Frequent falling and motor vehicle collision involvement of older drivers

Enhancing Driving Ability in Older Adults through Health Exercises and Physical Activity: A Randomized Controlled Trial

The global rise in the aging driving population has heightened concerns about traffic incidents involving this demographic. Beyond transportation, automobiles represent a vital lifeline for older adults, fostering social activities and influencing their health-related quality of life. This study explores improving and sustaining driving ability among older adults with anticipated declines through health-conscious exercises. Sixty-eight participants were randomly allocated into two groups. The exercise-oriented group (E-group) engaged in twelve 90 min health and exercise sessions over twelve weeks, while the control group (C-group) maintained their regular daily routines and did not receive any specific interventions during this period. The focal point of assessment was driving ability, as evaluated by a person using a real car on public roads without using a simulator. Driving ability and physical fitness were assessed before the intervention in both groups. Post-intervention measurements occurred twelve weeks after the initial gauging, encompassing both cohorts. Comparative analysis of pre- and post-intervention changes was executed between the two groups. The E-group demonstrated improved overall driving ability compared to the C-group. The results suggest that healthy exercise and physical activity may maintain and enhance driving ability for older adults.

BOLD signal response in primary visual cortex to flickering checkerboard increases with stimulus temporal frequency in older adults

Many older adults have difficulty seeing brief visual stimuli which younger adults can easily recognize. The primary visual cortex (V1) may induce this difficulty. However, in neuroimaging studies, the V1 response change to the increase of temporal frequency of visual stimulus in older adults was unclear. Here we investigated the association between the temporal frequency of flickering stimuli and the BOLD activity within V1 in older adults, using surface-based fMRI analysis. The fMRI data from 29 healthy older participants stimulated by contrast-reversing checkerboard at temporal flicker frequencies of 2, 4, and 8 Hz were obtained. The participants also performed a useful field of view (UFOV) test. The slope coefficient of BOLD activity regarding the temporal frequency of the visual stimulus averaged within V1 regions of interest was positive and significantly different from zero. Group analysis in the V1 showed significant clusters with positive slope and no significant clusters with a negative slope. The correlation coefficient between the slope coefficient and UFOV performance was not significant. The results indicated that V1 BOLD response to a flickering visual stimulus increases as the stimulus temporal frequency increases from 2 to 8 Hz in older adults.

Assessing Fitness-To-Drive among Older Drivers: A Comparative Analysis of Potential Alternatives to on-Road Driving Test

To enable older drivers to maintain mobility without endangering public safety, it is necessary to develop more effective means of assessing their fitness-to-drive as alternatives to an on-road driving test. In this study, a functional ability test, simulated driving test, and on-road driving test were carried out for 136 older drivers. Influencing factors related to fitness-to-drive were selected based on the correlation between the outcome measure of each test and the pass/fail outcome of the on-road driving test. Four potential alternatives combining different tests were considered and three modeling techniques were compared when constructing the fitness-to-drive assessment model for the elderly. As a result, 92 participants completed all of the tests, of which 61 passed the on-road driving test and the remaining 31 failed. A total of seven influencing factors from all types of tests were selected. The best model was trained by the technique of gradient boosted machine using all of the seven factors, generating the highest accuracy of 92.8%, with sensitivity of 0.94 and specificity of 0.90. The proposed fitness-to-drive assessment method is considered an effective alternative to the on-road driving test, and the results offer a valuable reference for those unfit-to-drive older drivers to either adjust their driving behavior or cease driving.

Odds ratios from logistic, geometric, Poisson, and negative binomial regression models

Background

The odds ratio (OR) is used as an important metric of comparison of two or more groups in many biomedical applications when the data measure the presence or absence of an event or represent the frequency of its occurrence. In the latter case, researchers often dichotomize the count data into binary form and apply the well-known logistic regression technique to estimate the OR. In the process of dichotomizing the data, however, information is lost about the underlying counts which can reduce the precision of inferences on the OR.

Methods

We propose analyzing the count data directly using regression models with the log odds link function. With this approach, the parameter estimates in the model have the exact same interpretation as in a logistic regression of the dichotomized data, yielding comparable estimates of the OR. We prove analytically, using the Fisher information matrix, that our approach produces more precise estimates of the OR than logistic regression of the dichotomized data. We also show the gains in precision using simulation studies and real-world datasets. We focus on three related distributions for count data: geometric, Poisson, and negative binomial.

Results

In simulation studies, confidence intervals for the OR were 56–65% as wide (geometric model), 75–79% as wide (Poisson model), and 61–69% as wide (negative binomial model) as the corresponding interval from a logistic regression produced by dichotomizing the data. When we analyzed existing datasets using our approach, we found that confidence intervals for the OR could be up to 64% shorter (36% as wide) compared to if the data had been dichotomized and analyzed using logistic regression.

Conclusions

More precise estimates of the OR can be obtained directly from the count data by using the log odds link function. This analytic approach is easy to implement in software packages that are capable of fitting generalized linear models or of maximizing user-defined likelihood functions.

Electronic supplementary material

The online version of this article (10.1186/s12874-018-0568-9) contains supplementary material, which is available to authorized users.

Driving Dilemmas: A Guide to Driving Assessment in Primary Care

Clinical assessment of fitness to drive can be a challenging part of primary care of older adults. There are no guidelines on screening for driver safety, so it falls to provider judgment on when to assess older drivers. This review offers recommendations on when to assess for driver safety based on red flag conditions, medications, acute events, and patient or family concerns. It reviews how to assess for visual, cognitive, and neuromuscular impairments and what to do as next steps for at-risk drivers once they are identified. Laws regarding driver reporting are also reviewed.

