Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety

Longitudinal changes in life-space mobility and autonomy in participation outdoors among Finnish community-dwelling older adults from pre-COVID-19 to through the pandemic

BACKGROUND

Among older people, community mobility was reduced at the beginning of the COVID-19 pandemic, but the longer-term changes are unclear.

AIMS

To study lower extremity performance and car driving as predictors of changes in older adults' life-space mobility, autonomy in participation outdoors, and the risk of developing restricted life-space mobility from 2017 to 2022.

METHODS

Life-space mobility (scoring range 0-120) and autonomy in participation outdoors (scoring range 0-20) were assessed in community-dwelling individuals (n = 657) in 2017-2018 (baseline age 75, 80, or 85 years), during the first wave of COVID-19 in 2020, and in 2021-2022. Lower extremity performance was assessed using the Short Physical Performance Battery, and car driving was self-reported at baseline. Data were analysed using generalized estimating equations and Cox regression.

RESULTS

During the first wave of COVID-19 in 2020, life-space mobility decreased on average by 10.3 (SD 21.6) points and partially recovered in 2021-2022 (+ 2.7, SD 21.8). The same pattern was observed for autonomy in participation outdoors. Non-drivers and those with impaired lower extremity performance had a 2.4-to-3.6-fold adjusted risk of developing restricted life-space mobility over the follow-up period compared to drivers with intact lower extremity performance.

CONCLUSIONS

For older people, the recovery of community mobility was incomplete after the restrictions stemming from the pandemic were lifted. Older adults with impaired lower extremity performance and who did not drive were particularly vulnerable to developing restricted life-space mobility, a situation that could lead to social isolation and reduced well-being.

Driving safety: Investigating the cognitive foundations of accident prevention

Driving is a crucial aspect of personal independence, and accurate assessment of driving skills is vital for ensuring road safety. This study aimed to identify reliable cognitive predictors of safe driving through a driving simulator experiment. We assessed the driving performance of 66 university students in two distinct simulated driving conditions and evaluated their cognitive skills in decision-making, attention, memory, reasoning, perception, and coordination. Multiple regression analyses were conducted to determine the most reliable cognitive predictor of driving outcome. Results revealed that under favorable driving conditions characterized by good weather and limited interactions with other road users, none of the variables tested in the study were able to predict driving performance. However, in a more challenging scenario with adverse weather conditions and heavier traffic, cognitive assessment scores demonstrated significant predictive power for the rate of traffic infractions committed. Specifically, cognitive skills related to memory and coordination were found to be most predictive. This study underscores the significance of cognitive ability, particularly memory, in ensuring safe driving performance. Incorporating cognitive evaluations in driver licensing and education/training programs can enhance the evaluation of drivers' competence and promote safer driving practices.

Medication and Road Test Performance Among Cognitively Healthy Older Adults

Importance

Older adults are increasingly prescribed medications that have adverse effects. Prior studies have found a higher risk of motor vehicle crashes to be associated with certain medication use.

Objective

To determine whether specific medication classes were associated with performance decline as assessed by a standardized road test in a community sample of cognitively healthy older adults, to evaluate additional associations of poor road test performance with comorbid medical conditions and demographic characteristics, and to test the hypothesis that specific medication classes (ie, antidepressants, benzodiazepines, sedatives or hypnotics, anticholinergics, antihistamines, and nonsteroidal anti-inflammatory drugs or acetaminophen) would be associated with an increase in risk of impaired driving performance over time.

Design, Setting, and Participants

This was a prospective cohort study of 198 cognitively healthy adults 65 years and older with a valid driver's license who were followed up annually, with rolling enrollment. Data were collected from participants in St Louis, Missouri, and neighboring Illinois who were enrolled in the Knight Alzheimer's Disease Research Center. Data were collected from August 28, 2012, to March 14, 2023, and analyzed from April 1 to 25, 2023. Participants with healthy cognition, defined as a Clinical Dementia Rating score of 0 at baseline and subsequent visits, who had available clinical, neuropsychological, road tests, and self-reported medication data were included.

Exposure

Potentially driver-impairing medication use.

