and
Maryland) and other states beginning as late as age 80 (Florida and
Virginia).
* In-person renewal--Five states--Alaska, Arizona, California,
Colorado, and Louisiana--that otherwise allow license renewal by mail
require older drivers to renew their licenses in person. Arizona,
California, and Louisiana do not permit mail renewal for drivers aged
70 and older. Alaska does not allow mail renewal for drivers aged 69
and older, while Colorado requires in-person renewal for those over age
61.
* Road test--Two states, New Hampshire and Illinois, require older
drivers to pass road examinations upon reaching 75 years and at all
subsequent renewals.
In addition, states have adopted other practices to assist licensing
agencies in assessing driver fitness and identifying older drivers
whose driving fitness may need to be reevaluated.
* Medical Advisory Boards--Thirty-five states and the District of
Columbia rely on Medical Advisory Boards (MAB) to assist licensing
agencies in evaluating people with medical conditions or functional
limitations that may affect their ability to drive. A MAB may be
organizationally placed within a state's transportation, public safety,
or motor vehicle department. Board members--practicing physicians or
health care professionals--are typically nominated or appointed by the
state medical association, motor vehicle administrator, or governor's
office. Some MABs review individual cases typically compiled by case
workers who collect and review medical and other evidence such as
accident reports that is used to make a determination about a person's
fitness to drive. The volume of cases reviewed by MABs varies greatly
across states. For example, seven state MABs review more than 1,000
cases annually, while another seven MABs review fewer than 10 cases
annually.
* Physician reports--While all states accept reports of potentially
unsafe drivers from physicians, nine states require physicians to
report physical conditions that might impair driving skills. For
example, California specifically requires doctors to report a diagnosis
of Alzheimer's disease or related disorders, including dementia, while
Delaware, New Jersey, and Nevada require physicians to report cases of
epilepsy and those involving a person's loss of consciousness. However,
not all states assure physicians that such reports will be kept
confidential, so physicians may choose not to report patients if they
fear retribution in the form of a lawsuit or loss of the patient's
business.
* Third-party referrals--In addition to reports from physicians, all
states accept third-party referrals of concerns about drivers of any
age. Upon receipt of the referral, the licensing agency may choose to
contact the driver in question to assess the person's fitness to drive.
A recent survey of state licensing agencies found that nearly three-
fourths of all referrals came from law enforcement officials (37
percent) and physicians or other medical professionals (35 percent).
About 13 percent of all referrals came from drivers' families or
friends, and 15 percent came from crash and violation record checks,
courts, self-reports, and other sources.[Footnote 19]
Figure 12: State Licensing Practices Related to Older Driver Safety:
[See PDF for image] - graphic text:
Source: GAO analysis of state licensing procedures.
[End of figure] - graphic text:
However, the assessment practices that state licensing agencies use to
evaluate driver fitness are not comprehensive. For example, our review
of state assessment practices indicates that all states screen for
vision, but we did not find a state with screening tools to evaluate
physical and cognitive functions.[Footnote 20] Furthermore, the
validity of assessment practices used by states is largely unknown.
While research indicates that in-person license renewal is associated
with lower crash rates--particularly for those aged 85 and older--other
assessment practices, such as vision screening, road tests, and more
frequent license renewal cycles, are not always associated with lower
older driver fatality rates.[Footnote 21] According to NHTSA, there is
insufficient evidence on the validity and reliability of any driving
assessment or screening tool. Thus, states may have difficulty
discerning which tools to implement.
NHTSA Is Developing More Comprehensive Practices to Assess Driver
Fitness:
NHTSA, supported by the NIA and by partner nongovernmental
organizations, has promoted research and development of mechanisms to
assist licensing agencies and other stakeholders--medical providers,
law enforcement officers, social service providers, family members--in
better identifying medically at-risk individuals; assessing their
driving fitness through a comprehensive evaluation of visual, physical,
and cognitive functions; and enabling their driving for as long as
safely possible. In the case of older drivers, NHTSA recognizes that
only a fraction of older drivers are at increased risk of being
involved in an accident and focuses its efforts on providing
appropriate research-based materials and information to the broad range
of stakeholders who can identify and influence the behavior of at-risk
drivers.[Footnote 22] Initiatives undertaken by NHTSA and its partner
organizations include:
* Model Driver Screening and Evaluation Program. Initially developed by
NHTSA in partnership with AAMVA and supported with researchers funded
by NIA--the program provides a framework for driver referral, screening
assessment, counseling, and licensing actions. The guidance is based on
research that relates an individual's functional abilities to driving
performance and reflects the results of a comprehensive research
project carried out in cooperation with the Maryland Motor Vehicle
Administration. Recent research supported under this program and with
NIA grants evaluated a range of screenings related to visual, physical,
and cognitive functions that could be completed at a licensing agency
and may effectively identify drivers at an increased risk of being
involved in a crash.[Footnote 23]
* Physician's Guide to Assessing and Counseling Older Drivers.
Developed by the American Medical Association to raise awareness among
physicians, the guide cites relevant literature and expert views (as of
May 2003) to assist physicians in judging patients' fitness to drive.
The guide is based on NHTSA's earlier work with the Association for the
Advancement of Automotive Medicine. This work--a detailed literature
review--summarized knowledge about various categories of medical
conditions, their prevalence, and their potential impact on driving
ability.
* Countermeasures That Work: A Highway Safety Countermeasure Guide for
State Highway Safety Offices. Developed with the Governors Highway
Safety Association, this publication describes current initiatives in
the areas of communications and outreach, licensing, and law
enforcement--and the associated effectiveness, use, cost, and time
required for implementation--that state agencies might consider for
improving older driver safety.[Footnote 24]
* NHTSA Web site. NHTSA maintains an older driver Web site with content
for drivers, caregivers, licensing administrators, and other
stakeholders to help older drivers remain safe.
* NIA research. NIA is supporting research on several fronts in
studying risk factors for older drivers and in developing new tools for
driver training and driver fitness assessment.
- A computer-based training tool is being developed to help older
drivers improve the speed with which they process visual
information.[Footnote 25] This tool is a self-administered interactive
variation of validated training techniques that have been shown to
improve visual processing speed. The tool is being designed as a cost-
effective mechanism that can be broadly implemented, at social service
organizations, for example, and made accessible to older drivers.
