Association between road vehicle collisions and recent medical contact in older drivers: a case-crossover study

Abstract

Objective: To estimate the association between past medical contacts and the risk of vehicle collision in a population of older drivers from the province of Quebec, Canada. Design: Case-crossover study. Setting: Quebec. Participants: 111 699 older drivers involved in at least one vehicle collision between January 1988 and December 2000. Main outcome measures: For each driver, the risk of having a vehicle collision while exposed and not exposed to a medical contact was compared. Separate conditional logistic regression analyses were conducted for all drivers and in four diagnostic-specific subgroups. Results: The study found a weak but statistically significant increased risk of all collisions being associated with a medical contact within 1 month before the collision, for all drivers (OR = 1.10, 95% CI 1.08 to 1.11) and for drivers with diabetes (OR = 1.07, 95% CI 1.03 to 1.11). Conclusion: Older drivers who have a collision are more likely to have been in contact with a physician shortly before the collision. These findings suggest that there might be an opportunity to detect medical conditions that put older drivers at higher risk of collision; however, further research is needed to assess the potential effectiveness and practical modalities of screening. B y 2030, one-quarter of the population in the member countries of the Organization for Economic Co-operation and Development will be aged 65 years and older.

Comparing responsible and non-responsible drivers to assess determinants of road traffic collisions: time to standardise and revisit

“…A time window just before a RTC or RTI is considered the case period and a time window appropriately selected in the previous weeks or months is considered the control period for that case. Case-crossover studies, however, are only appropriate to study the effect of short-term exposures, such as the recent medical contacts4 or phone calls,5 on the risk of RTC.…”

Risks and Advantages of Detecting Individuals Unfit to Drive: A Markov Decision Analysis

“…The only screening strategy that may be feasible and effective in real conditions would be the single-test screening strategy for dementia, targeted at drivers aged 85 years and older seen in a primary care practice. However, in the absence of valid diagnostic tools, there are multiple barriers to formal assessment of driving competences of drivers with dementia Nevertheless, a recent study indicated that a medical contact, associated with an increased risk of crash in a population of older drivers from Quebec, could represent an opportunity to detect drivers potentially at risk 45 . However, the acceptability and feasibility for the primary care physician to use a battery of tests to detect inability to drive in all patients of various ages are likely to be low.…”

Assessing fitness to drive in the elderly and those with medical conditions: guidelines should specify methods and evidence

“…Physicians are important first-line actors in potential early detection programmes 27. They have the skills to assess the physical and psychological abilities of patients, and to discuss the positive and negative personal consequences of any post-screening interventions.…”