Older drivers have elevated crash rates and are more likely to be injured or die if they have a crash. Medical conditions and medications have been hypothesized as determinants of crash involvement. This population-based case-control study sought to identify medical conditions and medications associated with risk of at-fault crashes among older drivers. A total of 901 drivers aged 65 years and older were selected in 1996 from Alabama Department of Public Safety driving records: 244 at-fault drivers involved in crashes; 182 not at-fault drivers involved in crashes; and 475 drivers not involved in crashes were enrolled. Information on demographic factors, chronic medical conditions, medications, driving habits, visual function, and cognitive status was collected. Older drivers with heart disease (odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.0, 2.2) or stroke (OR = 1.9, 95% CI: 0.9, 3.9) were more likely to be involved in at-fault automobile crashes. Arthritis was also associated with an increased risk among females (OR =1.8, 95% CI: 1.1, 2.9). Use of nonsteroidal antiinflammatory drugs (OR = 1.7, 95% CI 1.0, 2.6), angiotensin converting enzyme inhibitors (OR = 1.6, 95 CI: 1.0, 2.7), and anticoagulants (OR = 2.6, 95% CI: 1.0, 73) was associated with an increased risk of at-fault involvement in crashes. Benzodiazepine use (OR = 5.2, 95% CI: 0.9, 30.0) was also associated with an increased risk. Calcium channel blockers (OR = 0.5, 95% CI: 0.2, 0.9) and vasodilators (OR = 0.3, 95% CI: 0.1, 1.0) were associated with a reduced risk of crash involvement. The identification of medical conditions and medications associated with risk of crashes is important for enhancing the safety and mobility of older drivers.

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OBJECTIVES:To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change. DESIGN:Prospective, observational, cohort study. PARTICIPANTS:Nine hundred and five community-dwelling older adults. MEASURES:Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up. RESULTS:African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 ± ± ± ± standard deviation [SD] 24.5 vs. 72.7 ± ± ± ± SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites. CONCLUSIONS:There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility. 16 found that older African Americans were more likely than whites to show both improvement and decline in measures of physical performance; however, the limited number of African Americans in most prospective studies has made it difficult to assess racial differences in predictors of function. Prospective studies are needed to identify modifiable risk factors for functional loss and to understand the causes for disparities in function for older African Americans and whites. Such data are also needed to guide the development of interventions to eliminate racial differences. Life-space is a spatial measure of mobility describing the area through which a person moves over a specified time period. 6,7,[17][18][19][20] A life-space assessment incorporating where a person goes, the frequency of going there, and the need for assistance, can be used to define the full continuum and changes in mobility among community-dwelling older adults and provides a method to evaluate the impact of sociodemographic factors, diseases, geriatric syndromes, neuropsychological factors, and health behaviors on mobility change. We hypothesize that changes in life-space mobility precede adverse health outcomes such as nursing home placement and death (Fi...