- Driving simulators are being studied as a means of testing driving
ability and retraining drivers in a manner that is more reliable and
consistent than on-road testing. Virtual reality driving simulation is
a potentially viable means of testing that could more accurately
identify cognitive and motor impairments than could on-road tests that
are comparatively less safe and more subjective.
- Research is ongoing to evaluate the impacts of hearing loss on
cognitive functions in situations, such as driving, that require
multitasking.[Footnote 26] Results of the research may provide insights
into what level of auditory processing is needed for safe driving and
may lead to development of future auditory screening tools.
- Studies that combine a battery of cognitive function and road/driving
simulator tests are being conducted to learn how age-related changes
lead to hazardous driving. Results of these studies may prove useful in
developing screening tests to identify functionally-impaired drivers--
particularly those with dementia--who are at risk of being involved in
a crash and may be unfit to drive.
NHTSA is also developing guidelines to assist states in implementing
assessment practices. To date, NHTSA's research and model programs have
had limited impact on state licensing practices. For example, according
to NHTSA, no state has implemented the guidelines outlined in its Model
Driver Screening and Evaluation Program. Furthermore, there is
insufficient evidence on the validity and reliability of driving
assessments, so states may have difficulty discerning which assessments
to implement. To assist states in implementing assessment practices,
NHTSA, as authorized under SAFETEA-LU section 2017, developed a plan
to, among other things, (1) provide information and guidelines to
people (medical providers, licensing personnel, law enforcement
officers) who can influence older drivers and (2) improve the
scientific basis for licensing decisions. In its plan NHTSA notes that
the most important work on older driver safety that needs to occur in
the next 5 years is refining screening and assessment tools and getting
them into the hands of the users who need them. As an element of its
plan, NHTSA is cooperating with AAMVA to create a Medical Review Task
Force that will identify areas where standards of practice to assess
the driving of at-risk individuals are possible and develop strategies
for implementing guidelines that states can use in choosing which
practices to adopt. The task force will--in areas such as vision and
cognition--define existing practices used by states and identify gaps
in research to encourage consensus on standards. NHTSA officials said
that work is currently under way to develop neurological guidelines--
which will cover issues related to cognitive assessments--and
anticipate that the task force will report its findings in 2008.
Selected States Have Implemented Coordinating Groups and Other
Initiatives to Promote Older Driver Safety:
Of the six states we visited, five--California, Florida, Iowa,
Maryland, and Michigan--have active multidisciplinary coordination
groups that may include government, medical, academic, and social
service representatives, among others, to develop strategies and
implement efforts to improve older driver safety.[Footnote 27] Each of
these states identified its coordination group as a key initiative in
improving older driver safety. As shown in table 4, the coordinating
groups originated in different ways and vary in size and structure. For
example, Florida's At-Risk Driver Council was formally established
under state legislation while Maryland's group functions on an ad hoc
basis with no statutory authority. The approaches taken by these groups
in addressing older driver safety issues vary as well. For example,
California's large task force broadly reaches several state agencies
and partner organizations, and the task force leaders oversee the
activity of eight work groups in implementing multiple action items to
improve older driver safety. In contrast, Iowa's Older Driver Target
Area Team is a smaller group that operates through informal
partnerships among member agencies and is currently providing
consulting services to the Iowa Department of Transportation on the
implementation of older driver strategies identified in Iowa's
Comprehensive Highway Safety Plan.
Table 4: Older Driver Safety Coordination Groups' Organizations and
Functions:
Coordinating group: Older Californian Traffic Safety (OCTS) Task Force;
Organization and function:
* Established in 2003 under the California Highway Patrol;
* Supported by grants from California Office of Traffic Safety;
* Consists of 8 work groups--(1) aging services, (2) health services,
(3) law enforcement, (4) licensing, (5) mobility, (6)
policy/legislation, (7) public information, (8) transportation safety-
-of interested stakeholders who develop and promote implementation of
action items through the government agency or nongovernmental
organization that they represent;
* Work groups provide progress reports at quarterly OCTS Task Force
meetings;
Membership: 43 members that represent;
* state agencies,;
* federal agencies,;
* higher education institutions,;
* medical professional organizations, and;
* senior advocacy groups and service providers.
Coordinating group: Florida At-Risk Driver Council (FADC);
Organization and function:
* Established by state statute in 2003 and administratively supported
by Department of Highway Safety and Motor Vehicles;
* Chairperson elected by council members;
* FADC members rank issues and establish action items in four areas:
(1) prevention, early recognition, and education of at-risk drivers;
(2) assessments; (3) remediation, rehabilitation, and adaptation--
community and environment; (4) alternatives and accommodations for
transportation;
* Stakeholders implement action items through the government agency or
nongovernmental organization that they represent;
Membership: 33 members that represent;
* state agencies,;
* state legislators,;
* higher education institutions,;
* medical professional organizations, and; * senior advocacy groups and
service providers.
Coordinating group: Iowa Older Driver Target Area Team;
Organization and function:
* Established in 1999 and operated in various forms since then to (1)
coordinate public education and outreach, (2) promote research and
analysis efforts, (3) provide guidance for policy and legislative
considerations, and (4) promote implementation of low cost engineering
safety improvements;
* Team is currently reorganizing under the Iowa Traffic Safety Alliance
to assist in implementing the Iowa Comprehensive Highway Safety
Plan.[A];
Membership: 25 members that represent;
* state agencies,;
* FHWA,;
* higher education institutions, and;
* senior advocacy groups and service providers.
Coordinating group: Maryland Research Consortium;
Organization and function:
* Developed in 1996 under the Motor Vehicle Administration to support
the Maryland Pilot Older Driver Study.[B];
* Established working groups in four areas--(1) identification and
assessment, (2) remediation and counseling, (3) mobility options, (4)
public information and education--that set goals for members to meet
using resources of their respective organizations;
* Currently operates as ad hoc group to promote collaboration among
interested stakeholders;
* Quarterly meetings feature expert presentations on issues such as
medical care for older trauma patients and transportation alternatives
for older adults;
Membership: 250 members (approximate) that represent;
* state agencies,;
* federal agencies,;
* higher education institutions,;
* senior advocacy groups and service providers,;
* private businesses, and;
* interested individuals.
