[Column] Elderly driving became 'elephant in the room': Is returning a license the only way?

On the first day of July, marking the start of the second half of the year, a tragic event occurred in Seoul. A 68-year-old driver, traveling in the wrong direction, caused an accident that killed nine people and injured seven others. The driver attributed the incident to sudden unintended acceleration and brake failure, but witness statements, dashcam footage, and other evidence contradicted his claim.

The blame then turned to the driver's age, leading to widespread calls for banning or restricting older drivers. In my opinion, this entire issue highlights the “elephant in the room.” Korea entered the age of aging in 2000 when the proportion of older adults exceeded 7 percent. The country is expected to become a super-aged society next year. The controversy surrounding elderly drivers has existed for a long time. The lack of discussion, followed by intense attention after a major accident, is reminiscent of ignoring the elephant in the room until it has trampled several people.

Do older drivers cause more car accidents? As we age, our physical and cognitive functions generally decline, which can lead to poorer judgment. Reaction times may slow down, and driving ability may decrease accordingly.

When the National Assembly Research Service analyzed the rate of car crashes by age group, it found that the highest number of crashes and fatalities per 10,000 licensees occurred among those under 20. The rate of accidents and fatalities then decreased for those in their 30s and 40s. However, the risk of accidents began to rise again in the 50s, with a clear increase in the rate of fatal accidents per 10,000 licensees in the 65+ age group. This suggests that age-related changes in physical and cognitive function increase the likelihood of drivers being involved in accidents, especially high-consequence ones.

However, the issue is less about whether older drivers are dangerous and more about how to reform the licensing system to accommodate an aging population. Current policies focus on encouraging older drivers to voluntarily return their licenses. Some local governments offer transportation reimbursement for voluntary returns. As a result, 83,997 licenses were returned by drivers aged 65 and older in 2021.

The problem is that baby boomers are rapidly reaching the age of 65 at a rate of around 1 million per year. Unsurprisingly, the number of older drivers is also growing quickly. From 2012 to 2022, the average annual growth rate of older adult drivers’ licenses was 10.2 percent, more than double the 4.6 percent annual growth rate of the older adult population. According to the National Assembly Research Service, 4.98 million people over the age of 65 will have driver’s licenses next year, nearly half of that age group's population. By 2040, an estimated 13.16 million license holders will be aged 65 and older.

With the explosive growth of older drivers, policies that require drivers to give up their licenses after reaching a certain age are not only ineffective but can also have numerous negative consequences. Older drivers often rely on driving for their livelihood. Forcing them to return their licenses uniformly would not only threaten their livelihoods but also negatively impact the economy. In Korea, which is experiencing a severe birthrate decline, the participation of older adults in society is essential to keep society vibrant, and license revocation is a policy that goes in the opposite direction. For older adults, especially those living in rural areas with poor public transportation, it could be a matter of survival. The very idea of returning or revoking licenses based on a specific age is ageism and administrative nepotism, discriminating against people based on their age.

More important than a numerical age is the extent to which biological aging has accumulated and how it affects a person's actual driving ability, which is influenced by environmental factors. The initial step should be a thorough assessment of an individual's driving capabilities. Other countries have integrated this concept into their senior driver licensing systems by combining assessments of actual driving ability with conditional licensing.

A practical driving ability assessment evaluates the ability of the driver to operate a vehicle. It reflects the compensatory behaviors of older drivers who are aware of their physical and cognitive decline. For example, it can evaluate how they slow down or how much they can increase their attention to their surroundings. Current physical and cognitive function tests are insufficient to capture declines in driving ability in real-world driving. A conditional licensing system would issue a limited license based on the results of a practical driving ability assessment, subject to certain conditions such as time, area, speed, and assistive devices. This is more reasonable than having to return your license regardless of your physical ability.

Environmental factors are also crucial. Just as cars are designed to accommodate individuals with physical disabilities, developments in vehicle and road systems aim to compensate for physical and cognitive decline as we age. The effectiveness of these supportive systems can significantly influence safe driving. For instance, the European Union (EU) mandates that all new cars include advanced driver assistance systems (ADAS) such as emergency brake assistance and reversing assistance. Recently, Japan announced plans to require pedal misapplication prevention devices in automatic transmission vehicles. Driving comprises three factors: the vehicle environment, the road environment, and the driver. Therefore, solely blaming the driver while disregarding external factors is not fair.

In Korea, there is a tendency to overlook existing problems until an incident brings them to light. This reactive approach often leads to hastily implemented solutions that can exacerbate the situation. For instance, efforts to establish proper guidelines for medications crucial to older adults may stagnate. Then, if an adverse reaction to a specific medication prompts legal action against a doctor, that medication can become practically unavailable.

The same applies to driving in old age. We have been witnessing the rapid aging of populations in other countries, making the issues related to aging foreseeable. However, no one was willing to acknowledge the elephant in the room until it became a pressing problem. This approach is no longer sufficient for solving social problems.

Jung Hee-won, a geriatric physician at Asan Medical Center, graduated from Seoul National University College of Medicine and trained at Seoul National University Hospital. During his med-school days, while practicing the horn, he realized the importance of muscle maintenance and became interested in sarcopenia. His main research interests include frailty, sarcopenia and establishing age-friendly health systems for acute hospitals. This column was originally published in Chosun Ilbo in Korean on July 17, 2024. -- Ed.