Frailty and driving ability in older adults within an integrated framework for healthy aging

Background Frailty is a multidimensional geriatric syndrome characterized by reduced physiological reserve, increased vulnerability, and loss of independence. Healthy aging frameworks emphasize intrinsic capacity and functional reserve as key determinants of functional ability. Driving requires the integration of physical, cognitive, sensory, and psychosocial functions and may serve as a practical indicator of functional reserve and healthy aging. Methods This narrative review examined the relationship between frailty-related multidomain decline and driving-related outcomes in older adults. Evidence regarding frailty, driving performance, driving restriction and cessation, mobility, healthy aging, exercise interventions, and emerging digital assessment technologies was synthesized. Results Frailty is associated with impaired driving performance, increased driving restriction, and a greater likelihood of driving cessation. Longitudinal studies suggest that changes in driving behavior, including reduced driving frequency, self-regulation, and mobility limitation, may precede clinically recognized disability and cognitive decline. Driving cessation is linked to reduced social participation, social isolation, depressive symptoms, physical frailty, and poorer quality of life. Exercise-based interventions may improve driving-related capacity through enhancements in physical fitness, cognitive function, sensorimotor integration, and psychosocial well-being. Emerging technologies, including telematics, wearable sensors, digital mobility monitoring, and artificial intelligence-based approaches, may facilitate early detection of functional vulnerability. Conclusions The Frailty–Driving–Health framework is presented as a conceptual synthesis that organizes evidence linking driving-related function with multidimensional vulnerability in later life. The Driving-Related Frailty Screen (DRF-Screen) is proposed as a candidate multidomain framework requiring future development and validation.