Coordinating group: Michigan Senior Mobility Work Group;
Organization and function:
* Established in 1998 by SEMCOG to conduct an elderly mobility and
safety assessment and develop a statewide plan of action designed to
guide state policy;
* Used U.S. DOT and state funds to develop its plan, Elderly Mobility &
Safety--The Michigan Approach (1999), which outlines recommendations in
the areas of (1) traffic engineering, (2) alternative transportation,
(3) housing and land use, (4) health and medicine, (5) licensing, and
(6) education and awareness;
* Senior Mobility Work Group has continued to update this plan--that
forms the basis for strategy defined in Michigan's SHSP to address
older drivers' mobility and safety--in an advisory capacity to the
Governor's Traffic Safety Advisory Commission;
Membership: 23 members that represent;
* FHWA,;
* state agencies,;
* local agencies, and;
* senior advocacy groups and service providers.
Source: GAO.
[A] The Iowa Comprehensive Highway Safety Plan is the state's SHSP.
[B] This study was conducted under NHTSA's Model Driver Screening and
Evaluation Program.
[End of table]
Members of the coordination groups we spoke with said that their state
could benefit from information about other states' practices. For
example, coordinating group members told us that sharing information
about leading road design and licensing practices, legislative
initiatives, research efforts, and model training programs that affect
older drivers could support decisions about whether to implement new
practices. Furthermore, group members said that identifying the
research basis for practices could help them assess the benefits to be
derived from implementing a particular practice. While some mechanisms
exist to facilitate information exchanges on some topics, such as
driver fitness assessment and licensing through AAMVA's Web site, there
is no mechanism for states to share information on the broad range of
efforts related to older driver safety.
In addition to coordinating groups, the six states have ongoing efforts
to improve older driver safety in the areas of strategic planning,
education and awareness, licensing and driver fitness assessment,
engineering, and data analysis. The following examples highlight
specific initiatives and leading practices in each of these categories.
Strategic planning--Planning documents establish recommended actions
and provide guidance to stakeholders on ways to improve older driver
safety.
* The Michigan Senior Mobility Action Plan, issued in November 2006,
builds upon the state's 1999 plan (Elderly Mobility & Safety--The
Michigan Approach) and outlines additional strategies, discusses
accomplishments, and sets action plans in the areas of planning,
research, education and awareness, engineering countermeasures,
alternative transportation, housing and land use, and licensing
designed to (1) reduce the number and severity of crashes involving
older drivers and pedestrians, (2) increase the scope and effectiveness
of alternative transportation options available to older people, (3)
assist older people in maintaining mobility safely for as long as
possible, and (4) plan for a day when driving may no longer be
possible. In implementing this plan, officials are exploring the
development of a community-based resource center that seniors can use
to find information on mobility at a local level.
* Traffic Safety among Older Adults: Recommendations for California--
developed through a grant from California's Office of Traffic Safety
and published in August 2002--offers a comprehensive set of
recommendations and provides guidance to help agencies and communities
reduce traffic-related injuries and fatalities to older adults. The
Older Californian Traffic Safety Task Force was subsequently
established to coordinate the implementation of the report's
recommendations.
Education/awareness--Education and public awareness initiatives enable
outreach to stakeholders interested in promoting older driver safety.
* Florida GrandDriver®--based on a program developed by AAMVA--takes a
multifaceted approach to public outreach through actions such as
providing Web-based information related to driver safety courses and
alternative transportation; training medical, social service and
transportation professionals; offering safety talks at senior centers;
and sponsoring CarFit events.[Footnote 28] According to the Florida
Department of Highway Safety and Motor Vehicles, a total of 75 training
programs and outreach events were conducted under the GrandDriver
program between 2000 and 2006.
* California--through its Older Californian Traffic Safety Task Force-
-annually holds a "Senior Safe Mobility Summit" that brings subject-
matter experts and recognized leaders together to discuss issues and
heighten public understanding of long-term commitments needed to help
older adults drive safely longer.
Assessment/licensing--Assessment and licensing initiatives are
concerned with developing better means for stakeholders--license
administrators, medical professionals, law enforcement officers, family
members--to determine driver fitness and provide remedial assistance to
help older people remain safe while driving.
* California's Department of Motor Vehicles is continuing to develop a
progressive "three-tier" system for determining drivers' wellness--
through nondriving assessments in the first two tiers--and estimating
driving fitness in a third-tier road test designed to assess the
driver's ability to compensate for driving-relevant functional
limitations identified in the first two tiers.[Footnote 29] The system,
currently being tested at limited locations, is being developed to keep
people driving safely for as long as possible by providing a basis for
a conditional licensing program that can aid drivers in improving their
driving-relevant functioning and in adequately compensating for their
limitations.
* Oregon requires physicians and other designated medical providers to
report drivers with severe and uncontrollable cognitive or functional
impairments that affect the person's ability to drive safely. Oregon
Driver and Motor Vehicle Services (ODMVS) evaluates each report and
determines if immediate suspension of driving privileges is necessary.
A person whose driving privileges have been suspended needs to obtain
medical clearance and pass ODMVS vision, knowledge, and road tests in
order to have his or her driving privileges reinstated. In cases where
driving privileges are not immediately suspended, people will normally
be given between 30 and 60 days to pass ODMVS tests or provide medical
evidence indicating that the reported condition does not present a risk
to their safe driving.
* Maryland was the first state to establish a Medical Advisory Board
(MAB)--created by state legislation in 1947--which is currently one of
the most active boards in the United States. Maryland's MAB manages
approximately 6000 cases per year--most involving older drivers.
Drivers are referred from a number of sources--including physicians,
law enforcement officers, friends, and relatives--and the MAB reviews
screening results, physician reports, and driving records among other
information to determine driving fitness. The MAB's opinion is then
considered by Maryland's Motor Vehicle Administration in making
licensing decisions.
