When a car driven by a 91-year-old killed a woman and left a man and boy with life-threatening injuries on Thursday, it reignited discussion over whether Victoria's rules for elderly drivers needed revisiting. The morning after the incident, acting premier Ben Carroll said whether the rules should change was "a valid question". "I will work with the road safety minister on this," Mr Carroll said. The tragedy followed another crash in March, when six-year-old Caleb Wesley died when an 84-year-old woman hit him on Bannockburn-Shelford Road at Teesdale. Unlike Queensland, New South Wales, and the ACT, Victoria does not require drivers aged 75 and over to have annual medical assessments to keep their licence. Western Australia also requires medical assessments past the age of 80, and in some states, bespoke driving tests for the elderly are required at the request of a doctor, or when drivers pass a certain age. In Victoria, there are no mandatory medical checks or driving tests for the elderly. While drivers are required to notify VicRoads if they develop conditions that could affect their driving — and they may be asked to complete a medical review — responsibility largely falls on the individual to decide if they are fit to drive. Older drivers have fewer crashes, expert says Victoria Police data shows in the five years to June 30, 2023, motorists aged 65 or older were responsible for at least 145 road deaths and more than 7,000 injuries. But University of Adelaide centre for automotive safety deputy director Matthew Baldock said older drivers actually had fewer crashes. "Older drivers are often sort of maligned as being a group with a higher-crash risk than other age groups, but research actually indicates the opposite," Dr Baldock said. "If you look at overall crash numbers, the older the age group, the smaller the overall crash numbers they're involved in." Crash rates per licensed driver showed older drivers had the lowest crash rate of any age group, which Dr Baldock said may be in part because they drove less frequently. He said research also did not suggest mandatory medical exams or requirements to re-test for the elderly resulted in safer roads. "In Victoria, there's no mandatory age-based assessments for older drivers and Victorian older-driver crash rates are certainly no higher than anywhere else in Australia," Dr Baldock said. For Dr Baldock, the biggest concern with older drivers was that their inherent frailty meant any crash was more likely to result in injury. Swinburne University associate professor Amie Hayley has also investigated whether mandatory assessments of older drivers made roads safer. She found such measures did not translate to a meaningful difference in crash rates. Steps taken in Japan to cognitively screen older drivers for conditions such as dementia suggested a possible solution, but those too came with drawbacks. "[They] did translate to a reduction in road traffic crashes but paradoxically that also resulted in a higher proportion of older pedestrians becoming injured," she said. "If we're looking at driving performance among older people and assessing their risk of crashes, it needs to be a system which can incorporate things like cognitive performance, mental acuity, but also physical health as well." Current rules lead the country, says advocate Ben Rogers, Council on the Ageing Victoria (COTA) chief executive, said Victoria led the country on older-driver policy, despite having less screening. "Driving should be based on ability and not your age," he said. "A system that is based on ability rather than age is more likely to capture, for instance, when someone who is aged 45 who really should not be driving, should be taken off the road." Mr Rogers said he wanted to see more proactive support for drivers. "For instance, we have previously called for greater investment in driver-awareness programmes, which can often be inaccessible due to cost," he said. Mr Rogers said the presumption older drivers were more at risk or more at fault was ageist, adding that consideration had to be given to the isolation and mental health impact of an older person having their licence taken off them. Anita Muñoz, Royal Australian College of General Practitioners Victoria chair, said the organisation did not believe Victoria should impose mandatory annual medical check. But those over 65 should be asking their GP for help answering the question of whether they should keep driving, it said. While advanced age was not innately a barrier to safe driving, Dr Muñoz said people's reflexes, ability to see clearly, and judgement all changed as they aged. "Everyone of any age must recognise their personal responsibility for the actions that they take. If you drive a car, you need to be certain that you will be a safe driver," she said. Shadow minister for road safety, Danny O'Brien, said regulation change was not needed. "While this is a terrible tragedy, we need to avoid hasty responses that might unfairly tarnish older drivers," he said. "The law already requires drivers to be medically fit for driving, and we support that." The rules across Australia In Victoria, there are no mandatory medical checks or driving tests for the elderly. But all motorists are required by law to notify authorities if they have any illness that may prevent them from driving safely. If a driver is 75 years of over, they are offered the option to renew their licence every three years, rather than every 10 years. New South Wales From age 70, drivers with a multi-combination (MC) licence (required for the largest and most complex trucks and vehicles) require an annual medical assessment and bespoke test for older drivers. From 75, all licence holders are required to have medical assessments to assess their fitness to drive annually, and bespoke driver tests are required if a doctor recommends one. From 85, the same annual medical assessments are required, and driver tests are mandatory every two years. From age 75, drivers are required to have a doctor assess their medical fitness to drive every year and drivers must carry a current medical certificate while driving, issued by the doctor. Doctors can issue medical certificates for less than a year, if they feel more regular checks are required. Driving without a certificate can result in a fine of $161. South Australia Drivers and doctors are required by law to report medical conditions that affect ability to drive to the Registrar of Motor Vehicles. Such conditions can include alcohol or drug dependence, dementia, heart conditions, strokes, arthritis, eye issues, or blackouts. Elderly drivers can be required to undergo medical assessments, self-assessment and/or a practical driving assessment. Drivers are sent a self-assessment annually in the mail to complete from the age of 75. From 85, licence holders for other vehicles have to do an annual practical driving test, but this is not required of car drivers. Western Australia At 80, drivers must undergo an annual medical assessment before they can renew their licence. Mandatory practical driving assessments are not required by drivers aged 85 and older, unless recommended by a medical professional. However, these drivers still have to complete a licence renewal declaration. In the past, compulsory annual driving assessments for Tasmanian drivers aged 85 or older were required, but this rule was scrapped in 2011, and it is now the elderly driver's responsibility to regularly assess their own fitness to drive. Older drivers are required to disclose any conditions that might affect their driving ability, and the valid period of licences issued after the driver turns 65 is five years. Drivers aged 75 and over need to get annual medical assessments from their doctor. Drivers with heavy vehicle licences aged 70 and over also require annual medical examinations. Northern Territory The rules are similar to Victoria — there are no compulsory checks for older drivers. But drivers with a medical condition that may affect their ability to drive need to declare them to authorities.