Warning signs that it’s time for a senior driver to turn in the keys

Remember the excitement of being 16, eagerly preparing for your driver’s license test? Those nerves, the hours spent poring over the blue book, the endless practice sessions mastering three-point turns — it was all worth it for that first taste of freedom behind the wheel. Now, fast forward about six decades. Can you imagine having to go through it all over again?

“As we age, changes in our cognitive, visual and motor skills can impact our ability to drive safely,” explains Dr. Pooja A. Patel, an occupational therapist and certified dementia practitioner who hosts the “Aging Together” podcast. “But it’s important to know that age alone does not determine driving ability.” In other words, the precise age at which you or your senior loved one should stop driving is completely individual. 

Today, seniors make up a significant portion of drivers on US roads, accounting for about 20% of all drivers, according to the Federal Highway Administration. Many of them are independent baby boomers who remember the days of station wagons without seat belt laws or airbags.

Yet, as time goes on, the decision about when to retire from driving becomes increasingly important. Each state has its own set of rules regarding renewal procedures and testing requirements, adding another layer of complexity to the discussion.

Ahead, we’ll explore the warning signs that might indicate it’s time to consider other transportation options, decode state laws and provide resources. Because knowing when to transition from the driver’s seat to the passenger’s seat isn’t just about safety — it’s about maintaining independence and quality of life.

Why do driving abilities decline with age? 

As Patel noted, many issues could impair our driving as we age. The National Institute of Health (NIH) cites vision loss, hearing problems, certain medications and medical conditions such as dementia as main reasons for this decline. 

Vision loss

With age, nighttime visibility tends to diminish gradually. Scientifically, this is attributed to the loss of rod photoreceptors in our eyes, which are crucial for low-light vision. Additionally, conditions like cataracts, diabetic retinopathy, macular degeneration and glaucoma further complicate one’s ability to drive safely.  

“We’d been concerned about my dad’s vision for a long time,’ says Nena Contreras Barnett, whose father just turned 90. “But he’s very stubborn and didn’t want to lose his license.” Last year, when her father’s driver’s license was up for renewal, he failed to pass the vision test. “My dad’s driving days are now sadly behind him, but his eye doctor kept my sisters and I abreast that this would probably be the outcome,” Contreras Barnett says. “It gave us time to research transportation options and prepare him to accept it — which is still a struggle.”

Hearing problems

The ability to hear is also necessary for safe driving — think honking horns at a red light, emergency sirens, and noises from your own car that could signal a malfunction.

Medications

Three out of four older adults take at least one medication commonly linked to car crashes, according to the Centers for Disease Control and Prevention (CDC). Examples include drugs for bladder control, high blood pressure, heart conditions and mental health issues, which can cause drowsiness, lightheadedness and reduced alertness.

Dementia and other medical conditions

Safe driving is completely dependent on cognitive health. Some seniors in the early stages of Alzheimer’s disease or dementia can keep driving, given that people are now being diagnosed in the very early stages with only short-term memory loss. However, as the disease progresses and memory and decision-making skills get worse the question families need to ask is not “Should they stop driving?” but “When should they stop?” And because dementia also reduces the capacity to recognize one’s own driving difficulties or dangerous behaviors, you can’t expect them to hand over the keys easily. 

Patel, who is also an adjunct assistant professor and guest lecturer at Delaware State University, says, “Driving is one of those super touchy topics [for seniors with early signs of dementia]. You don’t quite know if they should still be driving, and you definitely don’t know how to approach the subject with them.” 

“Driving is one of those super touchy topics [for seniors with early signs of dementia]. You don’t quite know if they should still be driving, and you definitely don’t know how to approach the subject with them.” 

— Dr. Pooja A. Patel, an occupational therapist and certified dementia practitioner

In a recently published article in the journal, Health Affairs, Sharona Hoffman of Case Western Reserve University School of Law discusses how the burden of identifying and managing unsafe drivers with dementia should not be left to families. Instead, she argues the matter requires legal and medical intervention. 

