INTRODUCTION
The rising prevalence of older adult drivers has become a significant road safety concern globally, including Korea, where traffic accidents involving older adults continue to increase. To address this concern, the Korean government has implemented policies aimed at evaluating the driving capabilities of older adults.1) These policies include mandatory assessments that focus on cognitive and physical health to determine individuals’ fitness to operate a vehicle.1)
In the United States, a more comprehensive approach is employed in assessing older adult drivers. Physicians play a critical role in this process, as they are often responsible for evaluating patients’ health and initiating discussions about conditions that may affect driving performance. Many states permit or mandate medical professionals to report drivers with conditions that could impair driving ability.2)
This paper aims to examine the current landscape of policies related to older adult drivers, with a particular focus on the role of healthcare providers and assessment methods in the United States and Canada; both the United States and Canada offer well-established legal frameworks in which physicians are actively involved in evaluating the fitness of older adults to drive. It also seeks to identify best practices and propose effective strategies for improving the safety of older adult drivers in Korea. Ensuring a safe driving environment is essential for preserving autonomy and enhancing the quality of life for older adults in an aging society. We propose that the role of physicians should be strengthened to help prevent accidents involving the rapidly growing population of older adult drivers. Physicians can actively contribute to road safety by assessing patients’ driving capabilities and referring at-risk drivers to motor vehicle agencies. However, for physicians to take on this expanded role effectively, several barriers must be addressed.
CURRENT REGULATION RELATED WITH OLDER ADULT DRIVERS AND PHYSICIAN’S DUTY TO REPORT
United States
Physicians in the United States are permitted to report drivers who pose a medical risk, with such reports generally treated as confidential. However, confidentiality may be waived if reports are subpoenaed, presented as evidence, or requested by the driver. Only six states—California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania—mandate that physicians report to the Department of Motor Vehicles (DMV) or motor vehicle agency when patients have specified medical conditions that may impair driving.3) In most states (37 out of 51), physicians are legally protected from civil lawsuits stemming from these reports. Among these states, the most common reporting trigger is a patient experiencing lapses of consciousness.4)
Reporting procedures vary: 42 states provide a dedicated form for physician submissions, and 38 states offer this form online.5) Nearly all states (48 of 51) accept a physician’s letter as a valid reporting method. In California, the reporting form is also available from local county health officers. Overall, the regulation of older adult drivers across states falls into four categories: (1) treat older adult drivers the same as younger drivers; (2) shortening the renewal cycle for older adult drivers; (3) allowing physician discretion to report unfit older adult drivers to the DMV; and (4) requiring physicians to report medically unfit drivers to the DMV.6)
In Maryland, drivers are not required to renew their licenses more frequently based solely on age. However, those aged ≥40 years must pass a vision test at every license renewal.7) First-time driver’s license applicants aged ≥70 years must present either proof of prior satisfactory driving or a physician’s certification confirming physical and mental fitness to drive.8) Maryland also permits anonymous referrals of drivers with conditions such as Alzheimer’s dementia or visual impairments to the Driver Wellness & Safety Division.9) The Driver Wellness & Safety Division may collect additional information and consult the Medical Advisory Board, which relies on reports from the driver’s physician. Based on these findings, the Driver Wellness & Safety Division may permit continued driving, impose restrictions, or suspend the license.10) Individuals whose licenses are suspended may request an administrative hearing.11)
This reporting duty can create tension between physicians’ legal obligations and their commitment to patient confidentiality, potentially straining the physician–patient relationship. Physicians are generally expected to keep all communication within that relationship confidential.12) Maintaining confidentiality encourages patients to share relevant information, enabling accurate clinical assessments and appropriate care. In many states, physicians refrain from reporting medically unfit drivers due to fears of liability associated with breaching confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 outlines federal regulations concerning the confidentiality of the physician–patient relationship.
This legal ambiguity raises concerns about potential liability for breaching confidentiality when making such reports. Critics have identified three main shortcomings in current United States regulations: (1) statutory vagueness; (2) concerns over confidentiality and liability; and (3) lack of uniformity across states in reporting and evaluation processes.13) A 2004 National Transportation Safety Board (NTSB) Special Investigation Report also highlighted how a lack of clarity regarding liability and immunity discourages physician reporting.14)
Canada
Across Canada, provinces and territories have implemented legislation requiring physicians to report patients deemed unfit to operate a motor vehicle. While some jurisdictions mandate this reporting, others permit it at the physician’s discretion. This obligation serves as an exception to the general confidentiality of the physician–patient relationship. All jurisdictions provide statutory protection for physicians who fulfill these duties, though certain conditions must be met for immunity to apply. Only three provinces—Alberta, Nova Scotia, and Quebec—permit discretionary reporting. Although statutory language varies, Ontario’s Highway Traffic Act exemplifies the structure and language of mandatory reporting provisions nationwide.