* The Iowa Department of Motor Vehicles can issue older drivers
restricted licenses that limit driving to daylight hours, specific
geographic areas, or low-speed roads. Restricted licensing, also
referred to as "graduated de-licensing," seeks to preserve the driver's
mobility while protecting the health of the driver, passengers, and
others on the road by limiting driving to low risk situations. About
9,000 older drivers in Iowa have restricted licenses. Iowa license
examiners may travel to test older drivers in their home towns, where
they feel most comfortable driving.
Engineering--Road design elements such as those recommended by FHWA are
implemented to provide a driving environment that accommodates older
drivers' needs.
* A demonstration program in Michigan, funded through state, county,
and local government agencies, along with AAA Michigan, made low-cost
improvements at over 300 high-risk, urban, signalized intersections in
the Detroit area. An evaluation of 30 of these intersections indicated
that the injury rate for older drivers was reduced by more than twice
as much as for drivers aged 25 to 64 years.[Footnote 30] The next phase
of the program is development of a municipal tool kit for intersection
safety, for use by municipal leaders and planners, to provide a
template for implementing needed changes within their jurisdictions.
* The Iowa Department of Transportation (IDOT) has undertaken several
initiatives in road operations, maintenance, and new construction to
enhance the driving environment for older drivers. Among its several
initiatives, IDOT is:
- using more durable pavement markings on selected roads and servicing
all pavement markings on a performance-based schedule to maintain their
brightness,[Footnote 31]
- adding paved shoulders with the edge line painted in a shoulder
rumble strip to increase visibility and alert drivers when their
vehicles stray from the travel lane,
- converting 4-lane undivided roads to 3-lane roads with a dedicated
left-turn lane to simplify turning movements,[Footnote 32]
- encouraging the use of more dedicated left turn indications (arrows)
on traffic signals on high-speed roads,
- installing larger street name signs,
- replacing warning signs with ones that have a fluorescent yellow
background to increase visibility,
- converting to Clearview fonts[Footnote 33] on Interstate signs for
increased sign readability,
- demonstrating older driver and pedestrian-friendly enhancements on a
roadway corridor in Des Moines, and:
- promoting local implementation of roadway improvements to benefit
older drivers by providing training to city and county engineers and
planners.
* The Transportation Safety Work Group of the Older Californian Traffic
Safety Task Force provided engineering support in updating California's
highway design and traffic control manuals to incorporate FHWA's
recommended practices for making travel safer and easier for older
drivers. Technical experts from the work group coordinated with the
Caltrans design office in reviewing the Caltrans Highway Design Manual
and updating elements related to older driver safety. Additionally, the
work group managed an expedited process to have the California Traffic
Control Devices Committee consider and approve modifications to signing
and pavement marking standards in the California Manual on Uniform
Traffic Control Devices that benefit older drivers.
Data analysis--Developing tools to accurately capture accident data
enables trends to be identified and resources to be directed to
remediating problems.
* Iowa has a comprehensive data system that connects information from
multiple sources, including law enforcement records (crash reports,
traffic citations, truck inspection records) and driver license and
registration databases, and can be easily accessed. For example, the
system allows law enforcement officers to electronically access a
person's driving record and license information at a crash scene and
enter their crash reports into the data system on-scene. Data captured
through this process--including the location of all crashes--is less
prone to error and can be geographically referenced to identify safety
issues. In the case of older driver safety, several universities are
utilizing Iowa crash data in research efforts. For example, University
of Northern Iowa researchers utilized crash data and geospatial
analysis to demonstrate how older driver crash locations could be
identified and how roadway elements could be subsequently modified to
improve safety for older drivers.[Footnote 34] University of Iowa
researchers have used the data in behavioral research to study actions
of older drivers and learn where changes in roadway geometrics,
signing, or other roadway elements could assist older drivers with
their driving tasks. Also, Iowa State University's Center for
Transportation Research and Education (CTRE) has used the data to study
a number of older driver crash characteristics and supports other older
driver data analysis research projects with the Iowa Traffic Safety
Data Service.[Footnote 35]
* Florida is developing a Mature Driver Database (MDDB) that will
collect several types of data--vision renewal data, crash data, medical
review data--to be accessible through the Department of Highway Safety
and Motor Vehicles (DHSMV) Web site. According to DHSMV officials, this
database is intended to be used across agencies to facilitate strategic
planning. DHSMV may use the database, for example, to track driver
performance on screenings and analyze the effectiveness of screening
methods. Planned MDDB enhancements include providing links to
additional data sources such as census and insurance databases.
Conclusion:
Older driver safety is not a high-priority issue in most states and,
therefore, receives fewer resources than other safety concerns.
However, the aging of the American population suggests that older
driver safety issues will become more prominent in the future. Some
states--with federal support--have adopted practices to improve the
driving environment for older road users and have implemented
assessment practices to support licensing requirements for older
drivers that are more stringent than requirements for younger drivers.
However, information on the effectiveness of these practices is
limited, and states have been reluctant to commit resources to
initiatives whose effectiveness has not been clearly demonstrated. Some
states have also implemented additional initiatives to improve older
driver safety, such as establishing coordination groups involving a
broad range of stakeholders and developing initiatives in the areas of
strategic planning, education and outreach, assessment and licensing
practices, engineering, and data analysis. NHTSA and FHWA also have
important roles to play in promoting older driver safety, including
conducting and supporting research on standards for the driving
environment and on driver fitness assessment. While states hold
differing views on the importance of older driver safety and have
adopted varying practices to address older driver safety issues, it is
clear that there are steps that states can take to prepare for the
anticipated increase in the older driver population and simultaneously
improve safety for all drivers. However, state resources are limited,
so information on other states' initiatives or federal efforts to
develop standards for the driving environment and on driver fitness
assessment practices could assist states in implementing improvements
for older driver safety.
Recommendation for Executive Action:
To help states prepare for the substantial increase in the number of
older drivers in the coming years, we recommend that the Secretary of
Transportation direct the FHWA and NHTSA Administrators to implement a
mechanism that would allow states to share information on leading
practices for enhancing the safety of older drivers. This mechanism
could also include information on other initiatives and guidance, such
as FHWA's research on the effectiveness of road design practices and
NHTSA's research on the effectiveness of driver fitness assessment
practices.
