DRIVING SAFE IN YOUR SEVENTIES AND OVER
Bracco Dario, Sociologist Doctor
President of Ce.R.R.Co. (Cornaglia Research and Relations Centre)
Marchisio Ugo, MD
Chief of Emergency Department, Maria Vittoria Hospital, Turin, Italy
Ce.R.R.Co. (Cornaglia Research and Relations Centre), Turin, Italy, 24 Perugia
Road, 10152 Turin _ email@example.com, www.centrocornaglia.org
Driving at the age of seventy and over: challenge or right, skill or hazard? Older
persons driving around all over the world are continuously increasing: an important
target for industrial marketing, politics and economy. Moving around completely free
using your vehicle is a cornerstone for self-confidence and empowerment of older
persons. But is really there an “age factor” affecting safety on the road? And how can
older driver’s behavior be different from the younger population?
Our study is aimed to answer these questions by analysing old age-linked road
accident epidemiological data of the last ten years in Cuneo Province that boasts the
sad record of the highest number of fatal road accidents in Italy.
Very complete and detailed databases were provided by Motorway Police of the
Cuneo Province and Club UNESCO Cuneo and compared with national (ACI-Istat)
and international (Red Cross/Crescent) databases.
Then we asked for advise a qualified multidisciplinary panel of experts in order to
settle some comprehensive guidelines about driving safe in old age: public
administrators, medical doctors practicing different disciplines (including Forensic
Medicine), town-planners, car-designers, psychologists, sociologists etc.
The main subjects treated are the following:
1. The real over seventy people’s ability to drive, how we can actually evaluate their
skills and come up to their expectations, how highway code should be modified to
be more respectful of older people’s rights and all the citizens’ safety.
2. Car-design and ability-design experimental studies and projects, the state of the
art of car industry in Turin etc.
3. How to make our towns and our roads more “older driver-friendly” in a more age-
concerned environment as a whole: accessibility and safety-oriented town-
planning projects, “intelligent” roads able to interact with vehicles, check their
directions, give information and warning messages to the driver etc.
4. “Longlife learning” to promote older persons’ ability to drive, a new mind and a
new awareness about driving performance self-evaluation.
The results of our study show that older people are mostly “weak” road users and
when their behavior is dangerous, it is dangerous for themselves far more than for
other people. They are not “road killers” crashing into other vehicles or running over
other persons, at least in this region of Italy …The present study also shows the need
of new medical, forensic medicine and driving performance evaluation guidelines, a
higher attention by car-designers to new technological solutions and “intelligent
roads”, a wider use of driving rehabilitation training and continuous driving
performance evaluation and self-evaluation to ensure both older persons
empowerment and road safety.
Key Words: road accidents; aged drivers; safe driving; elderly empowerment
PUPOSE OF THE STUDY
Road accidents are a huge problem in terms of dead/injured people, disability and
social costs. In 2008, 1.3 million persons dead in road accidents (about 3,000 every
day) and 50 millions were injured! [International Red Cross/Red Crescent, 2009].
At the same time older persons driving around all over the world are continuously
increasing, especially in technologically developed countries. By the year 2030, 20%
of drivers will be aged 65 or older - some 30 millions in USA only! [US Census
Bureau, 2008] – an important target for industrial marketing, politics and economy.
Moving around completely free using your own vehicle is a cornerstone of self-
confidence and empowerment of older persons. But vehicles are supposed to be
designed and accessory-equipped for an easy and safe drive even when dealing with
persons late in their years. On the other hand, also urban environment and roadway
system conditions should be modified to make driving easier and safer for older
Our study is aimed to understand how and how much older drivers are involved in
road accidents in Cuneo Province, the most fatal accident-prone region in Italy, and
to submit our findings to a multidisciplinary panel of experts in order to settle some
comprehensive guidelines on driving safe in your seventies and over.
