A Preliminary Assessment of the Medical and Functional Factors Associated with Vehicle Crashes by Older Adults

Abstract

Functional assessments, such as a comprehensive test of visual processing, a falls history, and a review of current medications may be of greater relevance than specific medical conditions in the identification of older at-risk drivers. If prospective studies determine that falling and crashing share risk factors, a unified approach to the prevention of these mobility disorders could result. The finding of an independent association of black race with at-fault crashing is in need of further clarification because of the low representation of black drivers in this sample.

Mobility Impairments in Crash-Involved Older Drivers

“…In a casecontrol study of older health maintenance organization members who were injured in state-recorded motor vehicle crashes, Koepsell and colleagues noted a similarly marginal association of crashing with falls (OR 1.4; 95% CI 0.9-2.4) (1994). Although the fall crash association is weak, several studies document highly similar, if not identical, risk factors for falls and crashes in the elderly [Tinetti et al 1988, Nevitt et al 1989, Sims et al 1998, Fitten et al 1995, Foley et al 1995, Johansson et al 1996Koepsell et al 1994, Marottoli et al 1994. For example, sedative use, depression and cognitive impairment, among others, have been implicated in these events [Tinetti et al 1988and1995, Hemmelgarn et al 1997, Sims et al 1998, Fitten et al 1995.…”

“…Susceptible older adults consistently demonstrate multiple impairments due to the effects of medications, chronic medical conditions, affective disorders, and visual and cognitive dysfunction [Tinetti et al 1988, Nevitt et al 1989, Sims et al 1998, Fitten et al 1995, Foley et al 1995, Johansson et al 1996Koepsell et al 1994, Marottoli et al 1994.…”

Understanding Changing Risk Factor Associations With Increasing Age in Adults

“…For example, using thiazide diuretics for hypertension may decrease risk of hip fractures (32), and using beta-blockers for angina or hypertension may reduce the risk of auto crashes (55). Although this situation is complex and dependent on the particular scientific question, it seems likely that the presence of other conditions, detected or not, can affect study associations.…”

Neurologic Conditions: Assessing Medical Fitness to Drive

“…52 Compared to other visual and cognitive tools, there is a poor correlation using the UFOV with driving ability to predict collision rates. [53][54][55] …”