Medical conditions, medications, and physiologic changes from aging can affect driving ability.¹ Driving safety, self-regulation, and cessation are issues many older adults eventually face.² Family and physicians may influence driving decisions, depending on their availability and involvement and the older adult’s counseling preferences.^3–5

Prior research showed that drivers aged ≥50 years preferred discussing driving with family versus non-family.⁶ In another driving survey, 64% of community-dwelling older adults were open to family discussion but fewer to family (32%) or physicians (44%) making driving cessation decisions.⁷ How much interaction older adults have with family often determines their comfort with family involvement in driving decisions.⁸

Yet healthcare providers also play key roles in driving safety and cessation.¹ One study found that married older adults preferred hearing first from their spouse and adult children but also desired conversations with their physician.⁶ Those indicating physicians as first choice believed the physician could judge their driving capabilities. However, the study’s physician participants were reluctant to partake in driving decisions. Many physicians report assessing driving fitness or discussing driving with their older patients, but only with some patients and not frequently with each of them.^1,9 A retrospective medical record review documented that physicians discussed driving with only 8–22% of patients within a 12-month period.¹⁰

The LongROAD study, a multi-site longitudinal cohort study of older drivers, offers opportunities to examine the prevalence of driving discussions with family and providers in a larger sample than prior work. Understanding the frequency of such discussions and the demographic and driving characteristics associated with them may enhance communication strategy development and refinement.

Of 2,990 total LongROAD participants, approximately half were female and 65–69 years old; most were White and non-Hispanic. A majority were married and had household incomes ≥$50,000 yearly and Bachelor’s degrees or higher (Table 1). Overall, 337 participants (11.3%) reported driving reduction due to a health problem in the past year. Only 2.2% reported that, in the past year, someone had recommended limiting their driving.

Overall, 17.3% of participants reported ever having driving discussions with family or physicians. They were more likely to have spoken with family (14.2%; Table 1) than physicians (5.5%). Seventy-four participants (2.5%) had conversations with both. Similar patterns manifested across gender and age. Men and those aged 75–79 years (versus younger age groups) were significantly more likely to speak with family (Table 1). Most family conversations were initiated by family (60.6%), while most physicians conversations were initiated by older drivers (55.0%). When asked what triggered a family discussion, most said driving safety concerns (64.8%), followed by health issue (22.3%), driving infraction (8.7%), and crash (8.7%). Patterns were similar across gender and age (data not shown).

Common outcomes of physician discussions were medical or physical assessment (41.8%), education or advice (38.2%), follow-up visits to monitor health concerns (32.2%), and medical treatment (29.0%; Figure 1). Few reported referrals for driving assessment to a licensing bureau (3.6%) or occupational therapist (2.4%). Nearly one-quarter (22.5%) said no action resulted from these conversations.

Driving discussions with family were significantly associated with demographic characteristics (Table 2). Men, participants with Master’s degrees and higher (versus less than Bachelor’s degrees), and those who reduced driving for self-regulatory reasons in the past year were more likely to have driving conversations with family as well as those with lower self-rated driving ability, higher strategic self-regulation (i.e., pre-trip decisions attributed to self-regulation), and more driving errors or violations. Similar characteristics were associated with having driving discussions with physicians (Table 2).

In the large LongROAD cohort of older drivers, most had not discussed driving with their family or physician. Conversations that did occur were more common with family than with physicians, perhaps reflecting the relatively good health of participants. Few older drivers having physician discussions were referred for driving assessment.

Older drivers who anticipate and prepare for driving cessation experience better health outcomes, emphasizing the benefits of advance planning.³ Yet few participants had discussed driving safety with family or physicians, which is consistent with past research and may reflect avoidance of this sensitive subject¹³ or unawareness that many older adults are unable to drive for the last years of life.² Physicians in particular may believe that conversations about driving safety adversely affects patient-physician relationships, especially when they include recommendations for driving cessation.^14–16 Physicians may also feel they lack training or resources regarding driving assessments, licensing laws, or linkages to older driver testing or education programs.^17,18 Yet physicians do have obligations to protect patient and public safety,¹⁹ and available resources can help them with these difficult situations.^1,20

Participants were twice as likely to discuss driving safety with family as with physicians. While some resources exist to help physicians address this topic in clinical settings,¹ there are fewer available for families, who may also benefit from public awareness campaigns and education.^13,21 Also, physicians should pay special attention to older adults who are widowed, single, or without family, since this population may not have social support in driving matters.

Driving discussions with family were more likely to occur when participants were male and more educated. Gender-related findings may reflect that, similar to past studies, men may want to maintain a traditional provider role and continue driving later in life (hence prompting family discussions), while women are willing to relinquish driving earlier.²² Gender was not associated with physician conversations, but those with higher education and who self-restricted their driving often discussed driving safety with physicians. Generally, previous research shows physicians and older drivers tend not to initiate driving conversations until specific “red flags,” (e.g., crashes) manifest.⁸ Circumstances of conversation initiation with physicians were not considered in the LongROAD study and should be examined in future research.

Very few participants had driving discussions resulting in referral for driving assessment. Such evaluations are often unavailable, though they are often recommended and useful.²³ Creating and testing triage tools to identify older adults who may benefit from driving assessments is vital, as reliable tests or combinations of tests have not yet been identified.²⁴ Physicians desire simple protocols to screen older drivers so developing such resources may help them to properly address older adult driving in clinical settings.^17,25

In this study, most older adults did not report past driving discussions with family or physicians. Family and physicians may benefit from resources that address driving safety in the older population. Future interventions should utilize health education techniques targeting both families and physicians to raise awareness and provide information about this impending issue so they might knowledgeably participate in maintaining and improving older adults’ quality of life.