This will be the first step to experiment new technological solutions in viability and car
design: isn’t Turin the capital of Italian car industry? But above all to promote older
driver’s awareness about safety and driving skill self-evaluation as well as about their
own empowerment and independence.
APPROACH AND METHODOLOGY
1. Epidemiological study
We analyzed a selection of very detailed and complete databases about last ten
years road accidents in Cuneo Province that boasts the sad record of road fatal
accidents in Italy:
Motorway Police of Cuneo Province
Club UNESCO Cuneo
Provincial Committee on Road Safety of Cuneo
Department of Prevention – Agency of Cuneo – N.H.S.
We studied 70 years or over drivers/pedestrians’ epidemiological data about:
Age and gender
Number of accidents
Number of fatal accidents
Features of accidents (time, day of the week, season, vehicle, dynamics etc)
For all the variables we compared older and younger people’s risks and behaviors in
Data from Cuneo Province have been also compared with:
National database (ACI-Istat annual report: the latest issue - 2008)
Wold database (International Red Cross/Red Crescent: latest report – 2008 - and UN
Ministerial World Conference on Road Safety, Moscow 19 and 20 November 2009).
2. Experts’ comment and advice
The whole epidemiological information and analysis have been submitted to a panel
of experts listed below:
Geriatrics physician (Pierangelo Pieroni MD)
Neurologist (Leonardo Lopiano MD)
Cardiologist (Baldassarre Doronzo MD)
Ophthalmologist (Alberto Alberti MD)
Ear Nose and Throat Specialist (Guido Bongioannini MD)
Physiatrist-Rehabilitation Specialist (Tiziana Iacomussi MD)
Forensic Medicine Specialist (Maria Francesca Vizzi MD)
Car designer (Giuseppe Varalda - Engineer – FIAT Research Centre)
Car designer and producer (Paolo Pininfarina - Engineer)
Chief of the Motorway Police – Cuneo Province (Commissioner Franco Fabbri)
Responsible of Road Safety – Motorway Police – Cuneo Prov. (Inspector Anna Drai)
Car Insurance agent (Bruno Sillano)
Local political/administrative authorities of Cuneo Province
Older citizens advocacy associations (Consiglio Seniores - Turin)
We asked all the experts their suggestion about new solutions and new research
frontiers, but also about practical guidelines to ensure both independence for older
drivers and safety for all the people on the road.
EPIDEMIOLOGICAL RESULTS AND DISCUSSION
In the last ten years (1/1/2000 – 31/12/2009), the Cuneo Province showed the
highest mortality rate due to road accidents: 2.7% (33.687 accidents and 923 deaths)
[Motorway Police – Cuneo Province – database], versus an average national rate of
2.2% (218,963 accidents and 4,731 deaths) [ACI-Istat report 2008].
This sad Cuneo Province’s record holds out although the number of fatal crashes has
decreased, in Cuneo Province, faster than Italian average rate, even beyond the EU
target of 50% of the fatalities registered in 2000 by the year 2009 (see Fig. 1).
But what is the role of “age factor” in road accidents and how does it affect their
To ask this question we selected a randomized sample of 7,913 accidents (165
happened to result fatal) from the Motorway Police – Cuneo Province database
2000-2009. In 611 cases drivers/pedestrians were 70 years old or over (only 7.7%),
whereas the whole population in this class of age is 16% (93,155 out of 573,613
inhabitants) [31/12/2006 census]. As showed in Fig. 2, in Cuneo Province, the most
accident-prone age (mode) is 22 for both genders, while for age 70 or over the gap
between number of inhabitants and number of accidents becomes progressively
wider. See moreover the great difference between men and women that persists
even in the oldest age.
