Despite the proliferation of motor vehicles and the increase in number of miles traveled in this country during the past century, motor vehicle safety has improved. The annual death rate has declined dramatically since it was first measured in 1925. However, motor vehicle accidents remain the leading cause of injury death in children and young and middle-aged adults and the third leading cause of years of potential life lost prior to age 65, behind cancer and heart disease. There are some regional and vehicular factors, with higher motor vehicle death rates in the southeast and in scattered western states. The highest rates of vehicular fatalities are in the youngest and oldest drivers, their passengers, and in all who drive under the influence of alcohol or as a passenger in a car driven by someone under the influence. Medical conditions may also compromise driving ability and/or increase fatality rate in adults of all ages. These conditions and situations, particularly as applied to older adults, are presented here.