Relationship between areas of cognitive functioning on the Mini-Mental State Examination and crash risk

Previous studies have suggested that the pattern of cognitive impairment in crash-involved older drivers is different from non-crash-involved older drivers. This study assessed the relationship between seven areas of cognitive functioning (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction) on the Mini-Mental State Examination (MMSE) collected at baseline and rates of future crash involvement in a prospective population-based sample of older drivers. Motor vehicle collision (MVC) involvement was obtained from the Alabama Department of Public Safety. Poisson regression was used to calculate crude and adjusted rate ratios (RR). Older drivers having difficulties in place orientation were more than 6 times (95% CI 1.90–19.86) more likely to be involved in a future crash (adjusted RR = 6.14, 95% confidence interval (CI) 1.90–19.86) and at-fault crash (adjusted RR = 6.39, 95% CI 1.51–27.10). Impairment in the other cognitive areas was not associated with higher rates of crash or at-fault crash involvement. The findings were validated in an independent sample of high-risk older drivers and a similar pattern of results was observed. Spatial orientation impairment can help identify older drivers who are more likely to crash in the future.

Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review

OBJECTIVES

Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC).

METHODS

The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed.

RESULTS

Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone.

CONCLUSIONS

Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.

Functional Changes and Driving Performance in Older Drivers: Assessment and Interventions

With the increasing aging of the population, the number of older drivers is rising. Driving is a significant factor for quality of life and independence concerning social and working life. On the other hand, driving is a complex task involving visual, motor, and cognitive skills that experience age-related changes even in healthy aging. In this review we summarize different age-related functional changes with relevance for driving concerning sensory, motor, and cognitive functions. Since these functions have great interindividual variability, it is necessary to apply methods that help to identify older drivers with impaired driving abilities in order to take appropriate measures. We discuss three different methods to assess driving ability, namely the assessment of (i) functions relevant for driving; (ii) driving behavior in real traffic; and (iii) behavior in a driving simulator. We present different measures to improve mobility in older drivers, including information campaigns, design of traffic and car environment, instructions, functional training, and driving training in real traffic and in a driving simulator. Finally, we give some recommendations for assessing and improving the driving abilities of older drivers with multi-modal approaches being most promising for enhancing individual and public safety.

Zolpidem use and motor vehicle collisions in older drivers

OBJECTIVE

Prescription sleep medication use is most prevalent among women and older adults. Morning drowsiness and impaired coordination are side effects of sleep medications that may affect driving safety. The association between current use of zolpidem-containing medications and motor vehicle collisions (MVCs) was evaluated among drivers of advanced age.

METHODS

Participants were current drivers aged ≥70 years residing in north-central Alabama, spoke English, had a valid driver's license, and had driven within the past three months (n = 2000). Current zolpidem use was determined by pill bottle review. The participant's five-year MVC history was determined from Alabama Department of Public Safety accident reports. The five-year MVC and at-fault MVC rate ratios (RR) were estimated comparing zolpidem users with nonusers in the overall sample and a priori-defined age and sex subgroups.

RESULTS

The unadjusted RR (95% confidence interval [CI]) of MVCs comparing zolpidem users with nonusers was attenuated after adjustment (1.46 [1.02-2.08] and 1.38 [0.97-1.98], respectively). Among women, the unadjusted and adjusted RRs (95% CI) were 1.65 (1.03-2.66) and 1.61 (1.00-2.60), respectively. The unadjusted and adjusted RRs (95% CI) among those aged 80 years or more were 2.24 (1.19-4.57) and 2.35 (1.20-4.61), respectively. There were no statistically significant associations among men or participants less than 80 years old. Similar patterns were present for at-fault MVCs.

CONCLUSION

Current zolpidem users, specifically women and individuals aged 80 years or more, had higher MVC rates than nonusers. Practitioners should consider behavioral treatment before initiating low doses of zolpidem and increasing it as needed to achieve restorative sleep in women and individuals aged 80 years or more to reduce the risk of zolpidem-associated MVCs.

The driving visual field and a history of motor vehicle collision involvement in older drivers: a population-based examination

PURPOSE

We designed a visual field test focused on the field utilized while driving to examine associations between field impairment and motor vehicle collision involvement in 2000 drivers aged 70 years or older.

METHODS

The "driving visual field test" involved measuring light sensitivity for 20 targets in each eye, extending 15° superiorly, 30° inferiorly, 60° temporally, and 30° nasally. The target locations were selected on the basis that they fell within the field region utilized when viewing through the windshield of a vehicle or viewing the dashboard while driving. Monocular fields were combined into a binocular field based on the more sensitive point from each eye. Severe impairment in the overall field or a region was defined as average sensitivity in the lowest quartile of sensitivity. At-fault collision involvement for 5 years prior to enrollment was obtained from state records. Poisson regression was used to calculate crude and adjusted rate ratios (RRs) examining the association between field impairment and at-fault collision involvement.

RESULTS

Drivers with severe binocular field impairment in the overall driving visual field had a 40% increased rate of at-fault collision involvement (RR, 1.40; 95% confidence interval [CI]: 1.07-1.83). Impairment in the lower and left fields was associated with elevated collision rates (RR, 1.40; 95% CI: 1.07-1.82 and RR, 1.49; 95% CI: 1.15-1.92, respectively), whereas impairment in the upper and right field regions was not.

CONCLUSIONS

Results suggest that older drivers with severe impairment in the lower or left region of the driving visual field are more likely to have a history of at-fault collision involvement.