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Data: ACI-Istat (Italy) and Motorway Police -
Cuneo Pr => 1/100
Cuneo Province (Cuneo Province)
Fig.1: the decrease of fatal accidents in Cuneo Province in the last ten years has
been greater than the expected EU target of 50% by the year 2010, whereas the
average decrease in Italy has been only 33% in 2008 (less than the expected EU
Mode 80 y
22 years 22 years
5,000 4,000 3,000 2,000 1,000 1,000 2,000 3,000 4,000 5,000
Accidents = 1/10 Inhabitants Cuneo Province = 31/12/2006 Census
Accidents = Epidemiological Bulletin - Health Agency CN2 - 2007
Fig. 2: Age class distribution of Cuneo Province population and total road accidents
for both genders. The mode (pick) of accidents for men and women is 22 whreas for
older people (70 years or over) the gap between accidents and inhabitants is wider,
especially for women.
Older drivers/pedestrians cause, as a whole, less road accidents than younger
people, as confirmed by the main statements of recent scientific literature that
disagrees about the old concept of “U-shaped curve” you could obtain if you correct
the number of accidents the smaller amount of miles per year spent driving by older
people, because of the important biases that this kind of correction implies
[Julien.2008]. But if accidents caused by older persons are les frequent than those
caused by younger persons, the fatality rate of people involved is higher: 4.1% if the
driver is aged 70 and over versus 2.1% for rivers under 70, maybe just because
accidents with an older driver involve a higher average total number of older persons
as drivers, passengers or pedestrians. And older people show a worse prognosis
after a trauma …
We also studied another randomized sample of 266 fatal road accidents from the
Club UNESCO Cuneo database: 663 persons involved and 282 deaths (40%).
Taking into account only people aged 70 or over, the persons involved were 79 and
the deaths 63 (80%): this result confirms a higher mortality of older people in some
Eventually we studied in details a randomized sample of 100 fatal accidents with
driver/pedestrian aged 70 or over, from the Club UNESCO Cuneo database, in order
to find out specific behaviors or features linked to an older age. Among the tested
variables, the following showed an interesting correlation with an age of 70 or over:
Gender – 78% men and 22% women; for our older generations, driving a vehicle is
still “a man job”. From this point of view, we agree with other Authors describing the
important biases that a gender comparison entails: women usually drive less miles,
are more often involved in accidents as passengers etc. [Julien.2008]
Time – the top is between 6 and 8 PM; smaller peaks around 9-10 and 11-12 AM;
these findings show a “family-oriented” attitude of older drivers (to carry grand-
children to school or to practice sports and other leisure activities, to go shopping in
the afternoon etc).
Season – the top is around Christmas (December-January) with another smaller
peak in May, confirming the “family-oriented” use of vehicles by older people
whereas for younger drivers the highest peaks are in July, Fridays and week ends.
Vehicle _ car in 42 cases, pedestrians in 25, bicycle in 22, motor-bike in 5, truck or
farm tractor in 5 and motor-wheelchair in one. These results show that older persons
are very often “weak” road users (pedestrians, bicycle or wheelchair) more than
Dynamics – tackling crossroads or insertions, pulling out or up in 43 cases,
overtaking or changing lane in 13, bumping into in 7, getting run over in 36 and
running over other persons only in 1. These findings confirm that older people are
mostly “weak” road users and, if their behavior is dangerous, it is dangerous for
themselves far more than for other people. They are not “road killers” crashing into
other vehicles or running over other persons, at least in this region of Italy …
1. The car insurance broker (Bruno Sillano. Turin)
“I can boast a huge experience in examining dossiers of all kind of car crashes and I
can say that older drivers/pedestrians show a non intended dangerous behavior a bit
more frequently than younger persons, mostly because of sensorial and/or cognitive
impairment. But usually their average number of driving hours or miles per year is far
smaller and final per capita cost for insurance companies is a bit smaller and fares a
bit lower (at least in Italy).
