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Derafshi R, Babulal GM, Bayat S. Impact of cognitive impairment on driving behaviour and route choices of older drivers: a real-world driving study. Sci Rep 2024; 14:14174. [PMID: 38898026 PMCID: PMC11187060 DOI: 10.1038/s41598-024-63663-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Maintaining driving independence is important for older adults. However, cognitive decline, a common issue in older populations, can impair older adults' driving abilities and overall safety on the roads. This study explores how cognitive impairment influences driving patterns and driving choices among older adults. We analyzed real-world driving patterns of 246 older adults using GPS dataloggers. Our sample included 230 cognitively normal older adults (CN; Clinical Dementia RatingR [CDR] = 0) and 16 older adults with incident cognitive impairment (ICI; CDR = 0.5). The CN group had an average age of 68.2 years, with 46% females and an average of 16.5 years of education, while the ICI group's average age was 69.2 years, with 36% females and an average of 16.0 years of education. We employed spatial clustering and hashing algorithms to evaluate driving behaviours. Significant differences emerged: The ICI group used fewer distinct routes to their most common destination. These differences can be leveraged to develop driving as a digital biomarker for the early detection and continuous monitoring of cognitive impairment.
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Affiliation(s)
- Reihaneh Derafshi
- Department of Biomedical Engineering, University of Calgary, Calgary, Canada.
| | - Ganesh M Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Institute of Public Health, Washington University, St. Louis, USA
| | - Sayeh Bayat
- Department of Biomedical Engineering, University of Calgary, Calgary, Canada.
- Department of Geomatics Engineering, University of Calgary, Calgary, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
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Chiniard T, Dib É, Guénot F, du Baret de Limé M, Manen O, Monin J. Flight safety risk assessment of self-medication among fighter pilots: a cross-sectional study. Int J Clin Pharm 2023; 45:1415-1423. [PMID: 37430120 DOI: 10.1007/s11096-023-01611-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Fighter pilots are a specific population in which any adverse drug reaction can unpredictably interact with aeronautical constraints and thus compromise flight safety. This issue has not been evaluated in risk assessments. AIM To provide a semi-quantitative assessment of the risk to flight safety of self-medication in fighter pilots. METHOD A cross-sectional survey that aimed at identifying the determinants of self-medication in fighter pilots was conducted. All medications consumed within 8 h preceding a flight were listed. A modified Failure Mode and Effects Analysis was performed, and any adverse drug reaction reported in the French marketing authorization document of a drug was considered a failure mode. The frequency of occurrence and severity were evaluated using specific scales to assign each to three risk criticality categories: acceptable, tolerable, and unacceptable. RESULTS Between March and November 2020, the responses of 170 fighter pilots were analyzed, for an overall return rate of approximately 34%. Among them, 78 reported 140 self-medication events within 8 h preceding a flight. Thirty-nine drug trade names (48 different international nonproprietary names) were listed, from which 694 potential adverse drug reactions were identified. The risk criticality was considered unacceptable, tolerable and acceptable for 37, 325 and 332 adverse drug reactions, respectively. Thus, the risk criticality was considered unacceptable, tolerable and acceptable for 17, 17, and 5 drugs, respectively. CONCLUSION This analysis suggests that the overall risk to flight safety of the current practice of self-medication in fighter pilots may be considered at least tolerable, or even unacceptable.
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Affiliation(s)
- Thomas Chiniard
- Department of Anesthesiology and Intensive Care, Bégin Military Hospital, Saint-Mandé, France.
- French Military Medical Service Academy, École du Val-de-Grâce, Paris, France.
| | - Élise Dib
- 6th Medical Unit, 1st Medical Center, Vincennes, France
| | - François Guénot
- Medical Service, Nuclear Missile Submarines Squadron, Brest Naval Base, Brest, France
| | | | - Olivier Manen
- Medicine Department, Aeromedical Center, Percy Military Hospital, Clamart, France
- French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
| | - Jonathan Monin
- Medicine Department, Aeromedical Center, Percy Military Hospital, Clamart, France
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Carr DB, Beyene K, Doherty J, Murphy SA, Johnson AM, Domash H, Riley N, Walker A, Sabapathy A, Morris JC, Babulal GM. Medication and Road Test Performance Among Cognitively Healthy Older Adults. JAMA Netw Open 2023; 6:e2335651. [PMID: 37773496 PMCID: PMC10543136 DOI: 10.1001/jamanetworkopen.2023.35651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 10/01/2023] Open
Abstract
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.