To help you navigate it all, Patel recommends involving healthcare providers and scheduling a comprehensive (clinical and behind the wheel) driver evaluation, an independent assessment from an occupational therapists (OTs) certified as a driver rehabilitation specialist. “These evaluations involve an on-road assessment to evaluate a range of skills, including speed control, lane positioning, intersection navigation and decision-making,” she adds. 

To find a driver rehabilitation provider in your area, you can search the American Occupational Therapy Association (AOTA) directory or the Association for Drivers Rehabilitation Specialists (ADED) directory.  

Although Medicare doesn’t cover these evaluations for dementia patients, many families choose to cover the costs themselves, hoping their loved ones will heed the recommendations provided by evaluators. A comprehensive driving assessment costs about $400 to $600.

What are the new driving rules for seniors?

Each state already has its own rules for senior drivers, but they differ considerably across three areas: 

• Renewal intervals (i.e., shorter vs. longer periods).
• Renewal process (i.e., in person vs. mail in or electronic renewal).
• Requirements (e.g., routine vision and road tests).

State driving laws for seniors

Different states have different laws for senior drivers. In Texas, for example, where both Conteras Barnett and her father live, drivers 79 and older must renew their licenses in person, rather than by mail or online, and get a vision test. Starting at age 85, drivers must renew their licenses every two years instead of every six — a result of “Katie’s law,” which passed in 2007 in honor of a 17-year-old girl killed when a 90-year-old driver ran a stop light. 

Over in Arizona, a mere state away, state law says those 65 are only required to renew their license every five years by going to a DMV office for a vision test and to update their photo. No test drive is required. 

Mississippi, meanwhile, doesn’t even have a vision test requirement;  licenses can last up to eight years for everyone, with no older age requirements.

Here’s a few states and districts on the other side of the spectrum with stricter senior driving rules:

• Maine requires vision screening for drivers once they reach 40.
• California says once you hit 70, you must come into a DMV office and take a written test every five years.
• Illinois drivers 75 and older must pass a road test to renew their license.  
• Washington, D.C. drivers 70 and older need to have their doctor sign off on their license renewal.

State regulations vary on mandatory reporting of conditions that are impossible to evaluate at the DMV and affect the ability to drive (e.g., diabetes, seizure disorders, and most importantly, dementia.) 

For instance, California’s Health and Safety Code Section 103900 requires healthcare providers to submit a confidential report to the county health department when a patient is diagnosed as having Alzheimer’s disease or related disorders, including dementia, that are severe enough to impair their ability to operate a motor vehicle. This information is then forwarded to the DMV, however California has separate requirements and guidelines for drivers with other cognitive disorders such as strokes, head injuries, and epilepsy. 

In Illinois, on the other hand, you are required to self-report and file a medical report form (completed by your physician) with the Secretary of State’s office within 10 days of becoming aware of:  

• Any medical or mental condition that may result in a loss of consciousness or any loss of ability to safely drive a vehicle
• Taking any medications that may impair your ability to drive

If you haven’t already, look into the rules and regulations around older drivers where you or your senior loved one live. 

When to stop driving?

Although no US state mandates license surrender based on age, Consumer Reports indicates an intriguing trend: The average American man tends to outlive his driving ability by six years, while the average American woman surpasses her driving capability by 10 years.

Take that as you will while holding in mind that age alone doesn’t determine driving competence. An 85-year-old in excellent health may drive safely, while a 60-year-old experiencing hearing loss and memory decline could pose risks. 

There are plenty of examples to challenge ageism assumptions. Consider actor Paul Newman who, at age 70, became the oldest competitor to ever win his class at the Rolex 24, a 24-hour sports car endurance race held annually at Daytona International Speedway in Daytona Beach, Florida. He continued to race professionally until 2005, just three years before his death at age 83.  

