The impact of restricted driver's licenses on crash risk for older drivers: A systematic review

Background As the Canadian population ages, there is an urgent need to identify evidence-informed strategies that have the potential to enhance older adults’ safety and independent mobility. Previous research has demonstrated the positive impact of continued independent mobility on older adults’ quality of life, through improvements in health, and community engagement. Restricted driver licensing policies have been mandated in several countries, with the goal of facilitating traffic safety and independent mobility for older drivers. Studies testing the effectiveness of these policies have produced mixed findings; a systematic examination of the impact of restricted driver licensing policies on reducing morbidity and mortality among senior drivers is warranted. Aims The objectives of this study were to examine if restricted driver licenses are more effective than unrestricted driver licenses in (1) reducing crashes; (2) reducing traffic violations; and (3) facilitating continued independent mobility for older drivers. Methods A systematic review was completed. A comprehensive electronic database search was conducted to identify all literature related to restricted driver license policies. A total of 3331 abstracts and 39 full text articles were reviewed. Seven papers met the inclusion criteria and were evaluated for quality and risk of bias assessment using the Newcastle-Ottawa Scale (NOS). All seven studies reported motor vehicle collisions as the primary outcome, which included more than 2.1 million participants with or without a driving restriction. The search resulted in a heterogeneous set of included studies, meaning that meta-analysis was not appropriate. A narrative interpretation and discussion of the seven individual studies is presented. Results Results demonstrated that restricted driver licensing may be effective at reducing crash risk for older drivers who have few health conditions, and those requiring few driving restrictions. It was noted that medically-restricted drivers incur fewer traffic violations than non-restricted drivers, or drivers with non-medical restrictions. Overall, evidence on both crash risk and traffic violations yielded mixed, yet promising results. Only one included study assessed the impact of restricted licenses on older adults’ independent mobility, with results indicating a positive impact. A major limitation of this body of research is a failure to consider if, and how, restricted licenses facilitate older adults’ independent mobility. Discussion Restricted driver licensing has the potential to improve traffic safety among the general population and positively impact independent mobility of older Canadians. Efforts should be focused on providing education to health care professionals and motor vehicle licensing authorities on this topic, so that they may advise their clients appropriately, and avoid making premature driving cessation recommendations. Moving forward, more evidence is needed on the direct impact of restricted licensing on older adults’ independent mobility and, more generally, quality of life. Conclusion Supporting older drivers to safely remain independent and engaged in the community has positive impacts on all strata of society. Restricted licensing is one approach that has the potential to promote road safety for all and contribute to improved quality of life for older adults.