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Nguyen H, Di Tanna GL, Coxon K, Brown J, Ren K, Ramke J, Burton MJ, Gordon I, Zhang JH, Furtado J, Mdala S, Kitema GF, Keay L. Associations between vision impairment and vision-related interventions on crash risk and driving cessation: systematic review and meta-analysis. BMJ Open 2023; 13:e065210. [PMID: 37567751 PMCID: PMC10423787 DOI: 10.1136/bmjopen-2022-065210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs. DESIGN Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis. PARTICIPANTS Drivers of four-wheeled vehicles of all ages with no cognitive declines. PRIMARY AND SECONDARY OUTCOMES MVC involvement (primary) and driving cessation (secondary). RESULTS 101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I2=46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I2=0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I2=28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I2=93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I2=3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I2=22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I2=75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I2=63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I2=97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD. CONCLUSION Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety. PROSPERO REGISTRATION NUMBER CRD42020172153.
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Affiliation(s)
- Helen Nguyen
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Kristy Coxon
- School of Health Sciences, and the Translational Health Research Institute, Western Sydney University-Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Julie Brown
- George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kerrie Ren
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Justine H Zhang
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - João Furtado
- Division of Ophthalmology, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Shaffi Mdala
- Ophthalmology Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Gatera Fiston Kitema
- Ophthalmology Department, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
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Savoie C, Lavallière M, Voyer P, Bouchard S. Road safety of older drivers and the nursing profession: A scoping review. Int J Older People Nurs 2022; 17:e12452. [DOI: 10.1111/opn.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/05/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Camille Savoie
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
| | - Martin Lavallière
- Département des Sciences de la Santé Université du Québec à Chicoutimi Chicoutimi Quebec Canada
| | - Philippe Voyer
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
| | - Suzanne Bouchard
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
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Ng LS, Guralnik JM, Man C, DiGuiseppi C, Strogatz D, Eby DW, Ryan LH, Molnar LJ, Betz ME, Hill L, Li G, Crowe CL, Mielenz TJ. Association of Physical Function With Driving Space and Crashes Among Older Adults. THE GERONTOLOGIST 2020; 60:69-79. [PMID: 30624694 DOI: 10.1093/geront/gny178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Balancing both driver mobility and safety is important for the well-being of older adults. However, research on the association of physical function with these 2 driving outcomes has yielded inconsistent findings. This study examined whether physical functioning of older drivers, as measured by the Short Physical Performance Battery (SPPB), is associated with either driving space or crash involvement. METHODS Using cross-sectional data of active drivers aged 65-79 years from the AAA Longitudinal Research on Aging Drivers (LongROAD) study (n = 2,990), we used multivariate log-binomial and logistic regressions to estimate the associations of the SPPB with either self-reported restricted driving space in the prior 3 months or any crashes in the past year. Interaction with gender was assessed using likelihood ratio tests. RESULTS After adjustment, older drivers with higher SPPB scores (higher physical functioning) had lower prevalence of restricted driving space (8-10 vs. 0-7, prevalence ratio [PR] = 0.88, 95% confidence interval [CI]: 0.78-0.99; 11-12 vs. 0-7, PR = 0.78, 95% CI: 0.61-0.99). Fair (8-10), but not good (11-12), scores were significantly associated with reduced crash involvement (8-10 vs. 0-7, odds ratio [OR] = 0.71, 95% CI: 0.60-0.84). Gender was not a significant effect modifier. DISCUSSION AND IMPLICATIONS This study provides evidence that higher physical functioning is associated with better driving mobility and safety and that the SPPB may be useful for identifying at-risk drivers. Further research is needed to understand physical functioning's longitudinal effects and the SPPB's role in older driver intervention programs.