Since the late 1990s, the Ontario Medical Association has advocated for clearer and more effective physician reporting requirements concerning patients’ fitness to drive. The original 1968 legislation mandated that physicians report any patient potentially unfit to drive, but lacked specificity regarding which medical conditions warranted reporting. This ambiguity led to inconsistent practices and potential liability for physicians.15) In 1995, the Ontario Medical Association proposed a revised framework distinguishing between mandatory reporting for serious conditions and discretionary reporting for others. Following two decades of advocacy, the Highway Traffic Act was amended in 2015 to incorporate this hybrid model. The Ontario Medical Association continues to collaborate with the Ministry of Transportation to finalize regulations and reporting protocols, with input from medical experts.
Under Section 203(1) of Ontario’s Highway Traffic Act,16) and Ontario Regulation 340/94, physicians must report to the Ministry of Transportation any individual aged ≥16 years who, in their professional judgment, has or appears to have a listed medical condition, functional impairment, or visual impairment.17) Physicians are not required to report individuals if, in their opinion, the impairment is (1) distinctly transient or non-recurrent,18) or (2) due to modest or incremental changes associated with natural aging, unless the cumulative effect meets one of the listed conditions or impairments.19) When considering whether a patient has or appears to have a medical condition, functional impairment or visual impairment listed above, the physician may consider (1) the Canadian Council of Motor Transport Administrators Medical Standards for Drivers described in subsection 14(4) of the Highway Traffic Act; and (2) Determining Medical Fitness to Operate Motor Vehicles (9th edition), available on the Canadian Medical Association website.20)
Physicians who comply with mandatory reporting requirements are protected from liability. However, if they fail to report a patient whose condition meets mandatory criteria, they may face legal consequences. Two rulings by the Ontario Court of Appeal underscore the physician’s public duty to report, involving cases where patients were advised not to drive but were not reported to the Ministry of Transportation.
CURRENT REGULATION RELATED TO OLDER ADULT DRIVERS IN KOREA
In Korea, the issue of older adult drivers has grown increasingly urgent due to the country’s rapidly aging population. Recent regulations aim to improve road safety for individuals aged ≥65 years, particularly through mandatory cognitive and physical assessments for license renewal. As of 2023, these evaluations must be completed every three to 5 years to identify impairments that could compromise driving ability.1)
Statistics underscore the growing concern. In 2024, drivers aged 65 years and older were involved in approximately 21.6% of all traffic accidents—a substantial increase from 14.8% in 2020.21) Fatal accidents involving older adult drivers increased from 23.4% in 2020 to 30.2% in 2024,21) prompting policymakers to call for stricter regulations. These trends emphasize the urgent need for comprehensive safety measures to protect both older adult drivers and the general public.
Beyond regulatory assessments, the Korean government promotes technological interventions to aid older adult drivers. The adoption of advanced driver-assistance systems (ADAS) is encouraged to help reduce accident rates through features such as automatic emergency braking and lane-keeping assistance. Local governments have also developed community-based programs, including driving simulators and educational workshops tailored to older adults, to foster safer driving habits and enhance road safety.21)
Korea’s evolving regulatory approach to older adult drivers reflects a proactive response to the challenges of an aging society. By combining mandatory assessments, technological innovation, and community education, the government seeks to improve safety while supporting the mobility and independence of older adults. Table 1 summarizes the older driver licensing policies and physician reporting duties in the United States, Canada, and Korea.
A PROPOSAL: PHYSICIANS AS GATEKEEPERS
Physicians play a critical role in promoting driving safety among older adults in both the United States and Canada, often serving as the first point of contact in identifying health issues that may impair driving. Given the complexity of age-related medical concerns, physicians are well-positioned to evaluate cognitive, visual, and physical functions. Routine consultations offer opportunities to discuss the impact of conditions such as dementia, visual impairment, or physical decline on driving. Open communication allows patients to better understand when it may be necessary to limit or cease driving.
Beyond individualized assessments, physicians also bear legal and ethical responsibilities to protect public safety. In many jurisdictions in both the United States and Canada, they are permitted—or required—to report medically at-risk drivers to the motor vehicle agency. This obligation highlights the value of incorporating medical evaluations into licensing processes, enabling early intervention to prevent potentially hazardous driving. Such regulations emphasize the collaborative role of physicians and licensing authorities in maintaining road safety.