The table in Fig. 3 [ANIA – Associazione Nazionale tra le Imprese Assicuratrici – the
Italian national insurance association. 2008] shows the total number of road
accidents, for men and women, at different ages. On a national Italian scale, the total
number of accidents peaks around 50 year, and not at 22 as in Cuneo Province (see
Fig. 2), for both genders, but the trend toward a global reduction after 70 is
confirmed. The table also shows an interesting data about gender distribution of car
accidents: whereas young women are far less prone to car crashes than men (only
50% at the age of 20), then they progressively reach the men’s rate around 40 and
the risk remains the same thereafter.
AGE CLASSES MEN WOMEN RATIO
14-17 0.1 0.1 0.53
18-21 0.7 0.9 0.58
22-25 2.0 2.7 0.65
26-29 4.5 5.7 0.74
30-33 7.4 8.9 0.77
34-43 22.5 27.6 0.93
44-55 27.6 30.3 1.05
56-63 15.7 12.6 0.97
64-71 10.9 7.0 1.05
72 and over 8.7 4.4 0.97
Total 100.0 100.0 0.96
Fig. 3 – Car crash risk/year % distribution for both genders and women/men ratio in
Italy (2007) [ANIA.2009] _ The age classes are not uniform but the average value,
inside every class, shows a peak around 45 years in both genders.
I examined for you in details a randomized sample of 350 cases of road accidents
from the Assimoco database. In 12 cases only persons aged 70 or over were
involved: 8 as drivers, one as passenger and 3 as run over pedestrians (actually all
the three were crossing the street in a dangerous way…)
These findings stress again the low rate of accidents caused by older drivers but a
very high risk for older pedestrians”.
2. The Forensic Medicine doctor (Maria Francesca Vizzi MD – NHS, Ag. TO1,
“Italy is always amazing! Some times ago I discovered an ANIA survey concerning
350 older (60 or over) truck drivers: 30% were driving with some form of heavy visual
impairment but without any awareness of their disability! Ordinary renewal of the
driving license, in Italy as well as in other counties, is just a formal bureaucratic act,
especially if dispatched by private agencies and not public health services. In some
counties, like France for instance, the driving license is even granted once and
forever without any further evaluation of driving ability.
On the contrary, I think that a thoroughly evaluation should be performed, by a public
medical officer (or medical commission), not only in compulsory cases, but also in the
following situations: older persons discharged after a hospital admission due to a
disease possibly affecting driving ability (newly diagnosed diabetes, stroke,
narcolepsy etc), or from a rehabilitation or nursing home; people aged 80 or over
even in case of ordinary license renewal; all the citizens applying for disability or
blindness pension etc.
The medical evaluation should be performed following well defined and universally
accepted guidelines, continuously updated on a scientific base: for instance, visual
ability evaluation should include not only sight sharpness but also visual field.
3. The Geriatrics physician (Pierangelo Pieroni MD. Alba Hospital)
“A seventy year old person shouldn’t have any problem driving a car, but we have to
remember that driving involves al the five senses, often affected by aging, even when
everything is going smoothly …To help an older person’s sensorial ability we can
modify the vehicle (display with adjustable light and bigger types, more prehensile
drives etc.) and traffic signals (bigger and more visible types, horizontal
phosphorescent signals, acoustic signals for traffic lights etc).
Of course we have to carefully and frequently evaluate their ability to drive. Very
often older people suffer from chronic diseases, co-morbility and different degrees of
disability that can heavily impair their mobility, sensorial and mental performances
and psychological behavior. Often families can’t make grand-father give up driving,
even using deception and menacing, in spite of a true Alzheimer disease.
What I could suggest is a more frequent evaluation of driving ability for older persons
and a continuous educational effort in order to promote a hiher awareness of dangers
they can produce and a new “self-evaluation culture” instead of the present
compulsory, formal and often useless control system”.
4. The Physiatrist (Tiziana Jacomussi MD. Maria Vittoria Hospital. Turin)
“Analyzing older people’s driving ability from the strict point of view of the physical
movement modifications due to age, we should always take into account two
components: accessibility and driving. Both can be affected by morphological,
anthropometric, joint mobility and muscular strength modifications produced by the
aging process. For instance a hand prehensile ability and movement coordination
impairment can affect lock and door opening; main articulations and spine
degenerative changes affect getting on and out a vehicle.