Agency Comments and Our Evaluation:
We provided a draft of this report to the Department of Health and
Human Services and to the Department of Transportation for review and
comment. The Department of Health and Human Services agreed with the
report and offered technical suggestions which we have incorporated, as
appropriate. (See app. III for the Department of Health and Human
Services' written comments.) The Department of Transportation did not
offer overall comments on the report or its recommendation. The
department did offer several technical comments, which we incorporated
where appropriate.
We are sending copies of this report to interested congressional
committees. We are also sending copies of this report to the Secretary
of Transportation and the Secretary of Health and Human Services. We
also will make copies available to others upon request. In addition,
the report will be available at no charge on the GAO Web site at
[Hyperlink, http://www.gao.gov].
If you or your staff have any questions about this report, please
contact me at (202) 512-2834 or s [Hyperlink, siggerudk@gao.gov]
iggerudk@gao.gov. Contact points for our Offices of Congressional
Relations and Public Affairs may be found on the last page of this
report. GAO staff who made major contributions to this report are
listed in appendix IV.
Signed by:
Katherine Siggerud:
Director, Physical Infrastructure Issues:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
This report addresses (1) what the federal government has done to
promote practices to make roads safer for older drivers and the extent
to which states have implemented those practices, (2) the extent to
which states assess the fitness of older drivers and what support the
federal government has provided, and (3) what initiatives selected
states have implemented to improve the safety of older drivers.
To determine what the federal government has done to promote practices
to make roads safer for older drivers, we interviewed officials from
the Federal Highway Administration (FHWA) within the U.S. Department of
Transportation (DOT) and the American Association of State and Highway
Transportation Officials (AASHTO) and reviewed manuals and other
documentation to determine what road design standards and guidelines
have been established, the basis for their establishment, and how they
have been promoted. We also reviewed research and interviewed a
representative of the National Cooperative Highway Research Program
(NCHRP) to gain perspective on federal initiatives to improve the
driving environment for older drivers. Finally, to determine trends in
accidents involving older drivers, we reviewed and analyzed crash data
from the U.S. DOT's Fatality Analysis Reporting System database and
General Estimates System database.
To obtain information on the extent to which states are implementing
these practices, we surveyed and received responses from DOTs in each
of the 50 states and the District of Columbia. We consulted with NCHRP,
FHWA, and AASHTO in developing the survey. The survey was conducted
from the end of September 2006 through mid-January 2007. During this
time period, we sent two waves of follow-up questionnaires to
nonrespondents in addition to the initial mailing. We also made phone
calls and sent e-mails to a few states to remind them to return the
questionnaire. We surveyed state DOTs to learn the extent to which they
have incorporated federal government recommendations on road design
elements into their own design guides and implemented selected
recommendations in their construction, operations, and maintenance
activities. We also identified reasons for state DOTs rejecting
recommendations and determined the proportion of practitioners that
were trained in each state to implement recommendations. In addition,
we asked state DOTs to evaluate the extent to which they have developed
plans (defined in Strategic Highway Safety Plans) and programmed
projects (listed in Statewide Transportation Improvement Programs) for
older driver safety as provided for by SAFETEA-LU legislation.
Before fielding the questionnaire, we reviewed the Safe, Accountable,
Flexible, Efficient Transportation Equity Act: A Legacy for Users
(SAFETEA-LU) and prior highway legislation to identify the framework
for states to develop and implement older driver safety programs.
Additionally, we conducted separate in-person pretests with officials
from three state DOTs and revised our instrument as a result of the
information obtained during those pretests. We took steps in developing
the questionnaire and in collecting and analyzing the data to minimize
errors that could occur during those stages of the survey process. A
copy of the questionnaire and detailed survey results are available at
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-517SP].
To determine the extent to which states assess the fitness of older
drivers and what support the federal government has provided, we
interviewed officials and reviewed relevant documents from the National
Highway Traffic Safety Administration within the U.S. DOT, the National
Institute on Aging and the Administration on Aging within the U.S.
Department of Health and Human Services, and the American Association
of Motor Vehicle Administrators--a nongovernmental organization that
represents state driver licensing agencies. We determined the extent to
which the guidelines and model programs of these agencies addressed the
visual, physical, and cognitive deficits that may afflict older
drivers. We also reviewed federal, state, and nongovernmental Web sites
that contained information on states' older driver licensing practices
and analyzed their content so that we could compare practices across
states. To obtain information on the activities of partner
nongovernmental organizations in researching and promoting practices to
assess older driver fitness, among other initiatives, we interviewed
officials from AAA, AARP, the Insurance Institute for Highway Safety,
and the Governors Highway Safety Association. To learn of states'
legislative initiatives concerning driver fitness assessment and
licensing, we interviewed a representative of the National Conference
of State Legislatures. We also interviewed officials from departments
of motor vehicles in select states to report on their efforts in
developing, implementing, and evaluating older driver screening and
licensing programs.
To obtain information on initiatives that selected states have
implemented, we conducted case studies in six states--California,
Florida, Iowa, Maryland, Michigan, and Oregon--that transportation
experts identified as progressive in their efforts to improve older
driver safety. We chose our case study states based on input from an
NCHRP report highlighting states with leading practices in the areas
of: education/awareness, assessment/licensing, engineering, agency
coordination, strategic planning and data analysis. We compared
practices across the six states to identify common themes. We also
identified and determined, to the extent possible, key practices based
on our analysis.
The scope of our work focused on older driver safety. Prior GAO work
addressed the associated issue of senior mobility for those who do not
drive.[Footnote 36] We conducted our review from April 2006 through
April 2007 in accordance with generally accepted government auditing
standards. We requested official comments on this report from the U.S.
Department of Transportation and the U.S. Department of Health and
Human Services.
[End of section]
Appendix II: States' Licensing Requirements for Older Drivers:
Tables 5 through 7 list older driver licensing requirements in effect
in certain states.
Table 5: States with Vision Testing Requirements for Older Drivers:
State: Arizona;
Vision test and age requirement: 65 and over;
Additional requirements: None.
State: District of Columbia;
Vision test and age requirement: 70 and over;
Additional requirements: At age 70, or nearest renewal date thereafter,
a vision test is required and a reaction test may be required.