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Affiliation(s)
- David B. Carr
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Kebede Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St Louis, St Louis, Missouri
| | - Jason Doherty
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Samantha A. Murphy
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Ann M. Johnson
- Center for Clinical Studies, Washington University School of Medicine, St Louis, Missouri
| | - Hailee Domash
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Noah Riley
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Alexis Walker
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Ashwin Sabapathy
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - John C. Morris
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
| | - Ganesh M. Babulal
- Department of Neurology, Washington University in Saint Louis School of Medicine, St Louis, Missouri
- Institute of Public Health, Washington University School of Medicine, St Louis, Missouri
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Gutiérrez-Abejón E, Criado-Espegel P, Pedrosa-Naudín MA, Fernández-Lázaro D, Herrera-Gómez F, Álvarez FJ. Trends in the Use of Driving-Impairing Medicines According to the DRUID Category: A Population-Based Registry Study with Reference to Driving in a Region of Spain between 2015 and 2019. Pharmaceuticals (Basel) 2023; 16:ph16040508. [PMID: 37111265 PMCID: PMC10145018 DOI: 10.3390/ph16040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
The European DRUID (Drive Under the Influence of drugs, alcohol, and medicines) program classifies medications into three categories according to their effect on one’s fitness to drive. The trend in the use of driving-impairing medicines (DIMs) in a region of Spain between 2015 and 2019 was analyzed through a population-based registry study. Pharmacy dispensing records for DIMs are provided. The use of DIMs on drivers was weighted according to the national driver’s license census. The analysis was performed considering the population distribution by age and sex, treatment length, and the three DRUID categories. DIMs were used by 36.46% of the population and 27.91% of drivers, mainly chronically, with considerable daily use (8.04% and 5.34%, respectively). Use was more common in females than in males (42.28% vs. 30.44%) and increased with age. Among drivers, consumption decreases after 60 years of age for females and after 75 years of age for males. There was a 34% increase in the use of DIMs between 2015 and 2019, with a focus on daily use (>60%). The general population took 2.27 ± 1.76 DIMs, fundamentally category II (moderate influence on fitness to drive) (20.3%) and category III (severe influence on fitness to drive) (19.08%). The use of DIMs by the general population and drivers is significant and has increased in recent years. The integration of the DRUID classification into electronic prescription tools would assist physicians and pharmacists in providing adequate information to the patient about the effects of prescribed medications on their fitness to drive.
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DiGuiseppi CG, Hyde HA, Betz ME, Scott KA, Eby DW, Hill LL, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Association of falls and fear of falling with objectively-measured driving habits among older drivers: LongROAD study. JOURNAL OF SAFETY RESEARCH 2022; 83:96-104. [PMID: 36481041 PMCID: PMC10115437 DOI: 10.1016/j.jsr.2022.08.007] [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: 08/10/2021] [Revised: 02/28/2022] [Accepted: 08/09/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits. METHODS This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices. RESULTS Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics. DISCUSSION Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.
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Affiliation(s)
- Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Hailey A Hyde
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kenneth A Scott
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David W Eby
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA; Center for Advancing Transportation Leadership and Safety (ATLAS Center), University of Michigan, Ann Arbor, MI, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Vanya C Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia's Injury Control Research Center, Columbia University, New York, NY, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA; Center for Advancing Transportation Leadership and Safety (ATLAS Center), University of Michigan, Ann Arbor, MI, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia's Injury Control Research Center, Columbia University, New York, NY, USA; Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Van Gastel A. Drug-Induced Insomnia and Excessive Sleepiness. Sleep Med Clin 2022; 17:471-484. [PMID: 36150808 DOI: 10.1016/j.jsmc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Undesirable side effects of insomnia and/or sleepiness may occur with many prescribed drugs, psychotropics as well as non-psychotropics. These central nervous system effects can be explained by the interactions of the drug with any of the numerous neurotransmitters and receptors that are involved in sleep and wakefulness. Also a close - sometimes bidirectional - relationship between disease and (disturbed) sleep/wakefulness is often present e.g. in chronic pain; drug effects may lead this vicious circle in both ways. Besides the importance for health and quality of life, effects on sleep or waking function can be a potential source of non-compliance.
