Researchers urge Medicare coverage of driving assessments for at-risk, older adults

In 2020, approximately 48 million licensed drivers were older than 65 years. Within this age group, car crashes led to 7,480 deaths and 149,881 non-fatal injuries. Moreover, 17% of people older than 65 years (approximately 8.2 million) experience mild cognitive impairment and are at increased risk for crashes. Accurate assessment of driving skills in these individuals cannot be done in a doctor’s office. While there are existing driving safety evaluation programs for older adults, these assessments are not covered by Medicare.

Researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system, have analyzed the current landscape of driving safety evaluations and associated challenges in a viewpoint published in JAMA Neurology, calling for Medicare to cover driving safety evaluations that will equip health care professionals with critical information to determine whether a patient is competent to drive safely.

“Driving is a multifaceted activity that requires learned skills and the coordination of complex cognitive and physical functions. As we age, we are vulnerable to declines in our cognitive, visual and motor skills that can impact our ability to drive safely,” said corresponding author Kirk Daffner.

“Therefore, it is imperative to support programs in our health care system that can evaluate driving safety of at-risk individuals in a manner analogous to Medicare’s coverage of a fall risk assessment.”

Without the support of Medicare, the financial burden of a comprehensive driving evaluation can be prohibitive. In Massachusetts, for instance, comprehensive driving assessment costs about $500 to $800—a significant expense that many drivers with mild cognitive impairment and their families may not be able to afford, leaving them without the necessary support and guidance on whether it is safe to continue driving.

Moreover, the cost of not identifying potentially dangerous drivers can be substantial. Annual Medicare expenses for traumatic injuries in 2016 were estimated to be more than $16 billion, and motor vehicle crashes were the third-most leading cause of traumatic brain injury-related hospitalizations, emergency room visits, and deaths.

“The implications of this analysis are significant, extending beyond academic discourse, and highlighting the need to reconsider the current approach to driving safety assessment,” added Daffner.

“Motor vehicle crashes can be devastating, and impaired drivers pose safety risks for not only themselves, but also the public at large. Accurate assessment about driving fitness is critical to mitigating harm and improving safety on the road. It is time for Medicare to cover driving safety evaluation programs.”