Behind the Wheel: Unveiling the Cognitive Dynamics of Safe Driving

Most people get their first driver's license when they are teenagers. By midlife, driving has become an automatic task for many of us. Yet, it is anything but automatic. 

In the United States, more than 11,200 people will celebrate their 65^th birthdays every day between 2024 and 2027.¹ Most drivers retain their driver’s licenses as they grow older. For many older adults, driving is essential to their independence and one of the most critical factors in overall mobility.² 

A recent study reported that older drivers commit fewer moving violations and crash less frequently in absolute terms but have higher crash rates per distance driven than younger drivers. Notably, the rate of fatal crashes by older drivers is 40% higher than that of younger drivers.^3-5 

Read on to explore the complexities of driving as we age, learn how driving ability changes, and recognize the warning signs that an older adult might need a driving evaluation to remain safe on the road. 

Driving is a Complex Task

The ability to drive a car rests on a foundation of many overlapping abilities. Safe and successful driving requires that drivers integrate physical, perceptual, and cognitive skills. 

• ‍Physically, drivers must possess essential motor skills for steering, braking, and accelerating. Flexibility, fine motor coordination, mobility, and timing are also required. These skills must be integrated seamlessly under rapidly changing conditions. 
  

• Driving takes place in a constantly changing and sometimes unpredictable environment. Drivers must continuously monitor and evaluate road conditions, traffic signals, pedestrians, and other vehicles, all while controlling the car’s direction and speed. They must also be ready to respond to unexpected changes, stay within the bounds of their lane, and accurately judge their vehicle’s position relative to other objects and lanes within the driving environment.⁶ Adequate vision and hearing are essential for the safe operation of a motor vehicle. 
  

• ‍Cognitively, drivers must be able to sustain attention for the duration of the journey yet also divide their attention among tasks like monitoring the road, checking mirrors, and operating vehicular controls. Situational awareness and quick reaction time are necessary to adapt to sudden changes in traffic and other road conditions. Drivers must make quick decisions and solve problems based on changing road conditions, weather, lighting, traffic patterns, and potential hazards.
  

This combination of physical, perceptual, and cognitive demands, set against the potentially devastating consequences of even a brief lapse in attention or judgment, underscores the complex and possibly hazardous nature of driving. 

How Driving Skills Change with Age

• Physically, older adults often contend with reduced flexibility and limitations on their range of motion and possibly with less strength. These changes make it harder to respond quickly, to check blind spots, and to exert the strength needed for vehicular operations.

• Visually, older adults may develop problems with depth perception and night vision, especially glare.

• Even mild hearing loss can make hearing sirens, honking horns, or other auditory cues while behind the wheel harder. 

• Cognitively, older drivers also face an array of challenges. As noted, sustained attention requires more effort and problem-solving, and reaction times get slower with age. 
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• With aging often come medical conditions and medications that can impair driving. Osteoarthritis limits strength and range of motion; diabetes can cause both hypo- and hyperglycemia, leading to weakness and blurry vision; abnormal heart rhythms may lead to fainting; and sleep disorders increase fatigue while slowing reaction times. Medication side effects can also cause drowsiness, confusion, and poor coordination. 
  
  

Older people often respond to these changes by avoiding driving at night, in the rain, or on highways. In some cases, this is an adaptive response, but in other cases, it can indicate the need for an older adult driving evaluation. 

How Do I Know If I Need a Driving Evaluation?

Think back over the recent history of your driving. Have you noticed a tendency to drift out of your lane, to follow other cars too closely, or to drive slower or faster than the posted speed limit? Have you gotten multiple traffic tickets or warnings? Have you confused the brake and gas pedals? Have you gotten lost in areas that should have been familiar to you, or do you need help explaining why it takes you a long time to complete a simple errand? Does your car have unexplained dings and dents? Do family or friends tell you they worry that your driving is unsafe? These situations could indicate the need for an older adult driving evaluation. 

There are other, less obvious, warning signs, too. 

Obtaining a below-threshold score on a standardized cognitive screening test can indicate the need for a driving evaluation; for some tests, specific recommendations for a driving evaluation are attached to below-normal scores, although not all sources agree that this is adequate.^7,8 An evaluation is in order if your scores on thinking tests of attention, reaction time, and visual-spatial skills are below average. And, if you or your loved ones have become concerned about your driving ability, this is one of the strongest indicators that a driving evaluation is needed.⁷  

As of this writing, neither Medicare nor private insurers cover older adult driving evaluations. The cost varies, often according to geography. Typical costs fall between a couple hundred to more than $500. 

The goal of an older adult driving evaluation is safety for all drivers on the road. NEVER is the goal to deprive someone of their driving license. Occupational therapists typically perform the assessment and are frequently able to describe modifications that can help keep someone driving safely—like limiting driving to daylight hours or avoiding interstate driving. When driving can no longer be accomplished safely, alternative transportation options can be explored. 

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Do you have another question that the Sunday Health brain health experts can answer? We invite you to send your questions to hello@sundayhealth.com.

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Sources

1. https://www.protectedincome.org/peak65/?gad_source=1&gclid=Cj0KCQjwxqayBhDFARIsAANWRnSnRWs_TAc8JDHdUK8q6AcCFB5wRUvq8vLm2I_WuMXxGE5doOAV8HYaAgRxEALw_wcB
2. Toups R, Chirles TJ, Ehsani JP, Michael JP, Bernstein JPK, Calamia M, Parsons TD, Carr DB, Keller JN. Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety. Innov Aging. 2022 Jan 7;6(1):igab051.
3. Salvia E, Petit C, Champely S, Chomette R, Di Rienzo F, Collet C. Effects of Age and Task Load on Drivers' Response Accuracy and Reaction Time When Responding to Traffic Lights. Front Aging Neurosci. 2016 Jul 12;8:169.
4. Palumbo AJ, Pfeiffer MR, Metzger KB, Curry AE. Driver licensing, motor-vehicle crashes, and moving violations among older adults. J Safety Res. 2019 Dec;71:87-93.
5. Fabrigoule C, Lafont S. Conduite automobile, vieillissement cognitif et maladie d'Alzheimer [Car driving, cognitive aging and Alzheimer disease]. Presse Med. 2015 Oct;44(10):1034-41. French.
6. Lundqvist LM, Eriksson L. Age, cognitive load, and multimodal effects on driver response to directional warning. Appl Ergon. 2019 Apr;76:147-154. doi: 10.1016/j.apergo.2019.01.002. Epub 2019 Jan 8.
7. Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M; Quality Standards Subcomittee of the American Academy of Neurology. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010 Apr 20;74(16):1316-24.
8. Adler G, Rottunda S, Dysken M. The older driver with dementia: an updated literature review. J Safety Res. 2005;36(4):399-407.