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Affiliation(s)
- Ann Van Gastel
- Multidisciplinary Sleep Disorders Centre and University Department of Psychiatry, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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Professional Drivers’ Knowledge About the Influence of Medicines that May Impair Driving. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
More knowledge about the impact of medication on driving are indicative of a lower likelihood of having a motor vehicle crash. The aim of this study was to investigate knowledge of professional drivers about the influence of driving impairing medicines in Serbia and Bosnia and Herzegovina.
This multicenter cross-sectional study was conducted in 6 cities in Serbia and Bosnia and Herzegovina, during first trimester of 2017, with 221 professional drivers, using questionnaire with 35 statements, where participants expressed their agreement according to Likert scale, from completely disagree to completely agree.
The average score related to the drivers’ knowledge was 131,58 (range from 49 to 175), 22,6% were unaware that some medicines may influence psychophysical abilities and ability to drive. A high percentage of participants in the study don’t know that a negative impact on the driving ability can be the result of the use of medicines from groups for which it is unexpected to have such effects, medicines that are dispensed without a medical prescription, herbal remedies, dietary supplements and medicines that affects eyesight or hearing. More than half didn’t know that medicines labeled with warning symbols Δ, ▲ and § are not allowed to be used immediately before or during driving.
Professional drivers’ knowledge about driving impairing medicines is not satisfactory. Labeling system of these medicines is inadequate. These findings could help to identify drivers, who are at increased risk for using potentially impairing medicines, to inform and educate them, and to prevent driving under the influence of medicines.
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Beck LF, Luo F, West BA. Examining Patterns of Driving Avoidance Behaviors Among Older People Using Latent Class Analysis. J Appl Gerontol 2022; 41:1752-1762. [PMID: 35441554 DOI: 10.1177/07334648221086953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Some older drivers choose to avoid certain situations where they do not feel confident driving. Little is known about the process by which older drivers may use avoidance in transitioning to non-driving. Methods: We analyzed 2015 ConsumerStyles data for 1198 drivers aged 60+. Driving patterns were examined by sociodemographic and driving characteristics. Avoidance classes were characterized by latent class analysis. Results: Among drivers 60+, 79% reported driving 3+ days/week and 84% reported good to excellent health. We identified four driving avoidance classes (low, mild, moderate, and high). High- (versus low-) avoidance drivers were more likely female, 75+, not White/non-Hispanic, and to have income <$25,000/year. Discussion: Avoidance of selected driving behaviors may be one component of a multi-step process supporting the transition to non-driving. Drivers displaying avoidance behaviors may be receptive to resources to prepare for this transition and minimize negative health and quality of life outcomes that accompany driving cessation.
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Affiliation(s)
- Laurie F Beck
- Centers for Disease Control and Prevention, 1242National Center for Injury Control and Prevention, Atlanta, GA, USA
| | - Feijun Luo
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Bethany A West
- Centers for Disease Control and Prevention, 1242National Center for Injury Control and Prevention, Atlanta, GA, USA
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Kudrimoti AM. Selected Problems of Aging. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Development and validation of questionnaires on professional drivers’ knowledge and attitudes about various medications’ influence on driving ability. Zdr Varst 2021; 61:32-39. [PMID: 35111264 PMCID: PMC8776291 DOI: 10.2478/sjph-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Professional drivers’ knowledge about driving-impairing medications is not satisfactory. The aim of this study was to develop and test the reliability and validity of the questionnaires designed to measure the knowledge and attitude of professional drivers about the influence of various medications on driving ability. Methods The questionnaires for assessing professional driver’s knowledge (performance-based) and attitudes about influence of various medications on driving abilities were developed by creating the item pool, testing reliability and validity, and factor analysis. The study was conducted as a multicenter, cross-sectional study in Serbia and Bosnia and Herzegovina. The study population consisted of professional drivers, who filled out both questionnaires in three time intervals. Results Both questionnaires showed great internal consistency and temporal stability. Cronbach’s Alpha for the first questionnaire was 0.984 and for the second it was 0.944. The Kaiser–Meyer–Olkin test for the first questionnaire confirmed sampling adequacy with its value of 0.964 and for the second questionnaire it was 0.933. Exploratory factor analysis of the questionnaire showed that three factors were revealed after rotation for the first questionnaire and they explained 78.0% of variance. Both questionnaires showed high degree of correlation between scores after the first and repeated administration, Spearman’s rho coefficient of correlation for was 0.962 and 0.980. Conclusion Based on the results of this study, we believe that both questionnaires are useful tools for testing professional drivers’ knowledge and attitudes about the influence of medications on driving ability.
