Licensing authorities' options for assessing and managing older driver safety.

Much of the onus for the effective management of older driver safety falls on licensing authorities, which need to achieve a difficult balance between safety and mobility, and between social benefits and individual equity. In response to the challenges faced by licensing authorities, this thesis has three main objectives: •to assess older drivers' crash involvement and related risk factors; •to describe and evaluate the procedures and protocols available to licensing authorities to assess older drivers' fitness to drive; and •to identify the most promising interventions pertinent to licensing authorities for managing older driver safety. Chapter 1 considers older drivers' crash epidemiology and related risk factors by examining the following issues: older drivers as a road injury burden; their crash patterns and injury outcomes; their extent of crash responsibility; their crash rates; and their risk to other road users. Chapter 2 considers licensing authorities' options for assessing older drivers' fitness to drive by examining the following issues: ageing and the onset of disability and medical conditions; current international and Australian procedures for older driver licence renewal; an evaluation of current international and Australian older driver assessment procedures; and an evaluation of some leading individual assessment protocols. Chapter 3 identifies the interventions likely to assist licensing authorities in the assessment and management of older driver safety. The five interventions are: innovative licensing models; the use of Medical Advisory Boards; more strategic use of licence restrictions; promotion of on-road driver training; and promotion of off-road education. Chapters 4 to 13 consist of ten original research papers which address key issues identified in the first three chapters. Chapter 14 draws some key conclusions based on the material presented in this thesis. At the risk of simplifying a complex set of considerations, the older driver problem has been interpreted thus: • the majority of older drivers who are killed or seriously injured in road crashes incur this outcome because of physical frailty; • others are involved in crashes largely due to the location and amount of their driving (especially, short distances in urban locations); •a minority of older drivers in all likelihood represent an unacceptable road risk, due to various forms of functional impairment and reduced fitness to drive. The key challenge facing licensing authorities is to manage the minority without disadvantaging or threatening the majority of safe older drivers. While the empirical evidence for the five interventions recommended to assist in meeting this challenge is limited, all five interventions have sufficient face validity and hold sufficient promise to justify further research and development