As far as driving is concerned, a stiff neck and a reduced shoulder range of motion
(ROM), often with joint pain, can jeopardize or even prevent steering-wheel proper
use, especially in emergency situations. An impaired neck mobility (cervical arthrosis)
can affect head bending and rotation; together with a limitation of visual field (often
found in older persons) this limitation can heavily compromise driving ability and
A great effort must be pledged by designers to implement new technical solutions
and auxiliary devices tailored to older/disabled persons with this kind of problems
because their comfort and everybody’s safety can be extremely improved this way”.
5. Other medical experts (see panel. Coordinator Ugo Marchisio MD)
“Diseases mostly affecting driving ability in older persons are eyes diseases, stroke,
diabetes, arthrosis and cognitive impairment (Alzheimer disease etc.): widely found
in older people and often together. Any single driver has to be evaluated specifically
as the same diseases can create very different driving risks and disabilities,
especially when older persons are taking drugs.
Even temperature and humidity can affect older persons’ driving performance.
Checking to verify if an older person and his/her vehicle fit well together is something
as important as a medical checkup. Sometimes they can even need a training by a
driver rehabilitation specialist who is also able to evaluate all the possible adaptive
features for any kind of vehicle”.
6. The Motorway Policewoman (Inspector Anna Drai. Cuneo Province)
“Cuneo Province is very wide with a roadway network of over 3,500 Km (let alone
freeways and main national roads). In the last five years we built more than 300
roundabouts and carried out a pervasive preventive and educational campaign on
safe driving, together with widespread police controls on the road. So we achieved a
more tan 50% reduction of fatalities in our Province between 2000 and 2009.
In order to secure a safe driving in your seventies and over you have to start
educating young people and continue an all life long educational/preventive effort.
For older people moreover is of paramount importance to offer ability tests (driving
simulation) and behavioral counseling to promote their awareness about dangers and
a positive process of self-limitation”.
7. The car designer (Giuseppe Varalda. Centro Ricerche Fiat. Turin)
“When a car producer starts projecting a new car or an updating (restyling) of an
already existing model, always takes into account all the possible driving and driver
conditions, older drivers included. To project a car for all kind of users, doesn't mean
to project plenty of personalized models, one for each person, but to study and
project a sufficient number of components and accessories for all kind of outfit. So
each model of any car will be able to satisfy the needs of every “special driver”, for
instance older persons. Research in car industry today is first of all oriented toward
energy and environment, which generate, by themselves, several components, even
simple accessories and homologation is a very important process for all the out
sourcing production. The Company's policy is to project accessories and components
to be assembled in order to obtain a vehicle geared to the needs of older (and/or
disabled) drivers, but not opened targeted “welfare-vehicles” or “geront-vehicles”.
These “creative” adaptive features are movable steering-wheel (steer-by-wire
technology) that can move automatically into the dashboard with more room to get on
and out of the car, wider doors with an intermediate open position, easier seat
control, night vision technology, adjustable gas and brake pedals etc.
This was FIAT’s choice when, ten years ago, started its “Ability” program (standard
car accessories for disabled drivers) which is continuously updating”.
8. The town planner (Fabrizio Astrua. Polytechnic of Turin)
All the town planners consider safety first when projecting, especially today that
roads are overcrowded than ever and the number of older and disabled drivers is
The City of Turin has realized the PUT (Piano Urbanistico del Traffico -Traffic Town
Plan); thanks to PUT a lot of roundabouts have been built as well as cycle tracks,
pedestrian zones, limited traffic areas (ZTL), protected railways etc. To stimulate
greater attention by citizens a lot of acoustic traffic lights have been installed as well
as TV cameras and other road signals. Moreover town planners hope to be realized
a modern system of traffic light synchronization, able to direct the traffic following its
intensity, and a unified European road signal system.