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Unger A, Winston FK, Ruggieri DG, Remba J. Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving. TRAFFIC INJURY PREVENTION 2021; 22:S38-S43. [PMID: 34672890 DOI: 10.1080/15389588.2021.1976765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Objective: A frequently overlooked factor contributing to traffic crashes is driver medical conditions, including cognitive and physical impairments, which can compromise individuals' ability to drive safely. Clinicians are in a critical position (and often legally mandated) to identify patients with impairments that may affect their driving ability and counsel them on appropriate next steps. However, prior studies revealed that provider-patient discussions about driving occurred relatively infrequently and that clinician recommendations about when patients could resume driving varied substantially (Chen et al. 2008; Drazkowski et al. 2010). This research aimed to document current driver fitness assessment practices among neurology and neurosurgery clinicians at an academic medical center, with the overall purpose of informing quality improvement efforts.Methods: A cross-sectional, anonymous survey was distributed to physicians and advanced practice providers working in the neurosurgery and neurology departments of a large, Pennsylvania-based academic medical center. Survey question domains included: 1) frequency of discussions about driving, 2) comfort discussing driving with patients, 3) criteria used to assess patient fitness to drive, 4) driver rehabilitation program referral practices, and 5) Pennsylvania Department of Transportation (PennDOT) reporting.Results: The survey revealed that although most providers (68%) had high levels of perceived responsibility for counseling patients about driving, a minority regularly discussed driving issues with their patients (19% prior to discharge, 49% during clinic visits). In addition, only about half (54%) of providers reported having ever filed a report about a patient with the PennDOT, despite Pennsylvania's mandatory driver reporting law. Likelihood of PennDOT reporting was found to be strongly associated with provider knowledge of Pennsylvania unsafe driver reporting laws (p < 0.001).Conclusions: These findings highlight a need to enhance standard of care practices related to driver screening, counseling, and reporting. Overall, providers recognized the importance of their role in advising patients about safe driving and desired standardized protocols for guiding conversations about driving with patients, PennDOT reporting, and referring patients to driver rehabilitation services.
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Affiliation(s)
- Arianna Unger
- Master of Public Health Program, University of Pennsylvania and Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Flaura K Winston
- Center for Injury Research and Prevention at Children's Hospital of Philadelphia, Roberts Center for Pediatric Research and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dominique G Ruggieri
- Master of Public Health Program and Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Remba
- Master of Robotics Program, University of Pennsylvania, Philadelphia, Pennsylvania
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Ziakopoulos A, Theofilatos A, Laiou A, Michelaraki E, Yannis G, Rosenbloom T. Examining the relationship between impaired driving and past crash involvement in Europe: Insights from the ESRA study. Int J Inj Contr Saf Promot 2021; 28:376-386. [PMID: 34060421 DOI: 10.1080/17457300.2021.1928234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Driving under the influence of alcohol, drugs and fatigue are all important factors of crash causation. Exploring the link between driver attitudes and crash involvement provides understanding on these important issues. To that end, questionnaire answers of car drivers disclosing their attitudes on the impacts of driving under the influence of alcohol, drugs and fatigue, and their relationship with past crash involvement as car drivers were analysed. A two-step approach is adopted: Principal Component Analysis (PCA) was employed to consolidate relative questions in numeric factor quantities. Afterwards, binary logistic regression was implemented on the calculated component scores to determine the impact of perspectives of road users for each factor on past crash involvement of car drivers. Data from the international ESRA2015 survey were utilized. PCA indicated that it is possible to meaningfully merge 29 ESRA2015 questions relevant to driving under the influence of alcohol, drugs and fatigue into 8 informative components accounting for an adequate percentage of variance. Binary logistic analysis indicated that components involving overall personal and communal acceptance of impaired driving, overall and past year personal behaviour towards impaired driving and frequency of typical journey checks by traffic police were all quantities positively correlated with past crash involvement.
