Michael A. KnodlerJohn ColluraDonald FisherRothenberg, Heather A.2024-04-262024-04-262009-0910.7275/g721-2s38https://hdl.handle.net/20.500.14394/38554This research sought to understand the relationship between licensing policy and the opportunity for the development of a scientifically-based approach to identifying high risk older drivers based on prior driving history. This research focused on five tasks: 1) review of the literature, 2) compilation of information on licensing policy for use by decision-makers, 3) assessment of charges and payer source for older driver crashes using linked crash and hospital data , and 4) the development and 5) validation of an older driver crash prediction model. There is relatively little available in the way of information for policymakers regarding licensing, and there is even less information available on evaluation of licensing practice effectiveness. Emergency department charges for older males were lower than females even though males accounted for a larger percentage of the injured population. Older drivers were no more likely to be covered by public insurance than the comparison group. Crash and citation data used to develop a driver history showed no differences between drivers in injury causing crashes and drivers in non-injury crashes. Logistic regression, Poisson regression, and negative binomial regression models were unable to effectively predict crash involvement based on driver history. This is likely due to self-selection bias for older drivers and truncated distribution of count variable (injury causing crashes). Recommendations resulting from this research include Massachusetts and national policy recommendations and additional research. Massachusetts should expand beyond its referral-based system for reviewing older drivers, consider restriction rather than only revocation, review medical advisory board practices, conduct evaluation of any policies it does implement, and conduct a thorough review of alternative transportation options. Nationally, efforts should focus on developing effective cognitive/functional testing by licensing agents, identification of effective second phase of testing, determination of a mechanism for determining when to retest, and assessment of the differences between older males and females for potential use in training, education, and testing. Research recommendations include continued exploration of the potential for systematic identification of high risk drivers using administrative data and in-depth analyses of the differences between males and females in terms of aging and driver safety.Crash DataDriver LicensingHighway SafetyOlder DriversTransportationPolitical Sciencedissertation