What cars are safe for seniors? 

A study published in the Journal of Safety Research recommends making adjustments to your car, given that older drivers in crashes were more likely to be in vehicles that were lighter, older and without standard electronic stability control or standard head-protecting side airbags. 

The age of your car also factors into your auto insurance premiums, because the insurance company anticipates higher repair costs if you’re in an accident and knows older parts are harder to find. To reduce costs, you might consider getting a newer and safer car with rearview cameras, blind-spot monitors and lane departure warnings.

If you or your older loved one are set on keeping your current vehicle, Patel says certified driver rehabilitation specialists can make recommendations for modifications. “Intervention plans may include installing hand controls or adjusting the seat height,” she explains. “These OTs can also teach you how to use new car technology like GPS and blind-spot detection systems.”

For those who want to brush up on their driving skills and potentially get discounts on insurance premiums, here’s a few courses worth considering:

• The American Automobile Association’s (AAA) RoadWise, a defensive driving course designed for seniors available through the classroom and online.
• The National Safety Council’s Defensive Driving for Mature Seniors online course includes content from the expert in occupational first aid training.
• The American Association of Retired Persons (AARP) Smart Driver course is an  8-hour (2 session) classroom program designed for drivers age 50 and older.

Transportation alternatives for seniors without smartphones  

In 2017, Consumer Reports said almost three in four seniors lived in areas with few — if any — transportation alternatives. Call it one of COVID-19’s silver linings, but many transportation options and app-based services now exist to combat social isolation and access to care, food and medicine.  

One company, GoGoGrandparent, established in 2016, helps seniors without smartphones in all 50 states, Canada, and Australia, access new on-demand services like Uber and Lyft by calling their hotline, 1-855-464-6872. Caregivers can also schedule rides and grocery and meal deliveries on their loved one’s behalf. 

“Using just his flip phone, my dad can speak to a person in Spanish and request rides to go get groceries, visit his son-in-law, or even get to doctors appointments,” says Contreras Barnett, who first learned about the service from seniors she was picking up as a rideshare driver in San Antonio. Even though her dad lives across the state, in El Paso, she says the service has given her peace of mind and maintained her dad’s freedom. “My sisters and I can access his dashboard and see if the driver has connected with him and what time he will arrive somewhere, and he doesn’t even need to worry about making payments since it’s linked directly to my credit card,” she says. 

GoGoGrandparent charges a concierge fee of 27 cents per ride minute, in addition to Lyft or Uber’s fare. Members pay GoGoGrandparent via an established account, and then GoGoGrandparent pays the ride-hail companies.

For more options and help finding free or low-cost buses, taxis, or carpools for seniors, reach out to your local Area Agency on Aging. Rides in Sight, a service of the nonprofit ITN America, also provides information about transportation options for older adults; search their website or call 855-607-433.

Next steps for caregivers

If you’re starting to suspect your senior loved one’s driving abilities have declined, consider taking a look at their car for any unexplained damages like dents or scratches, as well as any recent traffic violations.

Here’s a handy tip: For long-distance caregivers concerned about incidents that may have occurred in their absence, many state DMV offices offer access to driving records for a small fee. This can provide valuable insights into your loved one’s driving history.

While one isolated incident doesn’t necessarily warrant turning in the keys, it can serve as a red flag and should warrant a conversation.

The bottom line

As the population gets older, more older drivers will be on the road and more family caregivers will be asking themselves, “What are the latest rules for senior drivers?” and “At what age is it best for a senior to stop driving?” 

Ultimately, navigating difficult driving decisions is easier once you do your research, learn the rules and regulations in your state and find solutions that work best for you and your senior loved one. 

“Remember that driving safety is a collaborative effort,” says Patel. “It involves not only the patient, but their healthcare providers, OTs, family members and the community working together to develop a coordinated plan that addresses their individual driving safety needs and promotes their overall health and well-being.”