University of Washington School of Public Health

UW SPH News: Older Drivers When Should They Give Up the Car Keys?

Older Drivers When Should They Give Up the Car Keys?


It’s as if Lake Wobegon issued all the drivers’ licenses – nearly everyone thinks he or she is an “above-average” motorist.

But statistics show that with increasing age, some drivers fail to grasp when they slip from “above” to below or even well-below-average, says PhD student Laura Fraade-Blanar of the University of Washington School of Public Health.

Laura Fraade-Blanar

Fraade-Blanar, a Department of Health Services student based at the Harborview Injury Prevention and Research Center, is trying to identify the point of cognitive decline at which driving becomes too risky. “We haven’t given families good ways to talk about this,” she says.

Why focus on older drivers?

With the aging of the baby boomer generation, older drivers are increasing in sheer numbers, and due to advances in health care, they’re staying on the road a lot longer. By 2024, it is estimated that one of every four drivers will be over 65. This is a huge group, and consequently a highly important group in terms of driving injury statistics.

What risk do they pose?

These older drivers are higher risk in some ways, but not in others. Many willingly limit their driving and avoid potentially dangerous driving situations such as driving at night, on high-speed highways, or in poor weather conditions, but they may also have changes in their driving ability due to diminished physical range of movement (e.g. ability to move the head to check blind spots) or cognitive state, which can affect reaction time and spatial awareness.

Changes in declining eyesight or medication can also affect crash risk. Unfortunately, it can be difficult for older drivers (or drivers of any age), to recognize the need to limit their driving or give up the keys.

It must be hard to give up that independence and freedom.

Many studies have shown that stopping driving can lead to depression, decreased life satisfaction, or early entry into nursing homes. Unfortunately, if older adults crash – and they have one of the highest crash rates in terms of vehicle-miles driven – it can be significantly more debilitating than for younger drivers, resulting in longer hospital stays, longer rehabilitation, or death. And of course they may also crash into someone else.

We haven’t given families good ways to talk about this. In my own family, when my father had to tell his mother it was time for her to give up her keys, it was one of the hardest talks they ever had. To this day, he knows how distraught she was. But it was just too dangerous both for her and others, to be on the road any longer. Her experience is not unique – every time I discuss my research with people, in professional or social settings, they always have a story about their grandfather, their mother, their aunt, etc. It reminds me of how this issue is far-reaching, but at the same time, deeply personal.

Tell us a bit about your research.

I’m doing three studies as part of my dissertation. The first uses data from the Adult Changes in Thought study at Group Health led by Drs. Paul Crane and Eric Larson. It follows individuals and their cognition over time. We will merge that with crash and licensure records from WA state and look at crash risk and ask: Is there a point we can identify at which driving becomes too risky?

The second study uses a data set from Dr. Ryan Hansen of the UW School of Pharmacy and Group Health. We’re looking at crash risk for individuals with dementia versus those without dementia. A secondary goal examines if anything be done to lessen the crash risk once a driver has dementia. Could driving with a friend or family member in the car help by providing an extra set of eyes? Are older drivers maintaining their cars in adequate working condition? Are they crashing more often turning to the right or the left? The goal with these two studies is to provide guidance to care providers, individuals with dementia, and families, with an aim of maximizing autonomy, mobility, and social engagement while managing and minimizing crash risk.

The third study looks at seniors who are active in the workforce. We are looking at data from the Health and Retirement Study from the University of Michigan and the overall risk of occupational injury for individuals over age 50. The study aims to assess how occupational injury risk among older workers is affected by health, cognition, hearing, sight, job demands, and age. My analysis informs how job demands and workers’ ability to meet those demands, based on their health and understanding of said demands, impact risk of occupational injury.

Overall, my research aims to preserve the self-sufficiency and health of older adults.