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Affiliation(s)
- Linda S Ng
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Jack M Guralnik
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland Medical System, Baltimore
| | - Cora Man
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | | | - David Strogatz
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, New York
| | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor
| | - Lindsay H Ryan
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor
| | - Marian E Betz
- Department of Epidemiology, Colorado School of Public Health, Aurora.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Linda Hill
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla
| | - Guohua Li
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York
| | - Christopher L Crowe
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Thelma J Mielenz
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
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Azarbarzin A, Younes M, Sands SA, Wellman A, Redline S, Czeisler CA, Gottlieb DJ. Interhemispheric sleep depth coherence predicts driving safety in sleep apnea. J Sleep Res 2020; 30:e13092. [PMID: 32441843 DOI: 10.1111/jsr.13092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
Obstructive sleep apnea is associated with increased risk of car crashes; however, conventional measures of sleep apnea severity do not clearly identify those individuals who are at greatest risk. Here we tested whether, among individuals with sleep apnea, those with reduced interhemispheric sleep depth coherence, measured by correlation between right and left hemisphere odds ratio product, are at greater risk. The sample was derived from the Sleep Heart Health Study, a prospective observational cohort study, and included 1,378 adults with sleep apnea. The occurrence of a car crash was ascertained by a questionnaire administered 2 years after the sleep study, which asked about the occurrence of crashes during the year prior to questionnaire administration. We computed the sleep depth coherence from electroencephalograms recorded during baseline sleep studies and after 5 years. The weighted kappa coefficient and Bangdiwala's B were 0.34 and 0.59, respectively, indicating a fair to moderate stability over a 5-year interval. Multivariate logistic regression, adjusted for age, sex, race, body mass index and miles driven per year, was used to assess the risk of a car crash. Compared to the lowest quartile of sleep depth coherence (<0.86), individuals in the highest quartile (>0.93) had a 62% (95% confidence interval, 22%-81%) lower risk of an accident. Further adjustments for usual sleep duration and sleepiness did not meaningfully alter these findings. Higher interhemispheric sleep depth coherence is associated with significantly lower risk of motor vehicle crashes in individuals with sleep apnea. This suggests that high interhemispheric sleep depth coherence may be a marker of resistance to sleep apnea-related adverse neurocognitive outcomes.
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Affiliation(s)
- Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Magdy Younes
- Sleep Disorders Center, University of Manitoba, Winnipeg, MB, Canada
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
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5
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Porter MM. An examination of the concordance between self-reported collisions, driver records, and insurance claims in older drivers. JOURNAL OF SAFETY RESEARCH 2018; 67:211-215. [PMID: 30553426 DOI: 10.1016/j.jsr.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/28/2018] [Accepted: 07/12/2018] [Indexed: 06/09/2023]
Abstract
Background Previous studies of older drivers have found that there are discrepancies between their retrospective self-reports of collisions and the official jurisdictional record. Objectives The purpose of this study was to examine how older drivers self-report collisions in comparison to what was recorded in their official driver abstract as well as insurance claims, in a prospective study. Methods Participants (n = 125, age ≥ 70 years) in this study were part of the University of Manitoba site of the Candrive longitudinal study of older drivers. During the operation of the Manitoba site (2009 to 2013), participants were periodically asked to report on any collisions (at-fault or not) in which they were involved, while they were enrolled in the study. In addition, driver records (abstracts and insurance claims) from the provincial licensing agency and public insurer (Manitoba Pubic Insurance; MPI) were provided annually. Results In total there were 101 separate instances of collisions (regardless of at-fault status), whether self-reported, or recorded by MPI. There were 20 at-fault collisions that were recorded on the driver abstract. Eighteen of these collisions were self-reported by participants. In total, our participants were involved in 70 insurance claims (42 at-fault) - 61 of these were self-reported to study staff. In addition, there were 31 collisions that were self-reported to study staff, that were not reported to MPI. Conclusions In this prospective study, older drivers were diligent in reporting collisions in which they were involved. While some collisions were not reported that ultimately became a claim or part of their driver abstract, the biggest discrepancy was in the collisions that were reported to study staff but that were not reported to authorities.
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Affiliation(s)
- Michelle M Porter
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada; Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada.
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Thompson T, Poulter D, Miles C, Solmi M, Veronese N, Carvalho AF, Stubbs B, Uc EY. Driving impairment and crash risk in Parkinson disease: A systematic review and meta-analysis. Neurology 2018; 91:e906-e916. [PMID: 30076275 DOI: 10.1212/wnl.0000000000006132] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To provide the best possible evidence base for guiding driving decisions in Parkinson disease (PD), we performed a meta-analysis comparing patients with PD to healthy controls (HCs) on naturalistic, on-the-road, and simulator driving outcomes. METHODS Seven major databases were systematically searched (to January 2018) for studies comparing patients with PD to HCs on overall driving performance, with data analyzed using random-effects meta-analysis. RESULTS Fifty studies comprising 5,410 participants (PD = 1,955, HC = 3,455) met eligibility criteria. Analysis found the odds of on-the-road test failure were 6.16 (95% confidence interval [CI] 3.79-10.03) times higher and the odds of simulator crashes 2.63 (95% CI 1.64-4.22) times higher for people with PD, with poorer overall driving ratings also observed (standardized mean differences from 0.50 to 0.67). However, self-reported real-life crash involvement did not differ between people with PD and HCs (odds ratio = 0.84, 95% CI 0.57-1.23, p = 0.38). Findings remained unchanged after accounting for any differences in age, sex, and driving exposure, and no moderating influence of disease severity was found. CONCLUSIONS Our findings provide persuasive evidence for substantive driving impairment in PD, but offer little support for mandated PD-specific relicensure based on self-reported crash data alone, and highlight the need for objective measures of crash involvement.