Physician involvement in driving safety is essential to protecting both older adults and the wider community. Through clinical evaluations, informed conversations, and public safety engagement, healthcare professionals can significantly reduce driving-related risks. However, challenges persist. A Canadian study found that 27.3% of physicians hesitated to report medically unfit drivers even when required by law.4) Another Canadian analysis of 1,605 drivers involved in severe accidents found that one-third had pre-existing, potentially reportable conditions, yet few had been reported.22)
Physicians may feel conflicted about reporting information that could result in license suspension, especially when it affects patient trust. Such emotional and ethical tensions may cause reluctance to report.23) Additionally, patients may withhold critical health information. A study from a neurology outpatient clinic in Oregon found that 28% of patients would not report a seizure if a mandatory reporting law were in effect.24)
Nonetheless, one of the most compelling arguments for mandatory reporting laws is the risk that physicians may not report unless legally obligated.6) According to the NTSB, physician awareness of legal duties is a key factor in whether at-risk drivers are reported.23) The NTSB reported that 28% of US geriatricians were unaware of their reporting responsibilities.23) In jurisdictions with mandatory reporting, there has been a marked increase in reports.23) For instance, Pennsylvania experienced a fourfold rise in motor vehicle agency reports following a 1992 public awareness campaign on its mandatory reporting law.6)
To encourage physicians to report at-risk older adult drivers, the government must grant them immunity from civil and criminal liability. Physicians have long faced challenges in deciding whether to report dangerous or unhealthy behaviors involving their patients. Mandatory reporting laws remove the discretion to report from physicians,13) transferring responsibility to a government agency that evaluates the report’s merit and determines appropriate actions.13) A comparable model is the mandatory child abuse reporting requirement. When a patient receiving treatment discloses an act of child abuse, the physician is typically required to report this to a child protective agency. This triggers an investigation and may result in temporary or permanent termination of parental rights. Such laws often impose penalties for failing to report, including potential criminal charges against physicians and other mandatory reporters. Designing a reporting system for at-risk older adult drivers modeled after child abuse regulations would likely be the most effective approach.
The physician’s primary role is to determine whether there is a reasonable basis to believe the driver has cognitive impairments that may render them unfit to drive. Because physicians generally lack the expertise to evaluate actual driving ability, it is critical that occupational therapists and motor vehicle agency officials conduct secondary assessments. According to the 2010 NTSB Special Investigation Report, the Board recommended that, for chronic conditions such as dementia, licensing agencies should measure performance related to driving, determine a threshold that can be used to screen drivers, and follow up periodically to gauge changes in performance.23) This aligns with findings from the National Highway Traffic Safety Administration.25) Reports would be submitted to the motor vehicle agency or occupational therapists, who would then investigate whether the driver poses a risk to themselves or public safety. If risk is confirmed, both written and field driving tests would be administered. Drivers who pass the tests retain their licenses, while those who fail have their licenses revoked.
To ensure compliance with the mandatory reporting scheme in Korea, liability should shift from breaches of confidentiality to physicians’ failure to report. Mandatory reporting alone is insufficient to fully mitigate the risks posed by older adult drivers; a systematic evaluation process is also essential. Requiring the reporting of specific impairments to licensing authorities relieves physicians from the burden of deciding when and whether to initiate evaluations.13) Instead of expanding liability for third-party accidents—similar to wrongful death suits holding physicians responsible for patients with cognitive impairments—liability should be based on failure-to-report standards.26)
CONCLUSION
In Korea, addressing the safety of older adult drivers is increasingly urgent as the population ages. Physicians play a key role in assessing the health of older adult drivers, but there is a growing need for structured collaboration between healthcare providers and regulatory authorities. Establishing appropriate infrastructure is the most effective way to address future challenges before they escalate. Under current regulations, physicians face conflicting responsibilities regarding the reporting of unsafe drivers. Although the Code of Ethics encourages physicians to refer patients to the motor vehicle agency, existing laws expose them to liability for such disclosures.
A statute mandating physician reporting of unfit older adult drivers would resolve this conflict. Reporting regulations would alleviate the tension between maintaining patient confidentiality and fulfilling the duty to report potentially unsafe older adult drivers. A clear reporting system would reduce ambiguity and encourage appropriate reporting. However, based on analyses of systems in the United States and Canada, a discretionary reporting framework should be introduced initially to ensure the system is properly established. Regulations can then gradually strengthen physicians’ roles and responsibilities. A more detailed legal and procedural discussion regarding the introduction of a physician’s duty to report within the Korean legal framework will be reserved for future study.
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