Nevada’s Roadblock to Care: How Driver’s License Laws Hamper Dementia Diagnoses

As we get older, it can become more difficult to participate in activities we once found commonplace, including driving. Reduced eyesight, increased reaction time, and cognition behind the wheel are all issues correlated with aging—but in most parts of the United States, including Nevada,  driving has become a necessary aspect of life and one of the only ways to access places outside of home.

Senior Citizens on the Roads

For many years the question of whether an older adult’s freedom to drive should be regulated has been left up to their physician as well as family members. However, with the population of Americans over the age of sixty-five growing faster than any other age group, the number of that age group on the road is also growing. In 2020, the Federal Highway Administration estimated more than forty-eight million drivers over the age of sixty-five on the road, which is more than seventy percent higher than two decades earlier. Additionally, FHA data shows that twenty percent of total drivers on US roads are seniors. [1]

Because of the increased number of senior citizens on roads, many states have enacted laws with regards to seniors’ license renewal and mandatory vision tests. For example, in Nevada, those over sixty-five years of age must renew their license every four years, in contrast to the regular eight-year period. Additionally, Nevadans over the age of seventy-one must pass a vision test every time they renew their license and may also be asked to take a written knowledge test. [2] Some states, like Nevada’s neighbors California and Oregon, also require that drivers or their doctors notify the Department of Motor Vehicles if they are diagnosed with a condition that cannot be evaluated during the license renewal process, examples include diabetes, seizure disorder and dementia.

Unintended Consequences of Nevada’s Drivers License Laws Relating to Senior Citizens

While the laws like self or physician reporting mentioned above are intended to ensure drivers remain capable of safe-driving practices as they age, new research presented in October 2023 at the Alzheimer’s disease Conference suggests that these laws may undermine the intended outcomes.

Hankyung Kate Jun, a researcher at Harvard Medical School was especially interested in how these reporting policies impact public health and driver safety, especially with regards to dementia, which seniors have been diagnosed with in rising rates in the past decade. Jun describes Dementia as a dual hazard because it not only impacts the person’s ability to drive, but also decreases a person’s ability to recognize their own impairment and dangerous behavior.

Jun and her team decided to compare expected and actual dementia diagnoses in each state and found that the physicians in the four states that require physicians to report it to the DMV were more likely to underdiagnose dementia. The rate of underdiagnoses in the four states requiring reporting (California, Oregon, Delaware, and Pennsylvania) is fourteen percent, versus the average of nine percent in other states.

So, what causes this discrepancy? Jun believes that the fear of losing the freedom to drive may prevent some people from seeking medical help in the first place, and she believes that the reason doctors underdiagnose it is because of the reluctance of patients to disclose all their symptoms.

While this study doesn’t provide insight into if these policies prevent car accidents or injuries, they do help us understand some of the ethical and safety concerns that states must consider when creating laws regarding the country’s growing senior population. [3]

Taking Precautions as a Senior Driver

As mentioned earlier, older Americans over the age of sixty-five is one of the fastest growing demographics in the United States, and it is estimated that by 2030 eighty to ninety percent of this demographic will be licensed to drive. [4]

If you or a loved one are contemplating whether it is safe for you to continue driving a car, the following are some tools that can help:

• Self-Rating: Self-evaluation is one of the easiest ways to figure out if you are still fit enough to be behind the wheel, as well as a good way to remind yourself of safe driving practices. Several companies like AAA have designed short self-assessments created to identify your strengths and weaknesses as a driver.
• Professional Assessment: If you are concerned about the results of your self-assessment, diagnosed with a medical condition like dementia, or have been told by friends or family to stop driving, this assessment is a good option. Professional Assessments usually consist of driving skills evaluation, as well as clinical driving assessments and ensure driving skills are adequate, as well as identifying any deficits in your driving skills. Clinical driving assessments can also help identify adaptive equipment that can make driving less difficult. Professional assessments can also identify if you are no longer fit to be on the road.

[1] https://www.fhwa.dot.gov/policyinformation/statistics/2020/dl22.cfm

[2] https://www.thezebra.com/resources/driving/driving-rules-seniors/

[3] https://time.com/6329992/drivers-license-laws-dementia-underdiagnosis-2/

[4] https://exchange.aaa.com/safety/senior-driver-safety-mobility/