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Affiliation(s)
- Trevor Thompson
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
| | - Damian Poulter
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Clare Miles
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Marco Solmi
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Nicola Veronese
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - André F Carvalho
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Brendon Stubbs
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Ergun Y Uc
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
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Duncanson H, Hollis AM, O'Connor MG. Errors versus speed on the trail making test: Relevance to driving performance. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:125-130. [PMID: 29407659 DOI: 10.1016/j.aap.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/14/2017] [Accepted: 01/06/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND/OBJECTIVES Many studies have demonstrated that speed to complete items on the Trail Making Tests (TMT A and TMT B) is useful in the prediction of driving safety. However, there is no consensus regarding optimal "cut scores" to discriminate between safe and unsafe drivers. In this study, we examine TMT speed and errors in drivers referred for a road test. DESIGN Retrospective analysis. SETTING Patients referred for a DriveWise® evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts. PARTICIPANTS Drivers age 65 or older were included (total n = 373). Forty-five percent of the sample had been diagnosed with Cognitive Impairment (CI) whereas the remaining participants were in the No Cognitive Impairment (NCI) group. MEASUREMENTS TMT Parts A & B, Folstein Mini Mental Status Examination, Washington University Road Test. RESULTS CI drivers with TMT A speed exceeding 46 s were more likely to fail the road test whereas TMT B speed was not a sensitive metric in this group. In the No Cognitive Impairment (NCI) group, TMT B speed exceeding 131 s predicted driving impairment whereas TMT A speed was not sensitive. Error scores were not useful in the determination of driving fitness for either group. CONCLUSIONS This study provides useful criteria for health providers working with older people in the determination of driving fitness. Results suggest that TMT speed, but not error rate, is associated with road test performance. Based on our work, we advocate that pre-existing dementia should be taken into consideration when using TMT performance as a screen for driving.
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Affiliation(s)
- Haley Duncanson
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States; Harvard Medical School, United States.
| | - Ann M Hollis
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States
| | - Margaret G O'Connor
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States; Harvard Medical School, United States
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Gottlieb DJ, Ellenbogen JM, Bianchi MT, Czeisler CA. Sleep deficiency and motor vehicle crash risk in the general population: a prospective cohort study. BMC Med 2018; 16:44. [PMID: 29554902 PMCID: PMC5859531 DOI: 10.1186/s12916-018-1025-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/12/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Insufficient sleep duration and obstructive sleep apnea, two common causes of sleep deficiency in adults, can result in excessive sleepiness, a well-recognized cause of motor vehicle crashes, although their contribution to crash risk in the general population remains uncertain. The objective of this study was to evaluate the relation of sleep apnea, sleep duration, and excessive sleepiness to crash risk in a community-dwelling population. METHODS This was a prospective observational cohort study nested within the Sleep Heart Health Study, a community-based study of the health consequences of sleep apnea. The participants were 1745 men and 1456 women aged 40-89 years. Sleep apnea was measured by home polysomnography and questionnaires were used to assess usual sleep duration and daytime sleepiness. A follow-up questionnaire 2 years after baseline ascertained driving habits and motor vehicle crash history. Logistic regression analysis was used to examine the relation of sleep apnea and sleep duration at baseline to the occurrence of motor vehicle crashes during the year preceding the follow-up visit, adjusting for relevant covariates. The population-attributable fraction of motor vehicle crashes was estimated from the sample proportion of motor vehicle crashes and the adjusted odds ratios for motor vehicle crash within each exposure category. RESULTS Among 3201 evaluable participants, 222 (6.9%) reported at least one motor vehicle crash during the prior year. A higher apnea-hypopnea index (p < 0.01), fewer hours of sleep (p = 0.04), and self-reported excessive sleepiness (p < 0.01) were each significantly associated with crash risk. Severe sleep apnea was associated with a 123% increased crash risk, compared to no sleep apnea. Sleeping 6 hours per night was associated with a 33% increased crash risk, compared to sleeping 7 or 8 hours per night. These associations were present even in those who did not report excessive sleepiness. The population-attributable fraction of motor vehicle crashes was 10% due to sleep apnea and 9% due to sleep duration less than 7 hours. CONCLUSIONS Sleep deficiency due to either sleep apnea or insufficient sleep duration is strongly associated with motor vehicle crashes in the general population, independent of self-reported excessive sleepiness.
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Affiliation(s)
- Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, 221 Longwood Ave, BLI 225E, Boston, MA, 02115, USA.
- VA Boston Healthcare System, Boston, MA, USA.
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | - Jeffrey M Ellenbogen
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Matt T Bianchi
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, 221 Longwood Ave, BLI 225E, Boston, MA, 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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