Applicant must provide a statement from a practicing physician
certifying the applicant to be physically and mentally competent to
drive. At 75 years, or nearest renewal date thereafter, and on each
subsequent renewal date, the applicant may be required to also complete
the written and road tests.
State: Florida;
Vision test and age requirement: 80 and over;
Additional requirements: Renewal applicants 80 and older must pass a
vision test administered at any driver's license office or if applying
for an extension by mail must pass a vision test administered by a
licensed physician or optometrist.
State: Georgia;
Vision test and age requirement: 64 and over;
Additional requirements: None.
State: Maine;
Vision test and age requirement: 40 and over;
Additional requirements: Vision test required at first renewal after
driver reaches age 40 and at every second renewal until age 62;
thereafter, at every renewal.
State: Maryland;
Vision test and age requirement: 40 and over;
Additional requirements: Vision test required at every renewal from age
40.
State: Oregon;
Vision test and age requirement: 50 and over;
Additional requirements: None.
State: South Carolina;
Vision test and age requirement: 65 and over;
Additional requirements: None.
State: Utah;
Vision test and age requirement: 65 and over;
Additional requirements: None.
State: Virginia;
Vision test and age requirement: 80 and over;
Additional requirements: None.
Source: GAO analysis of data contained in federal, state, and
nongovernmental organizations' Web sites on states' older driver
licensing practices.
[End of table]
Table 6: States with Accelerated Renewal Cycles for Older Drivers:
State: Arizona;
Standard renewal cycle: Expires at age 65;
Accelerated renewal for older drivers with relevant ages: 5 years (65
and over).
State: Colorado;
Standard renewal cycle: 10 years;
Accelerated renewal for older drivers with relevant ages: 5 years (61
and over).
State: Georgia;
Standard renewal cycle: 5 or 10 years (driver option);
Accelerated renewal for older drivers with relevant ages: 5 years (60
and over).
State: Hawaii;
Standard renewal cycle: 6 years;
Accelerated renewal for older drivers with relevant ages: 2 years (72
and over).
State: Idaho;
Standard renewal cycle: 4 years or 8 years (age 21-62);
Accelerated renewal for older drivers with relevant ages: 4 years (63
and over).
State: Illinois;
Standard renewal cycle: 4 years;
Accelerated renewal for older drivers with relevant ages: 2 years (81
to 86); 1 year (87 and over).
State: Indiana;
Standard renewal cycle: 4 years;
Accelerated renewal for older drivers with relevant ages: 3 years (75
and older).
State: Iowa;
Standard renewal cycle: 5 years;
Accelerated renewal for older drivers with relevant ages: 2 years (70
and older).
State: Kansas;
Standard renewal cycle: 6 years;
Accelerated renewal for older drivers with relevant ages: 4 years (65
and older).
State: Maine;
Standard renewal cycle: 6 years;
Accelerated renewal for older drivers with relevant ages: 4 years (65
and older).
State: Missouri;
Standard renewal cycle: 6 years;
Accelerated renewal for older drivers with relevant ages: 3 years (70
and older).
State: Montana;
Standard renewal cycle: 8 years;
Accelerated renewal for older drivers with relevant ages: 4 years (75
and older).
State: New Mexico;
Standard renewal cycle: 4 years or 8 years (driver option);
Accelerated renewal for older drivers with relevant ages: 4 years (for
drivers who would turn 75 in last half of an 8-year cycle).
State: North Carolina;
Standard renewal cycle: 8 years;
Accelerated renewal for older drivers with relevant ages: 5 years (54
and older).
State: Rhode Island;
Standard renewal cycle: 5 years;
Accelerated renewal for older drivers with relevant ages: 2 years (70
and older).
State: South Carolina;
Standard renewal cycle: 10 years;
Accelerated renewal for older drivers with relevant ages: 5 years (65
and older).
Source: GAO analysis of data contained in federal, state, and
nongovernmental organizations' Web sites on states' older driver
licensing practices.
[End of table]
Table 7: States Requiring In-Person Renewals:
State: Alaska;
Age for in-person renewals: 69 and over;
Additional requirements: Mail renewal not available to people 69 and
older and to people whose prior renewal was by mail.
State: Arizona;
Age for in-person renewals: 70 and over;
Additional requirements: It cannot be renewed by mail.
State: California;
Age for in-person renewals: 70 and over;
Additional requirements: At age 70, mail renewal is prohibited. No more
than two sequential mail renewals are permitted, regardless of age.
State: Colorado;
Age for in-person renewals: 61 and over;
Additional requirements: Mail or electronic renewal not available to
people 61 and older and to people whose prior renewal was electronic or
by mail.
State: Louisiana;
Age for in-person renewals: 70 and over;
Additional requirements: Mail renewal not available to people 70 and
older and to people whose prior renewal was by mail.
Source: GAO analysis of data contained in federal, state, and
nongovernmental organizations' Web sites on states' older driver
licensing practices.
[End of table]
[End of section]
Appendix III: Comments from Department of Health and Human Services:
Office of the Assistant Secretary for Legislation:
Department Of Health & Human Services:
Washington, D.C. 20201:
Mar 10 2007:
Ms. Katherine Siggerud:
Director, Physical Infrastructure Issues:
U.S. Government Accountability Office:
Washington, DC 20548:
Dear Ms. Siggerud:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's (GAO) draft report entitled, "Older Driver
Safety: Knowledge Sharing Should Help States Prepare for Increase in
Older Driver Population" (GAO-07-413), before its publication.
The department appreciates the opportunity to comment on this daft
report.
Sincerely,
Signed by:
Vincent J. Ventimiglia:
Assistant Secretary for Legislation:
General Comments On The Department Of Health And Human Services On The
Government Accountability Office Draft Report Entitled: Older Driver
Safety: Knowledge Sharing Should Help States Prepare Or Increase In
Older Driver Population (GAO 07-413):
HHS Comments:
As indicated in this report, older driver safety is important now,
since based on miles driven older drivers have a comparatively higher
involvement in fatal crashes; and it is important for planning for the
future, since by 2030 the number of licensed drivers 65 and older is
estimated to nearly double.