Main Outcomes and Measures

The primary outcome measure was performance on the Washington University Road Test (pass or marginal/fail). Multivariable Cox proportional hazards models were used to evaluate associations between potentially driver-impairing medication use and road test performance.

Results

Of the 198 included adults (mean [SD] baseline age, 72.6 [4.6] years; 87 female [43.9%]), 70 (35%) received a marginal/fail rating on the road test over a mean (SD) follow-up of 5.70 (2.45) years. Any use of antidepressants (adjusted hazard ratio [aHR], 2.68; 95% CI, 1.69-4.71), serotonin and norepinephrine reuptake inhibitors (aHR, 2.68; 95% CI, 1.54-4.64), sedatives or hypnotics (aHR, 2.70; 95% CI, 1.40-5.19), or nonsteroidal anti-inflammatory drugs (aHR, 2.72; 95% CI, 1.31-5.63) was associated with an increase in risk of receiving a marginal/fail rating on the road test compared with control individuals. Conversely, participants taking lipid-lowering agents had a lower risk of receiving a marginal/fail rating compared to control individuals. There were no statistically significant associations found between anticholinergic or antihistamines and poor performance.

Conclusions and Relevance

In this prospective cohort study, specific medication classes were associated with an increase in risk of poor road test performance over time. Clinicians should consider this information and counsel patients accordingly when prescribing these medications.

Exploring the Causal Impact of Age and Nighttime Driving on Road Traffic Injuries among Elderly Drivers: A Bayesian LASSO Approach

Objective

To determine the causal relationship between aging and nighttime driving and the odds of injury among elderly drivers.

Methods

In this cross-sectional study, 5460 car accidents were investigated from 2015 to 2016. The data were extracted from the Iranian Integrated Road Traffic Injury Registry System. Pedestrian accidents, motorcycle crashes, and fatalities were excluded from the study. To account for major confounders, Bayesian-LASSO, and treatment-effect cutting-edge approaches were used.

Results

Overall, 801 injuries (14.67%) were evaluated. The results of the univariable analysis indicated that aging and nighttime had adverse effects on the odds of road traffic injuries (RTIs), even after adjusting for the effect of other variables, these effects remained statistically significant. According to a newly developed approach, the overall effects of aging and nighttime were significantly and directly correlated with the odds of being injured for older adults (both p<0.001). Our findings indicated that drivers over 75 years old experienced 23% higher injury odds (OR=1.23, 95% CI:1.11 to 1.39; p<0.001), while driving at night increased the odds by 1.78 times (OR=1.78, 95% CI:1.51 to 1.83; p<0.001).

Conclusion

Aging and nighttime driving are significant risk factors for RTIs among elderly drivers. This highlights the importance of implementing targeted interventions to enhance road safety for this vulnerable population. Furthermore, the use of advanced Bayesian-LASSO and treatment-effect statistical methods highlights the importance of utilizing sophisticated methodologies in epidemiological research to effectively capture and adjust for potential confounding factors.

Older adult driving performance assessed under simulated and on-road conditions

Simulated driving offers a convenient test of driving ability for older drivers, although the viability of using simulated driving with this population is mixed. The relative weighting of the relevant perceptual, cognitive, and physical factors may vary between simulated and on-road driving. The current study was designed to assess this possibility. We conducted simulated and on-road driving tests of 61 older adults aged 66-92 years. To ensure that the driving performance was measured similarly between the two driving modalities, we employed the Record of Driving Errors (RODE) driving assessment system during both driving tests. Correlation and random weights analysis (RWA) results indicated only modest evidence of correspondence between the simulated and on-road driving performances. The primary factors operative in both simulated and on-road driving was Useful Field of View and a measure of basic cognition. Unique factors for simulated driving included a measure of physical mobility (Time-Up-and-Go) and spatial reasoning (Line), and for on-road driving included chronological age and sensorimotor processing (Trail-Making Task A). Chronological age was correlated primarily the on-road rather than simulated test, was greatly reduced with the inclusion of additional explanatory factors, and likely reflects driving efficiency rather than driving safety. We conclude that simulated driving in healthy older drivers can be beneficial for research purposes to assess cognitive and perceptual factors that underly driving effectiveness, although it cannot serve as a clear proxy for on-road driving.