Continued increases in the number of older drivers during the next several decades will increase the importance of medical, ethical, and health policy issues related to driving privileges. Physicians have a critical role in examining patients for driving competence and in screening for impairments that increase the risk of motor vehicle injuries. Both age-related and disease-related factors may affect driving ability in older adults. Research related to the impact of chronic diseases, medications, visual problems, and various neurologic disorders should provide guidance to clinicians in the assessment of driving ability. Performance-based functional assessment, including the use of driving simulators and road tests, may provide information that is useful in the evaluation and rehabilitation of possibly impaired older drivers. Further research related to human, vehicular, and environmental factors and the development of intervention strategies for prevention of crashes and crash-related injuries will reduce the risk of injury and death in older adults.