As Virginia’s elderly population continues to grow, folks across the state are wrestling with whether to give up driving, or whether to coax an older family member to give up driving.

But when someone who struggles to drive doesn’t give up his license voluntarily, there is a process by which the Department of Motor Vehicles can take it away or restrict it.

It’s a process with which former Suffolk mayor Andy Damiani, 92, is intimately familiar. He recently had to submit documents showing a recent physical and eye exam after someone — he doesn’t know who — reported to DMV that his license should be reviewed.

“I got the notice, and I did what they told me to do,” he said. “I have not heard anything. I don’t know if I’m in the clear or not.”

Damiani says he has voluntarily given up nighttime driving and driving out of town. His family in Virginia Beach picks him up when they want him to visit, he said.

“I’m sane and in good health,” Damiani said. “I do things that a lot of people don’t do much younger than me.”

The medical review process is conducted thousands of times a year, said Sunni Brown, a spokeswoman for the DMV.

In 2012, the DMV received 4,502 referrals for medical reviews, about 42 percent of which were for older drivers. The number stays fairly consistent from year to year, she said.

The review process can apply to someone of any age that could be having trouble driving because of a health issue. Pretty much anybody can refer a driver to DMV, Brown said.

“It could be law enforcement, someone within DMV, a family member, a neighbor … anyone can report a person they believe may have impaired driving ability for us to take a look at.”

Drivers who are referred could be asked to submit statements from physicians regarding any aspect of their health that affects safe driving — loss of motor function, reaction time, seizures, vision changes and the like. They could also be asked to undergo various assessments such as a knowledge exam or a road skills test.

“It’s not the same for everybody,” Brown said. “It depends on what the situation is, and that’s why we have folks that evaluate on a case-by-case basis.”

Once the process is over, the medical review team could decide to revoke, temporarily suspend or restrict a license or require the driver to submit periodic statements.

Common license restrictions the medical review team requires are daytime-only driving, no interstate driving, driving only on roads where the speed limit is 45 miles per hour or less and driving only within a certain radius of their home.

Elderly drivers are a concern throughout the state, according to the Mature Drivers Study conducted last year in response to a General Assembly request. Drivers 65 and older comprise only 16.1 percent of licensed drivers in the state. They have fewer crashes per licensed driver, but when they are involved in crashes, they have a higher likelihood to be found at fault and to suffer injury or die. They also have a higher rate of crashes per miles driven than middle-aged drivers, though not quite as high as drivers in their teens and early 20s.

The General Assembly has enacted a few new laws based on recommendations in the report.

Drivers age 75 and older now will be required to renew their license in person so they can pass a vision test. That requirement presently only applies to those 80 and above.

There also will be a five-year limit on how long a license can be renewed for someone 75 or older.

The code also has been amended to give judges the option of requiring drivers to attend a “mature driver motor vehicle crash prevention course,” which would cover special topics of concern to older drivers and update them on new laws and recommendations that may have come into existence since they started driving.