This report provides a focus on two critical priority issues: what the
states need to do to improve highway safety and adoption of screening
practices for older drivers. The report covers what the federal
government has done to promote older driver safety through practices
related to road construction and highway signage, especially relating
to intersections; and what the states have done to implement these
practices and what initiatives they have undertaken either specifically
targeted at older drivers or as a product of safety measures for
drivers of all ages. The report also provides much useful information
about older driver assessment practices across a number of states.
There is a recommendation for executive action by the Secretary of
Transportation to implement a mechanism to allow states to share
information on leading practices for enhancing the safety of older
drivers. We would also suggest that other issues to be addressed are
the transition out of driving by assisting older adults with the
decision to stop driving; and how communities can best provide viable
alternative forms of transportation enabling older adults to maintain
optimal autonomy.
This a well conceptualized and executed report on current state
practices and federal initiatives which will provide a sound foundation
for identifying and implementing measures that will enhance the safety
of older drivers.
[End of section]
Appendix IV: GAO Contact and Staff Acknowledgments:
GAO Contact:
Katherine Siggerud, (202) 512-2834, or siggerudk@gao.gov:
Staff Acknowledgments:
In addition to the individual named above, Sara Vermillion, Assistant
Director; Michael Armes; Sandra DePaulis; Elizabeth Eisenstadt; Joel
Grossman; Bert Japikse; Leslie Locke; Megan Millenky; Joshua Ormond;
and Beverly Ross made key contributions to this report.
(542091):
FOOTNOTES
[1] This report generally refers to survey responses from the 50 states
and the District of Columbia as "states' responses."
[2] GAO, Transportation Disadvantaged Seniors: Efforts to Enhance
Senior Mobility Could Benefit from Additional Guidance and Information,
GAO-04-971 (Washington, D.C.: Aug. 30, 2004).
[3] Hauer, E., "The Safety of Older Persons at Intersections."
Transportation in an Aging Society, vols. 1 and 2, Special Reports 218.
Transportation Research Board. (Washington, D.C.: 1988).
[4] Pub. L. No. 109-59, 119 Stat. 1144 (2005).
[5] Section 1405 of SAFETEA-LU directs DOT to carry out a program to
improve traffic signs and pavement markings to accommodate older
drivers and authorizes to be appropriated such sum as may be necessary
to carry out this section for the fiscal years 2005 through 2009. No
funds have been specifically appropriated for this purpose, and FHWA
officials indicated that they are using limited available program funds
to satisfy the intent of the legislation. Section 2017 of SAFETEA-LU
authorizes NHTSA's research and demonstration program.
[6] Practices are based on guidelines and recommendations published in
three FHWA documents: Highway Design Handbook for Older Drivers and
Pedestrians (2001); Guidelines and Recommendations to Accommodate Older
Drivers and Pedestrians (2001); and Travel Better, Travel Longer: A
Pocket Guide to Improve Traffic Control and Mobility for Our Older
Population (2003). FHWA researched and developed its guidelines and
recommendations in collaboration with highway engineering experts from
the American Association of State Highway and Transportation Officials-
-a nonprofit association representing highway and transportation
departments in the United States and Puerto Rico; the National
Committee on Uniform Traffic Control Devices--a group that makes
recommendations to FHWA on standards codified in the Manual on Uniform
Traffic Control Devices; and the Transportation Research Board--a
division of the National Research Council which serves as an
independent adviser to the federal government to promote innovation and
progress in transportation through research.
[7] FHWA issues national standards for traffic control devices in its
Manual on Uniform Traffic Control Devices (MUTCD). States are required
by federal code to adopt the federal MUTCD or adopt a state MUTCD that
is in substantial compliance with FHWA's MUTCD within 2 years of FHWA
issuing a new edition or revision. Of the 136 recommendations in FHWA's
Highway Design Handbook for Older Drivers and Pedestrians (2001), 43
relate to traffic control devices and are included in the current
edition (2003) of the federal MUTCD. FHWA does not issue geometric road
design standards for the layout of roads. Rather, FHWA works with
states and other transportation industry groups to establish national
geometric road design standards, and state transportation officials
then rely on those standards in developing their own road design
standards.
[8] The study is being supported by funds "pooled" from multiple
sources to investigate 20 selected strategies described in the National
Cooperative Highway Research Program (NCHRP) Report 500 guidebooks. The
NCHRP Report 500 is a series of guides being developed by the
Transportation Research Board to assist state and local agencies in
reducing injuries and fatalities in targeted areas, such as older
drivers. Each guide includes a general description of the problem,
strategies and countermeasures to address the problem, and a model
implementation process; however, not all strategies in the guides have
been proven through properly designed evaluations. Most roadway and
engineering strategies highlighted in the NCHRP Report 500 (Volume 9: A
Guide for Reducing Collisions Involving Older Drivers) also appear in
FHWA's Highway Design Handbook for Older Drivers and Pedestrians. The
goal of the research is to develop reliable estimates of the
effectiveness of safety improvements identified in the NCHRP Report 500
guidebooks in locations where these strategies are being implemented.
[9] SAFETEA-LU provides funding for many types of projects under
programs such as the Interstate Maintenance Program, the Surface
Transportation Program, and the National Highway System Program. These
programs have set requirements as to the types of roads that are
eligible for project funding and the purposes for which the funds can
be used.
[10] SAFETEA-LU requires each state receiving funds under the HSIP to
develop a SHSP that identifies safety problems and analyzes
opportunities for corrective action. SHSPs are to be based on a system
that collects crash data, identifies problems, and analyzes
countermeasures that can be implemented. By October 1, 2006, each state
was to have a strategic highway safety plan and, as of January 8, 2007,
FHWA reports having received SHSPs from 28 states.
[11] Fifty states and the District of Columbia responded to the survey.
One state did not respond to this question.
[12] According to FHWA Highway Statistics (2005), states own, on
average, 19 percent of public roads, while local agencies own 76
percent of public roads nationwide. However, ownership varies
considerably by state. For example, Iowa owns 7.8 percent of the public
roads in the state, while West Virginia owns 91.8 percent.
