Around the world, there’s a hodgepodge of rules determining whether the transportation authorities can extend the driver’s license of a senior citizen. Often, the driver needs an eye examination; in other cases, the person’s physical and mental health has to be assessed. A family physician may know too little to recommend or oppose a driver’s license renewal.
The car is a symbol of independence, a normal life, and the ability to “manage on one’s own.” According to data from Israel’s Central Bureau of Statistics, over 150,000 Israelis aged 75 and older hold a driving license; when including the 65-to-74 age bracket, the total exceeds 680,000 licensed drivers. Senior citizens account for about 13.8% of all licensed drivers nationwide. However, these figures don’t indicate how many are actually driving, even though they have the coveted card.
While about 82% of Israelis aged 25 to 54 hold a license, this drops to 57% for those aged 65 and over. Israeli driver’s licenses of all types include classes B (passenger cars up to 3.5 tons and up to eight passengers, excluding the driver); and C1 (commercial and small trucks, up to 12 tons).
In Israel, drivers under 75 don’t need to undergo medical tests for their license renewal. From that age onward, medical and eye examinations are required. After age 70, licenses must be renewed every five years until age 80; thereafter, licenses have to be renewed every two years.
Those aged 70 and above have to undergo a medical examination, usually by their primary physician, as a condition for renewal; from age 75, drivers of private vehicles must undergo standard medical and vision tests. Generally, there are fewer drivers aged 75 and older.
The Medical Institute for Road Safety, run by the Health Ministry, is responsible for weeding out elderly drivers whose licenses should not be renewed due to their physical health, including visual and cognitive health.
The National Road Safety Authority, run by the Transportation Ministry, is responsible for reducing the number of injuries and deaths on the road. However, the Transportation Ministry does not have statistics regarding the number of licensed drivers over 75 who are still driving.
The Health Ministry’s Marvad assesses elderly drivers’ physical and cognitive fitness for license renewals. Conversely, the Transport Ministry’s similarly sounding Ralbad (National Road Safety Authority) aims –with limited success – to reduce traffic injuries and fatalities.
Although the ministry has announced that the elderly are more likely to be injured or killed in road accidents, it doesn’t state whether they are pedestrians or drivers. It may be that due to an elderly driver’s physical or visual changes, he or she may be involved in more accidents.
However, older pedestrians are more likely to be killed or injured because they walk more slowly, and drivers may be impatient with them. There is also the possible deterioration of various physical and mental abilities, among them the narrowing of the field of vision, slowing of eye movement speed, and slowing of decision-making processes that can affect their driving capability.
Drivers under age 25 are involved in about 20% of all fatal traffic accidents. While young drivers make up a smaller fraction of the driving population, they are apparently involved in serious accidents at a rate 1.4 to 1.6 times higher than drivers aged 25 and older. Some are not only careless, but may also drink alcohol or take various drugs that affect their driving performance.
The issue of setting down logical regulations for allowing the elderly to renew their licenses was discussed in the article “Policy of age-related health examinations as a condition of drivers’ license renewals in OECD Countries: A systematic review,” in the Israel Medical Association Journal.
Study tries to understand when someone can't drive anymore
The study was initiated by emeritus Prof. Francis Mimouni, a longtime epidemiologist who has worked as a senior pediatrician at Jerusalem’s Shaare Zedek Medical Center, and Dr. Sefi Mendlovic, the associate director-general of the Health Ministry, who is also a pediatrician at Shaare Zedek; they were joined by Dr. Yuval Dadon of Wolfson Medical Center in Holon.
The team searched in a variety of languages for requirements of age-related medical exams for renewal of driver’s licenses in all 38 OECD countries; of these, they found what they needed in 32 of the countries. The remaining six had no stated policies at all. Half of those countries that did set the exam threshold at age 70.
While the US lacks a unified federal policy, each of the 50 states decide their own policies, with the variation among them between ages 63 and 85. How often the applicants had to be reassessed also varied widely.
“The most important thing is the functioning of the driver and his chronological age,” Mimouni told The Jerusalem Post. “There are people who get dementia in their 50s, and there are people in their 90s who are clear-headed. To set down a uniform age limit is wrong.
“The concept of aging is different among countries. I visited Peru when the life expectancy there was 60 or even less. In Israel, the life expectancy for women is about 87, and for men at around 81. There are countries in which residents are old already at 35.”
Pressing the brakes, turning the steering wheel, and looking in the mirror all require coordination between the brain and muscles. In some elderly, but not all, this coordination becomes slower and sometimes less accurate. Medications taken for chronic diseases can also affect driving ability.
Mimouni insisted that “every country has to study its population, decide when the elderly have to be tested, what kind of tests, and who will conduct them. In Scandinavia, elderly drivers who want to continue have to undergo a cognition test; in Israel, it isn’t required.
“Some drivers can pass if they are on good terms with their primary physicians or pressure them. The general practitioner probably doesn’t know what their mental condition really is. They have to speak to the family and look at their patient’s accident record. Do they remember what day it is? Why do older drivers, like me, who have had cataract operations and have perfect vision as a result, have to undergo periodic vision tests?” Mimouni asked.
Mendlovic told the Post that he is working hard to reform the whole process. “Our medical institute had a huge backlog of requests for elderly drivers to check their health so they could renew their licenses. That was the most urgent thing to do first. Some couldn’t drive for over a year because of that.
The institute has six main branches and evaluation centers, with its main administrative headquarters located on Rehov Menachem Begin in Tel Aviv, plus two more in that city. There are also branches in Holon, Haifa, Beersheba – but none in Jerusalem, even though a 10th of the population lives there.
A few years ago, Health Ministry figures showed that only a tiny percentage of drivers aged 65 and up who were examined by the Road Safety Medical Institute had their licenses revoked or were instructed to drive under specified limitations.
“Upgrading the system has been problematic,” Mendlovic continued. “Every time, we have had to solve a new problem. We’ve been working on this for three years. We used to require older truck drivers who wanted to renew their license to see a psychologist, but we realized this was not necessary.
“We base our requirements on medical evidence. We don’t want to place the assessment burden on personal physicians, so they just have to report relevant medical or other problems to the Medical Institute for Road Safety.
“General practitioners have to inform the institute if their patients have been diagnosed with Parkinson’s disease, or have had a stroke whose effects have continued for at least a week, or some other problem that would be evidence for not approving renewal or for canceling a license.”
Mendlovic has high hopes that the institute will soon improve and speed up the assessment of elderly drivers’ capabilities, making these drivers, as well as the public, safer on the roads.