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Affiliation(s)
- Apostolos Ziakopoulos
- Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Athanasios Theofilatos
- School of Architecture, Building, and Civil Engineering, Loughborough University, Leicestershire, UK
| | - Alexandra Laiou
- Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Eva Michelaraki
- Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - George Yannis
- Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Tova Rosenbloom
- Department of Management, Bar Ilan University, Ramat Gan, Israel
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13
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Gutiérrez-Abejón E, Herrera-Gómez F, Álvarez FJ. Trends in the use of antihistamines with reference to drivers between 2015 and 2019: A population-based registry analysis. Fundam Clin Pharmacol 2021; 35:1168-1178. [PMID: 33834510 DOI: 10.1111/fcp.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND First-generation antihistamines are considered driving-impairing medicines (DIM), while second- and third-generation antihistamines are relatively safe for driving. OBJECTIVES The aim of this study was to know the trend of consumption of antihistamines and other DIMs in Spain between 2015 and 2019. METHODS This is a population-based registry study. The population distribution by age and gender has been taken into account, as well the treatment duration with these medicines and the concomitant use of other DIMs. Adjusted consumption for licensed drivers is also presented. RESULTS Between 2015 and 2019, antihistamines were dispensed to 12.1% of the population and 9.25% of drivers. Oral antihistamines are the most consumed with 85.83%, and generally more used by women than men. Regardless of systemic antihistamines, the second-generation were the most consumed (8.9%) followed by the third-generation (2.07%) and the first-generation (0.61%). Subacute use was predominant in second -generation antihistamines (4.96%) and third-generation (1.26%), while acute use was predominant in third-generation antihistamines. On the other hand, only 0.36% of the population consumed antihistamines daily. The concomitant use of antihistamines with other DIMS was considerable, especially anxiolytics, opioids, other analgesics and antipyretics and antidepressants. The results in drivers were similar than in the general population. CONCLUSIONS The use of antihistamines has increased in recent years, however, in Spain, the use of less sedatives predominates, which is safe for driving. Finally, it is important to consider that concomitant use with other DIMs was frequent, which may affect the fitness to drive.
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Affiliation(s)
- Eduardo Gutiérrez-Abejón
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.,Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Francisco Herrera-Gómez
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.,Hospital Virgen de la Concha-Sanidad de Castilla y León, Zamora, Spain
| | - Francisco Javier Álvarez
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.,CEIm, Hospital Clínico Universitario de Valladolid-Sanidad de Castilla y León, Valladolid, Spain
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14
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Morton L, Macfarlane GJ, Jones G, Walker-Bone K, Hollick R. Driving difficulties in patients with axial spondyloarthritis: Results from the Scotland Registry for Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2021; 74:1541-1549. [PMID: 33734612 DOI: 10.1002/acr.24595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To describe the driving difficulties experienced by individuals with axial spondyloarthritis (axSpA), and characterise associated clinical and sociodemographic features, and impact on work. METHOD The Scotland Registry for Ankylosing Spondylitis (SIRAS) is a cohort study of patients with a clinical diagnosis of axSpA. Baseline information was collected on clinical and patient-reported measures, and work participation measures (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI: SHP)). Patient-rated difficulties with nine driving tasks were used in a factor analysis, and relationships between driving difficulty and work participation investigated. RESULTS 718 patients provided data for analysis, of which 642 (89%) had some difficulty with at least one driving task and 72 (10%) had some difficulty with all nine tasks. Three domains of driving difficulty were identified: dynamic driving scenarios, crossing traffic, and the physical act of driving. Chronic widespread pain, knee and back pain, fatigue, high disease activity and anxiety/depression were significantly associated with reporting driving difficulties across all three domains, particularly the physical act of driving. After adjusting for socio-demographic, disease activity, physical and mental health, driving difficulties in each domain were associated with a 2-3 times increased likelihood of restricted work productivity and with an increased risk of sickness absence in the past seven days. CONCLUSION Driving difficulties are common in individuals with axSpA and impact on work, even after adjusting for clinical status. Improving understanding and awareness of driving disability will help direct advice and resources to enable individuals to remain independent and economically active.
