In-person license renewal tied to fewer crash hospitalizations of drivers with dementia

January 31, 2018

PITTSBURGH, Jan. 31, 2018 - Requiring physicians to report patients with dementia to state driver's licensing authorities is not associated with fewer hospitalizations from motor vehicle crashes. However, in-person license renewal laws and vision testing dramatically cut crashes involving drivers with dementia, according to a new study led by the University of Pittsburgh Graduate School of Public Health.

The results, reported in today's issue of the journal Neurology, the medical journal of the American Academy of Neurology, indicate that physician reporting laws - mandated or legally protected - either aren't working or lack any observable safety benefits.

"This was surprising, as we know that older drivers stop driving based on the advice of their physicians and, if reported to licensing authorities, few regain driving privileges," said lead author Yll Agimi, Ph.D., M.P.H., M.S., a health data scientist at Salient CGRT Inc. who did the research while a doctoral student at Pitt Public Health. "Physicians are required to ensure the well-being of patients with dementia by also monitoring their driving competence. That leads us to conclude that other licensing requirements may act as the principal means of identifying at-risk older drivers, before physicians identify and report a patient with a medical impairment, such as dementia."

Previous studies have shown that drivers with dementia perform significantly worse in on-road testing, compared to those without dementia. Prevalence of dementia increases with age, from 9 percent among adults ages 65 and older, to 30 percent among those over 85.

At the time of the study, three states - Pennsylvania, Oregon and California - required physicians to report drivers with dementia to licensing authorities. Twenty-seven states provided legal protection to physicians who report their patients, regardless of whether such reporting is required by law.

Only five states do not require that drivers present in-person - which is thought to allow licensing personnel to assess driving fitness - for license renewal at least once within two or three renewal cycles. Two states require road testing at licensing renewal, and 36 states require vision testing.

Agimi and his colleagues analyzed the crash-related hospital admissions from the states reporting data between 2004 and 2009. Among 136,987 hospitalized older drivers, 5,564 had a diagnosis of dementia.

Hospitalized drivers aged 60 to 69 in states with in-person renewal laws were 37 to 38 percent less likely to have dementia than drivers in states without such laws and 23 to 28 percent less likely in states with vision testing at in-person renewal. However, physician reporting laws were not associated with a lower likelihood of dementia among hospitalized drivers. These findings held even after the researchers accounted for other factors that could influence crash rates, ranging from police enforcement of safe driving to inclement weather.

"The results of our study point to age-based licensing requirements as an effective way to improve safety," said co-author Steven M. Albert, Ph.D., M.S., chair and professor of the Department of Behavioral and Community Health Sciences at Pitt Public Health. "But such requirements also may cause social isolation and depression, and may be seen as ageist and discriminatory. So it is very important that our findings spur further study to determine the best approach to ensure safe driving for all on the road while avoiding a negative impact on the mental health of older adults."
Additional authors of this study are Ada O. Youk, Ph.D., and Patricia Documet, M.D., Dr.P.H., of Pitt Public Health, and Claudia A. Steiner, M.D., M.P.H., Agency for Healthcare Research and Quality (AHRQ) at the time of study.

This work was supported by an Association of Schools and Programs of Public Health/National Highway Traffic Safety Administration fellowship awarded to Agimi, and data access obtained through collaboration with the Healthcare Cost and Utilization Project, AHRQ of the U.S. Department of Health and Human Services.

About the University of Pittsburgh Graduate School of Public Health

The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at


Allison Hydzik
Office: 412-647-9975
Mobile: 412-559-2431

Ashley Trentrock
Office: 412-586-9776
Mobile: 412-529-9092

University of Pittsburgh Schools of the Health Sciences

Related Dementia Articles from Brightsurf:

The danger of Z-drugs for dementia patients
Strong sleeping pills known as 'Z-drugs' are linked with an increased risk of falls, fractures and stroke among people with dementia, according to new research.

The long road to dementia
Alzheimer's disease develops over decades. It begins with a fatal chain reaction in which masses of misfolded beta-amyloid proteins are produced that in the end literally flood the brain.

Why people with dementia go missing
People with dementia are more likely to go missing in areas where road networks are dense, complicated and disordered - according to new research from the University of East Anglia.

PTSD may double risk of dementia
People who have experienced post-traumatic stress disorder (PTSD) are up to twice as likely to develop dementia later in life, according to a new study by UCL researchers, published in the British Journal of Psychiatry.

Dementia education
School-based dementia education could deliver much needed empathy and understanding for older generations as new research from the University of South Australia shows it can significantly improve dementia knowledge and awareness among younger generations.

Building dementia friendly churches
A project to help church communities become more 'dementia friendly' has had a significant impact across the country.

A "feeling" for dementia?
A research team led by the DZNE concludes that personal perception can be an important indicator for the early detection of Alzheimer's disease.

New biomarker for dementia diagnosis
Medical researchers in the UK and Australia have identified a new marker which could support the search for novel preventative and therapeutic treatments for dementia.

Digital solutions for dementia care
Telehealth delivery of dementia care in the home can be as effective as face-to-face home visit services if carers and recipients take advantage of the technologies available, Australian researchers say.

Despite a marked reduction in the prevalence of dementia, the number of people with dementia is set to double by 2050 according to new Alzheimer Europe report
Today, at a European Parliament lunch debate, Alzheimer Europe launched a new report presenting the findings of its collaborative analysis of recent prevalence studies and setting out updated prevalence rates for dementia in Europe.

Read More: Dementia News and Dementia Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to