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“You don’t want to go around and say, ‘This person is 85. We’ve got to take them off the road.’ That wouldn’t be fair,” said Assemblyman David Gantt of New York, where licenses last for eight years.

On the other side is the family of a Baltimore college student who died last year after being run over by an 83-year-old driver who turned into his bike lane. Maryland next month begins issuing licenses that last longer — eight years instead of five — despite an emotional appeal from the mother of Nathan Krasnopoler that that’s too long for the oldest drivers.

“You should be looking at your drivers to be sure they’re able to safely drive. There’s plenty of research that as we age, things do change and we may not be aware of those changes,” said Susan Cohen, who now is urging Maryland officials to study adding some form of competency screening, in addition to the required eye exams, to license renewals.

“Do we have to lose a 20-year-old with an incredible future ahead of him in order to determine that this particular driver shouldn’t be driving?” she asked.

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Traffic challenges change for older drivers, who are less likely than younger ones to be in crashes involving alcohol or speeding. Instead, they have more trouble with intersections, making left turns, and changing lanes or merging, because of gradual declines in vision, reaction times and other abilities, according to the National Institutes of Health.

Scientists are hunting screening tests to check for such things as early warning signs of cognitive problems that might signal who’s more at risk. But such screenings are a long way from the local license office. In a closely watched pilot project, California tried a three-step screening process to detect drivers who might need a road test before getting their licenses renewed — but it didn’t reduce crashes, sending researchers back to the drawing board.

Today, AAA’s Nelson said in-person renewals are “the single most effective thing states can do to improve safety.”

That’s because workers in the driver’s license office can be trained to look for signs of confusion or trouble walking as people come in — two big clues that they may have trouble behind the wheel — and refer those drivers for a road test or a medical exam to see if there’s really a problem.

Virginia, for example, lets even the oldest drivers hold a license for eight years, but starting at 80 they must renew in person and pass an eye test. California has five-year renewals, and starting at 70 they must be in-person with both a written test and eye check.

Those eye tests can make a difference. In senior-filled Florida, 80-year-olds renew their licenses every six years instead of every eight, with a vision check each time. A study found highway deaths among Florida’s older drivers dropped 17 percent after the vision test was mandated in 2003.

How long between renewals is best? There’s no scientific consensus, but Nelson recommends every four to six years.

Another big key: Programs that make it easy for doctors, police and family members to alert licensing officials to possibly unsafe drivers of any age, so the experts can investigate. But in states that don’t allow confidential reporting, families in particular hesitate in fear of backlash if upset relatives learn who turned them in.

Utah adopted confidential reporting in 2008 “to encourage more people to report problematic drivers without the risk of retaliation of repercussion,” said Chris Caras of Utah’s Department of Public Safety.

Nor should the question be only whether someone should drive or not: Iowa is leading a growing number of states that customize license restrictions to allow people to stay on the road under certain conditions. People with early-stage Alzheimer’s or Parkinson’s disease, for instance, may qualify for a one-year license; people with other health conditions may be allowed to drive only during the day or within a few miles of home.

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