We have a lifespan, a healthspan, and we have to accept that we have a drivespan.

Illinois has given up road-testing drivers, which many called ageist; In fact, we have to recognize that our bodies and abilities change.

The State of Illinois was the last in the USA to require mandatory behind-the-wheel driving tests for drivers 79 years and older, raised from 75 in 2024. As of July 1, the age for mandatory testing is raised to 87, “removing an outdated age-based requirement that made Illinois the only state in the nation to require a behind-the-wheel test solely because of a driver’s age.” As in many other states and Canadian provinces, a visual acuity test is still required. The Secretary of State says:

“The Road Safety & Fairness Act is about replacing outdated assumptions with facts,” Giannoulias said. “Illinois seniors have consistently proven they are among the safest drivers on our roads. This law removes an unnecessary burden for older drivers while preserving strong safeguards to protect everyone who travels on our streets.”

The justification for saying that older drivers are the safest:

“The changes are supported by extensive safety data. According to the Illinois Department of Transportation, drivers age 75 and older had a crash rate of 25.54 per 1,000 licensed drivers in 2024 – lower than every age group between 16 and 74.”

However, the crash rate per 1,000 licensed drivers is not how the data are usually measured. According to the Insurance Institute for Highway Safety, (IIHS), the fatal crash rate per miles driven increases significantly starting at age 70. The fatal crash involvement rate graph is U-shaped, with teenagers at one end and drivers over 80 at the other. Older drivers are no longer commuting and are travelling far fewer miles than the younger drivers, so the rate per 1,000 drivers is lower. The rate per miles travelled is higher.

The demographic time bomb is about to detonate

Also, the demographic time bomb means that every year, the proportion of older drivers increases, so every year, the rate per 1,000 drivers will increase as well.

The Illinois change is celebrated by organizations like AARP: “The Road Safety and Fairness Act is a vital step toward ending outdated and discriminatory practices that unfairly target older drivers in Illinois,” said Philippe Largent, State Director of AARP Illinois. “With 1.7 million members across the state, AARP Illinois proudly supports this legislation because it promotes fairness, respects individual ability over age and helps older adults stay safely connected to their communities.”

Many others agree. On her Substack, Melanie Jordan writes Older Adult Drivers, Ageism and Illinois and even objects to there still being a test at age 87:

“We’re going to hopefully have many people age 87+ who are perfectly capable of still driving as we have longer lifespans and healthspans. Using a specific number to draw a line in the sand and say, in essence, “you’re now 87, show me you can still drive” is just offensive.”

I thought this interesting because Jordan acknowledges that we have both lifespans, how long we live, and healthspans, how long we live well. If you can accept the concept of healthspans, then you have to acknowledge my new term, drivespan, how long we can safely drive.

We may soon have 70 million boomers too old to drive, too car-dependent to stop.

I am 73 years old, and I work hard at lengthening my healthspan, but I am aware of where things are going and can feel how functions are deteriorating. After writing an earlier article about aging boomer drivers, I was asked to expand on it for a major publication. I withdrew for personal reasons, but did a bit of research into what happens to your body as you age, and how it affects your drivespan. It goes way beyond vision:

Medication

Many medicine labels say, “do not operate heavy machinery,” but that is what cars are, especially today, when everyone is driving SUVs, and many older drivers are taking a lot of medication, much of which affects their driving. The AAA Longroad study found that 69% of drivers 55 and older were taking one or more Potentially Inappropriate Medications (PIMs). Different drugs apparently cause different driving behaviours; those that affect the central nervous system (CNS), like analgesics, hormones, and gastrointestinal drugs, are associated with speeding and risky driving. Antihistamines seem to cause problems with turning, probably due to drowsiness.

According to the AAA, 44% of men and 57% of women aged 65 and older use five or more medications weekly. Most drivers don’t even know that this is a problem;

“Only 18% had received warning about potentially driver impairing medications – include ACE inhibitors, sedatives, and beta blockers – from a healthcare professional. However, 69% currently use one or more prescription potentially driver impairing medication and 10% said they currently use five or more potentially driver-impairing medications.”

A review of medication and impaired driving notes that “After participants took diphenhydramine (Benadryl), driving performance was poorest, indicating that diphenhydramine had a greater impact on driving than alcohol did.”

Driving while old is like wearing sunglasses at night, and it is going to get worse

Vision

Most states and provinces that do vision tests use the Snellen chart, which only measures static visual acuity, the ability to resolve fine detail in a stationary high-contrast target under good lighting conditions. However, there are many other issues with our eyes.

According to the National Research Council (US) Committee on Vision, “the retina of a 60-year-old typically receives one-third the light of a 20-year-old’s retina.” As one ages, the pupil doesn’t open as wide. The lens yellows, reducing the amount of light that gets through. The number of cones, the cells that detect low-level light, significantly decreases between 40 and 60 years of age. “Electrical measurements of visual activity of the brain, recorded from the scalp, appear to indicate that visual processing is slower in the elderly.” The useful field of view shrinks- a study of Visual attention problems as a predictor of vehicle crashes in older drivers found that “Older adults with substantial shrinkage in the useful field of view were six times more likely to have incurred one or more crashes in the previous 5-year period.” Glare becomes a major problem at night; a study on Nighttime Driving in Older Adults found that “older drivers function as though they are wearing sunglasses at night.”