[13] In cooperation with other units of government, each state produces
a STIP that describes those projects that will be implemented over (at
least) the following 4 years. The STIP includes all projects or phases
of transportation project development that will use federal
transportation funds and includes all regionally significant
transportation projects requiring federal approval or permits (even if
no federal funds are to be used in the construction). The type of
information provided for each project in the STIP includes the project
description, estimated cost, amount and category of federal funds to be
used, amount and source of nonfederal funds to be used, and the agency
responsible for project implementation.
[14] See J.T. Bruff and J. Evans, Elderly Mobility and Safety--The
Michigan Approach, Final Plan of Action. SEMCOG. (Detroit: 1999).
[15] FHWA safety analysts have recently analyzed the results of several
studies on intersection improvements implemented in Iowa, Michigan, and
overseas in France. In general, FHWA found that intersection
improvements have an even greater benefit, in terms of reduced crashes,
for older drivers than for younger drivers.
[16] Under the HSIP in SAFETEA-LU, 21 types of projects can be funded,
including safety projects for high-risk rural roads, railway/highway
crossings, work zones, collection and analysis of crash data, roadside
obstacle elimination, pedestrian, bicycle intersections and others. Our
survey asked to what extent state DOTs had invested resources in a
selection of safety projects (from the HSIP), older driver safety
projects (from the Roadway Safety Improvements for Older Drivers and
Pedestrians program), and projects to create safe routes to schools
(from the Safe Routes to School program).
[17] To obtain information on states' licensing requirements, we
reviewed federal, state, and nongovernmental Web sites that contained
information on states' older driver licensing laws and analyzed their
content so that we could compare practices across states.
[18] Visual acuity measures the clarity or sharpness of vision. The
test for visual acuity measures how clearly a person can see from a
distance, and results are expressed in a fraction such as 20/20. The
top number refers to the distance the person being tested stands from
the chart--usually 20 feet. The bottom number indicates the distance at
which a person with normal eyesight could read the same line that the
person being tested correctly read. For example, 20/20 is considered
normal, and a 20/40 measure indicates that the line the person being
tested correctly read at 20 feet can be read by a person with normal
vision from 40 feet away.
[19] Stutts, J.C., Improving the Safety of Older Road Users. National
Cooperative Highway Research Program Synthesis Project 20-5, Synthesis
Topic 35-10. (Washington, D.C.: Transportation Research Board, 2005).
[20] All states require vision testing, and visual acuity of 20/40 or
better (corrected or uncorrected) in one eye alone is typically needed
in order to obtain a license.
[21] See David Grabowski, Christine Campbell, and Michael Morrisey,
"Elderly Licensure Laws and Motor Vehicle Fatalities," Journal of the
American Medical Association 291 (2004): 2,840-2,846.
[22] While outside the purview of this report, NHTSA is also conducting
vehicle-related research efforts on older driver safety, including
crashworthiness research to develop more effective restraints for older
occupants.
[23] Karlene K.Ball et al., "Can High-Risk Older Drivers Be Identified
through Performance-Based Measures in a Department of Motor Vehicles
Setting?" Journal of the American Geriatrics Society 54 (2006): 77-84.
[24] The Governors Highway Safety Association (GHSA) is a nonprofit
association representing state highway safety offices that promotes the
development of policy and programs to improve traffic safety. GHSA
members are appointed by their governors to administer federal and
state highway safety funds and implement state highway safety plans.
[25] As people age, their speed of visual processing, or ability to
recognize what they see, diminishes. Previous NIA-sponsored research
shows that reduced visual processing speed--determined through a
measure termed "useful field of view"--increases the crash risk for
older drivers. (See Owsley, C. et al., "Visual Processing Impairment
and Risk of Motor Vehicle Crash Among Older Adults," Journal of the
American Medical Association 279, vol. 14 [1998].)
[26] Hearing impairment, common among older adults, compromises
cognitive functions in that attention is diverted away from other tasks
to focus on auditory processing.
[27] Oregon, the remaining state we visited, previously had an At-Risk
Driver Public Education Consortium to coordinate a pubic education
initiative addressing older driver safety among other issues.
Consortium members represented state agencies, public transit
districts, senior service providers, and other stakeholders. The
consortium was disbanded in 2003.
[28] The CarFit program is designed to help mature drivers find out how
well they currently fit their cars and what actions they might take to
improve their fit. The program is a joint venture by the American
Occupational Therapy Association, the American Society on Aging, AAA
Auto Club, and AARP.
[29] The three-tier system addresses the driving-related medical
problems and functional limitations that occur most often among older
drivers but also occur among younger drivers. A driving wellness
assessment that includes evaluation of a person's functional health
relevant for driving, understanding of driving practices, and knowledge
of laws and rules of the road is the focus of the first two tiers. The
tiers are progressive in that a person who successfully passes the
first-tier assessment and knowledge test will not be assessed further.
A driving fitness assessment that evaluates how a driver actually
drives with his/her functional limitations is the focus of the third
tier.
[30] AAA, Intersection Improvements Reduce Senior Driver Injuries at a
Rate Much Higher Than Other Age Groups, According to AAA Study
(Washington, D.C.: 6/27/2005).
[31] Iowa based its strategy to improve pavement marking visibility on
research conducted by the University of Iowa Center for Computer Aided
Design, Operator Performance Laboratory. The research report "Enhancing
Pavement Marking Visibility for Older Drivers" was prepared for IDOT in
March 2003.
[32] Having a dedicated left-turn lane simplifies left-turn movements
onto and off of the mainline. Iowa State University researchers studied
14 of these converted corridors and documented a 24 percent reduction
in the crash rate for all drivers and a 28 percent reduction in the
crash rate for drivers aged 65 and older.
[33] FHWA has given interim approval for states to use Clearview font
legends (lettering) on guide signs. Clearview fonts were designed to
make highway signs easier for older drivers to read without having to
increase letter height or sign size.
[34] Strauss, Tim and Elder, Jess, "Crash Patterns of Older Drivers in
Iowa: A Systematic Spatial Analysis," University of Northern Iowa, July
2004. This report was funded by the Iowa Department of Transportation.
[35] The Iowa Traffic Safety Data Service is a program of the CTRE that
produces crash data analyses for use by traffic engineers, researchers,
law enforcement officials, and others who need the information for
purposes such as making funding decisions, developing road improvement
projects, and implementing enforcement actions.
[36] GAO-04-971.
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