9. The elderly advocacy associations (Cesare Palenzona. Consiglio dei Seniores.
Driving a car means mobility and independence: two very important benefits for older
persons. Driving in town is very different then on country roads: a lot of heavy
accidents happen in town.
The Municipality of Turin hosts the Consiglio dei Seniores (Senior Council), about
300.000 aged people (from about 50 Elderly Associations) living in Turin area.
Senior Council is prepared to make a survey on “Driving safe in your seventies and
over”, involving UGAF (Fiat retired persons association- member of Senior Council)
with some 80,000 affiliates: a very suitable sample of older persons to be studied
with driving simulator tests.
A continuous updating of older drivers ability through tests (especially self-tests) and
medical check-up, could contribute to ameliorate safety and independence.
Older persons are not, as a whole, a major road danger: as drivers they are
responsible of car crashes less often than younger people, even in Cuneo Province
that boasts, in Italy, the sad record of the highest number of fatal road accidents.
Probably an impaired sensorial and/or cognitive ability is counterbalanced by a
reduced number of hours (or miles) spent driving so that the number of accidents
caused per year is eventually smaller. As a matter of fact insurance companies, at
least in Italy, offer lower fares to people aged 70 or over.
As far as gender is concerned, whereas the Italian national data show no risk
difference for older people (from 50 year of age on), our study in the Cuneo Province
shows a great gap (men > women) even at 70 and over, probably due to a very wide
country roadway network, with a lot of little villages and only a few little towns.
On the other hand, accidents caused by older drivers/pedestrians show a higher
fatality rate due to a worse dynamics: for instance a completely absent driver’s
reaction facing a dangerous situation because of an impaired vision or a syncope.
Moreover older persons involved in road accidents (as drivers, passengers or
pedestrians) show a higher risk of dying in major road accidents, mostly just because
an advanced age and pre-existing co-pathologies make the prognosis of any kind of
trauma worse. Accident risk and fatality rate rise tremendously when the older
persons involved are “weak” road users (pedestrians, bicycle or wheelchair users),
as they often happen to be.
Analysis of time, day of the week and season shows a “family-oriented” distribution of
accidents for older drives/pedestrians, in Cuneo Province at least.
The analysis of dynamics shows that older persons cause fatal accidents mostly
when facing new or unexpected situations and that they are “weak” road users far
more often then reckless drivers bumping into or running over other people. These
results are explained by the well proved theory that older people, with a mild
cognitive impairment or even with completely normal mental tests, show an impaired
sustained, selective and divided attention. Procedural and working memory, mainly
involved in driving ability, are also impaired so that executive function can be
seriously jeopardized with a reduction of flexibility and inhibition, especially when
facing double task and task switching. No doubt cognitive impairment is also deeply
connected with personality and personality changes due to aging (locus of control,
copying strategies etc): a matter that still deserves more attention and further
The panel of experts we sought for advise gave us a lot of precious pieces of
suggestion you can see in the “discussion” chapter above.
It is of paramount importance to face this issue by putting together all the
competences needed for a 360° effort to promote both older persons ‘ empowerment
and everybody’s safety on the road. Control by Motorway Police and elderly
advocacy, technological design and car industry, public health and roadway system
should be absolutely brought up to date together.
The right question is not “Why older drivers are at higher risk of road accidents?”,
that is not true (or at least not proved) and politically incorrect, but “Which older
drivers are more at risk than others?” [Julien.2008].
For this reason Ce.R.R.Co. is going to organize a great congress in Turin , next year,
and to invite Regional Authorities , car firms, technology researchers from the
Polytechnic of Turin, medical, Psychology and Sociology experts, insurance brokers
and elderly advocacy associations.
Ce.R.R.Co. will also produce a practical handbook to help older persons and
caregivers to optimize comfort and safety when driving around in your seventies and
over: education and long-life learning remain the cornerstones of older people
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