Reaction time

A French study found that 27.7% of elderly drivers failed to respond to events within 2 seconds versus only 0.3% of the middle-aged group. Another study concluded:

“In unpredictable situations, slower brake time in elderly drivers is associated with lower limb muscle strength, agility and low-contrast sensitivity. Therefore, for safe driving, these parameters should be considered as guidelines for maintaining the driving ability of elderly drivers and aging people.”

Mild Cognitive Impairment

Two out of three adults over 70 suffer from Mild Cognitive Impairment, and according to the study, Cognitive Decline and Older Driver Crash Risk, “Cognitive function influences ability to perceive hazards in the road, process visual cues (e.g., stop lights), focus on driving tasks, anticipate other road users’ actions, and make quick decisions.” Another study, Association of Daily Driving Behaviors with Mild Cognitive Impairment in Older Adults Followed Over 10 Years, found a five-fold increase in motor vehicle crashes in the three years before a dementia diagnosis. This is likely why the IIHS notes that intersections are the site of 39% of crashes for drivers over 80, while only 21% for drivers under 59- they are complicated and require processing speed, quick decisions, gap judgement; it is a wonder that anyone can do it.

Pedal Errors

Many crashes have been attributed to “pedal errors.” A Japanese study found that pedal errors account for 0.6% of fatal crashes for drivers under 75, but 7.8% for drivers over 75 — more than thirteen times higher.

I do resistance training and follow Dr. Howard Luks, an orthopedic surgeon and fitness nut who publishes “Built to Move, Born to Heal: Notes on Midlife Fitness. He writes often about needing both strength and power. I asked him if these pedal errors could be attributed to a lack of fitness. He says, "There's no doubt that it has a large role in what you're describing." He describes the difference between strength and power, and the need for both.

“Power is the application of force quickly. It’s force times velocity. So there’s a speed component to it. It’s not just moving the weight, or you being able to squat your body weight. It’s you being able to squat your body weight, but get that foot to move quickly and powerfully.”

Then there are metabolic disorders. How does this all add up to affect our ability to find the pedals? Diabetes is the leading cause of peripheral neuropathy [weakness or numbness], and Luks explains the sequence of loss.

“What you lose first in peripheral neuropathy is proprioception [perception or awareness of the position or movement of the body]. What you lose next is sensation. What you lose last is strength or power. So they’re not feeling the pedals well at all. That’s metabolic in nature.”

When doctors do intervene with older drivers, Luks says, it is almost always because of daytime vision. The cascade of deficits he describes- lost power, compromised proprioception, peripheral neuropathy- never enters the conversation. “Nobody tests for this. After 65, we should have to take another round of testing.”

So we have older drivers, 20% of whom might be diabetic and have sarcopenia, power loss, proprioception, or peripheral neuropathy, who don’t have the explosive power that might be needed in a hurry and might not be able to even feel the pedals.

This is why we need testing

If you think it is ageist to test at 79 or 87, let’s do it as they do in Italy, where they require testing every 10 years up to age 50 and every 5 years after that, with a required medical certificate covering vision, hearing, general physical health, and a review of medical history and medications.

Or look at private pilots: to fly a 2,500-pound Cessna 172, they have to get a medical certificate every 5 years until they are 40, then every 2 years. The test covers vision, hearing, cardiovascular health, mental health, and neurological function. They supply a urine sample to screen for diabetes or kidney disease. But anyone can drive a 5,000-pound SUV at high speeds through urban neighbourhoods with no testing after age 16 other than an eye test developed in 1862 for another purpose. And nobody accuses the FAA of age discrimination.

We all have a drivespan

Healthspan is a relatively new concept, popularized by the likes of Peter Attia, and defined in a study as “the period of life spent in good health, free from the chronic diseases and disabilities of aging." Many of us will face a number of years between when our healthspans and lifespans end. Our society has not done a very good job of preparing for this.

We also have to accept the concept of drivespan- the recognition that as we age, our driving gets progressively worse until we reach the point that we can’t safely do it anymore. Society has done an even worse job preparing for this. But we have to recognize that at some point, many of us are a danger to ourselves and others, like the two pedestrians minding their own business standing on the sidewalk in Toronto last Friday, killed by a 79-year-old woman who ran a red light.

And because we are so dependent on our cars and so unwilling to give them up, and because there are so many of us due to the relentless demographics, I fear that the only way to find out who has reached the end of their drivespan is to test them or pry them out of the wreckage.

This isn’t ageism; it is about fitness and capability. It’s not ageism to insist kids wait until they are 16 to get a driver’s licence, even though we know some could drive at 14 and others should never be allowed behind a wheel. As Matthew Lewis of California Nimby notes,

“The argument that testing by age is unfair is frankly nonsense. We have the statistics about who the most dangerous drivers are — it's men under 19 and everyone over 70. And if they want to talk about fairness, let's talk about the fairness of being killed or injured by a driver who isn't qualified to operate the vehicle. If I want to walk to the supermarket, I shouldn't have to take my life in my hands because a cohort of retirees wants to keep driving indefinitely.”

It’s the recognition of the reality that we not only have a lifespan and a healthspan, but we have a drivespan.

Picking an age for testing, whether it is at 16 at one end or 79 at the other, is just a trigger based on estimates of when our physiology changes, perhaps an arbitrary one. It’s not the purpose, which is to determine fitness and capability. If anyone can figure out a better method, I am open to suggestions.