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Affiliation(s)
- LaKrista Morton
- Epidemiology Group, University of Aberdeen, UK, Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK, Aberdeen.,Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, University of Aberdeen, UK, Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK, Aberdeen.,Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Gareth Jones
- Epidemiology Group, University of Aberdeen, UK, Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK, Aberdeen.,Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Karen Walker-Bone
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Southampton, UK
| | - Rosemary Hollick
- Epidemiology Group, University of Aberdeen, UK, Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK, Aberdeen.,Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
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15
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Xue Y, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Lang BH, Kelley-Baker T, Li G. Potentially Inappropriate Medication Use and Hard Braking Events in Older Drivers. Geriatrics (Basel) 2021; 6:20. [PMID: 33672575 PMCID: PMC8005989 DOI: 10.3390/geriatrics6010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study came from the Longitudinal Research on Aging Drivers study, a multisite naturalistic driving study of older adults. Multivariable negative binominal modeling was used to estimate incidence rate ratios and 95% confidence intervals of hard braking events (proxies for unsafe driving behavior defined as events with a deceleration rate ≥0.4 g) associated with PIM use among older drivers. The study sample consisted of 2932 drivers aged 65-79 years at baseline, including 542 (18.5%) who used at least one PIM. These drivers were followed through an in-vehicle recording device for up to 44 months. The overall incidence of hard braking events was 1.16 per 1000 miles. Use of PIMs was associated with a 10% increased risk of hard braking events. Compared to drivers who were not using PIMs, the risk of hard braking events increased 6% for those using one PIM, and 24% for those using two or more PIMs. Use of PIMs by older adult drivers is associated in a dose-response fashion with elevated risks of hard braking events. Reducing PIM use in older adults might help improve driving safety as well as health outcomes.
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Affiliation(s)
- Yuqing Xue
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (Y.X.); (T.J.M.)
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; (S.C.); (B.H.L.)
| | - Howard F. Andrews
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO 80045, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - David W. Eby
- University of Michigan Transportation Research Institute, Ann Arbor, MI 48109, USA; (D.W.E.); (L.J.M.)
- Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI 48109, USA
| | - Linda L. Hill
- School of Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Vanya Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Thelma J. Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (Y.X.); (T.J.M.)
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Lisa J. Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, MI 48109, USA; (D.W.E.); (L.J.M.)
- Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI 48109, USA
| | | | - Barbara H. Lang
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; (S.C.); (B.H.L.)
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (Y.X.); (T.J.M.)
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; (S.C.); (B.H.L.)
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16
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Bahrampouri S, Khankeh HR, Hosseini SA, Mehmandar M, Ebadi A. Components of driving competency measurement in the elderly: A scoping review. Med J Islam Repub Iran 2021; 35:2. [PMID: 33996653 PMCID: PMC8111623 DOI: 10.47176/mjiri.35.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Iran will face the "aging Tsunami" phenomenon by the 2040s. Therefore, paying attention to the elderly's driving to maintain and promote their independence and quality of life on the one hand and paying attention to the dangers of driving by the elderly for road safety will be important. The purpose of this research was to determine the components of driving competency in the elderly.
Methods: The research has employed a scoping review. To this end, searches of scientific databases were conducted using keywords between 1990 and 2019. The process of selecting the documentation was-based on the PRISMA chart.
Results: In the first phase, 2769 records were found, and finally, 37 records met the inclusion criteria set for this study. The results indicated that 18 components were extracted that were classified into seven main categories including cognitive, sensory, motor, mental functions, and medications, diseases, and driving history.
Conclusion: Sensory, motor, and cognitive abilities are the most important components of elderly safe driving. Therefore, as age increases, chronic disease, multiple drug use, and subsequent problems increase. This can affect the ability to drive safely and can cause traffic injuries. Therefore, it is recommended to use the results of this research to design a suitable tool and model for assessing driving competency in the elderly.
