Physicians, elderly drivers, and dementia.

In western countries, the proportion of drivers who are elderly is increasing rapidly; over a quarter of the driving population will be 55 years of age or older by the year 2000. Although elderly drivers tend to drive less and may avoid night driving, the number of car accidents and the severity of injuries sustained in such accidents by distance driven increases strikingly after the age of 65. But how can doctors identify those elderly drivers who are a danger to themselves and others? And, once they are identified, how should clinicians balance the effects of removing a driving licence, which may greatly affect a patient's lifestyle, against public safety and breach of confidentiality if the patient refuses to give up his or her licence voluntarily? Medical decisions about illnesses that predispose to loss of consciousness are fairly clear-cut, but normal ageing processes and dementia can be much more difficult to identify and to assess; moreover, there seems little correlation between tests of mental performance and driving ability. Comparisons between practices in different countries may provide some answers, but the introduction of modified driving tests for elderly drivers with some evidence of mild impairment but who wish to retain their driving licence should be considered.