As the overall population ages, driving-related accidents and injuries, associated with elderly drivers, have risen. Existing research about elderly drivers mainly focuses on factual data collection and analysis, indicating the elderly's growing fatal accident rates and their different behaviours compared to younger drivers. However, few research has focused on design-led practical solutions to mitigate the elderly's growing fatal accidents, by considering their usability and body conditions, afflicting the elderly, such as decreased vision, hearing, and reaction times. In this paper, first, current worldwide situations on growing fatal accident rates for elderly drivers is reviewed and the key impact factors are identified and discussed with regarding to usability and design trend in the automotive technology for elderly. Second, existing smart vehicle technology-based solutions to promote safe driving are explored and their pros and cons are discussed and analysed. Most of solutions are not created by people with driving difficulties, which are caused by health problems most commonly afflicting the elderly. Thirdly, diverse design-led research activities are taken such as a survey, observation, and interviews to gain new understanding of what kinds of driving problems elderly drivers have and demonstrate how new system concepts could be developed for the elderly's benefits. Finally, it is found that the elderly's low vision and late reaction are main factors causing their driving difficulties. Based on this finding, usable vehicle system design ideas have been proposed, by utilising facial expression sensing technology as a solution. The proposed solutions would ensure reducing both the elderly's driving problems and high fatal accident rates and provide a more enjoyable driving environment for the elderly population.