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Affiliation(s)
- Saiedeh Bahrampouri
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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17
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Skopp G, Graw M, Mußhoff F. Medikamente und Fahrsicherheit. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Falkenstein M, Karthaus M, Brüne-Cohrs U. Age-Related Diseases and Driving Safety. Geriatrics (Basel) 2020; 5:E80. [PMID: 33086572 PMCID: PMC7709672 DOI: 10.3390/geriatrics5040080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
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Affiliation(s)
- Michael Falkenstein
- Institute for Work Learning and Aging (ALA), Hiltroper Landwehr 136, 44805 Bochum, Germany
| | - Melanie Karthaus
- Leibniz Institute for Working Environment and Human Factors (IfADo), 44139 Dortmund, Germany;
| | - Ute Brüne-Cohrs
- LWL University Hospital, Clinic for Psychiatry, Psychotherapy and Preventive Medicine, 44791 Bochum, Germany;
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19
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Hill LL, Andrews H, Li G, DiGuiseppi CG, Betz ME, Strogatz D, Pepa P, Eby DW, Merle D, Kelley-Baker T, Jones V, Pitts S. Medication use and driving patterns in older drivers: preliminary findings from the LongROAD study. Inj Epidemiol 2020; 7:38. [PMID: 32741358 PMCID: PMC7397667 DOI: 10.1186/s40621-020-00265-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors. Methods Data for this study came from the five-site Longitudinal Research on Aging Drivers (LongROAD) project. Participants were active drivers, age 65–79 years at enrollment, and patients at one of the 5 participating sites. Medication names and doses were obtained at baseline based on the “brown-bag review” method. Medications were coded using the American Hospital Formulary Service system. Driving data were collected by a GPS accelerometer installed in the study participants’ main vehicles. Results Medication data were available for 2949 (98.6%) of the 2990 participants, and 2898 (96.9% of all participants) had both medication data and at least 30 recorded days of driving. The median number of medications taken per study participant was seven, with a range of 0–51. Total number of medications was significantly associated with a higher rapid deceleration rate. Certain medication classes were significantly associated with other driving outcomes, including central nervous system agents (more speeding events), hormones and gastrointestinal medications (more rapid decelerations), electrolytes (fewer rapid decelerations), and antihistamines (greater right to left turn ratio). Conclusions Older adult drivers are taking large quantities of prescription and non-prescription medications that may affect their driving safety. Certain medication classes are associated with potentially adverse driving patterns, such as speeding and rapid decelerations, while others are associated with potentially protective maneuvers, such as right hand turning. Further research is warranted to identify and mitigate potential adverse effects of such medications on driving safety in older adults.
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Affiliation(s)
- Linda L Hill
- Department of Family Medicine and Public Health, University of California, 200 W Arbor Dr., MC 0811, San Diego, CA, 92103, USA.
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 1051 Riverside Dr. Unit 47, New York, NY, 10032, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St. Rm 524, New York, NY, 10032, USA.,Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 W 168th St. Rm 524, New York, NY, 10032, USA.,Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, 722 W 168th St. Rm 524, New York, NY, 10032, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Bldg. 500, Rm. W3138, Aurora, CO, 80045, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Leprino Building, Campus Box B215, 12401 East 17th Ave, Aurora, CO, 80045, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, 1 Atwell Rd, Cooperstown, NY, 13326, USA
| | - Patricia Pepa
- Department of Ambulatory Care Clinical Pharmacy, Kaiser Permanente, Oakland, USA
| | - David W Eby
- Transportation Research Institute, University of Michigan, 2901 Baxter Rd, Ann Arbor, MI, 48109, USA
| | - David Merle
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 1051 Riverside Dr. Unit 47, New York, NY, 10032, USA
| | - Tara Kelley-Baker
- AAA Foundation for Traffic Safety, 607 14th St. NW, Ste. 201, Washington, DC, 20005, USA
| | - Vanya Jones
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Samantha Pitts
- Department of Medicine, School of Medicine, Johns Hopkins University, 733 North Broadway, Baltimore, MD, 21205, USA
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20
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Caron J, Kaye R, Wessel T, Halseth A, Kay G. An assessment of the centrally acting muscle relaxant tolperisone on driving ability and cognitive effects compared to placebo and cyclobenzaprine. J Clin Pharm Ther 2020; 45:774-782. [PMID: 32390248 PMCID: PMC7383672 DOI: 10.1111/jcpt.13165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/27/2020] [Accepted: 04/18/2020] [Indexed: 12/05/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tolperisone is a centrally acting muscle relaxant under development in the United States as a treatment for acute and painful symptoms of muscle spasms. The objective of this three-way, randomized, blinded, three-period crossover study was to assess the safety and cognitive effects of tolperisone compared to placebo and the widely used muscle relaxant cyclobenzaprine in healthy volunteers. METHODS Subjects were randomized to 1 of 3 treatment arms to receive tolperisone (150 mg), cyclobenzaprine (10 mg) or placebo 3 times per day (TID) in 3 separate study periods. Subjects completed a driving test on the Cognitive Research Corporation's Driving Simulator (CRCDS Mini-Sim), a validated driving simulator, on day 1 at time to maximum plasma concentration, on day 2 before the morning dose of study drug and on day 3 at steady state following the morning dose. Subjects were assessed on various driving parameters and on a computer-administered digit-symbol substitution test (CogScreen symbol digit coding test). The driving scenario is a monotonous 100 km highway route on which subjects are instructed to maintain speed and lane position. RESULTS AND DISCUSSION The performance of subjects who had received tolperisone was not significantly different from those who had received placebo in terms of the primary end point: standard deviation of lateral position, a measure of weaving. Subjects who had received tolperisone also performed comparably to those who had received placebo on a range of secondary measures assessing driving ability, cognition and psychomotor performance. In contrast, subjects who had received cyclobenzaprine showed significant impairment compared to placebo (P < .01) on the primary end point of standard deviation of lateral position and on the majority of the secondary end points of driving ability. Despite their markedly poorer driving performance after receiving cyclobenzaprine, few subjects reported feeling unsafe to drive on day 1 (10.3%) and day 2 (3.4%). The incidence of adverse events was similar for tolperisone (36.4%) and placebo (29.0%) and was greater for cyclobenzaprine (45.4%). WHAT IS NEW AND CONCLUSION Subjects who received tolperisone (150 mg TID) experienced no impact on various measures of driving, self-reported sleepiness and cognition measures compared to placebo, in contrast to those who received the widely used muscle relaxant cyclobenzaprine (10 mg TID).
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Affiliation(s)
- Judy Caron
- Neurana Pharmaceuticals, Inc.San DiegoCAUSA
| | | | | | | | - Gary Kay
- Drug DevelopmentCognitive Research CorporationSt. PetersburgFLUSA
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21
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Asbridge M, Macnabb K, Chan H, Erdelyi S, Wilson M, Brubacher JR. Prescription medication use as a risk factor for motor vehicle collisions: a responsibility study. Inj Prev 2020; 27:324-330. [PMID: 32732340 DOI: 10.1136/injuryprev-2020-043840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Previous studies on the effect of prescription medications on MVCs are sparse, not readily applicable to real-world driving and/or subject to strong selection bias. This study examines whether the presence of prescription medication in drivers' blood is associated with being responsible for MVC. METHODS This modified case-control study with responsibility analysis compares MVC responsibility rates among drivers with detectable levels of six classes of prescription medications (anticonvulsants, antidepressants, antihistamines, antipsychotics, benzodiazepines, opioids) versus those without. Data were collected between January 2010 and July 2016 from emergency departments in British Columbia, Canada. Collision responsibility was assessed using a validated and automated scoring of police collision reports. Multivariable logistic regression was used to determine OR of responsibility (analysed in 2018-2019). RESULTS Unadjusted regression models show a significant association between anticonvulsants (OR 1.92; 95% CI 1.20 to 3.09; p=0.007), antipsychotics (OR 5.00; 95% CI 1.16 to 21.63; p=0.03) and benzodiazepines (OR 2.99; 95% CI 1.56 to 5.75; p=0.001) with collision responsibility. Fully adjusted models show a significant association between benzodiazepines with collision responsibility (aOR 2.29; 95% CI 1.16 to 4.53; p=0.02) after controlling for driver characteristics, blood alcohol and Δ-9-tetrahydrocannabinol concentrations, and the presence of other prescription medications. Antidepressants, antihistamines and opioids exhibited no significant associations. CONCLUSION There is a moderate increase in the risk of a responsible collision among drivers with detectable levels of benzodiazepines in blood. Physicians and pharmacists should consider collision risk when prescribing or dispensing benzodiazepines. Public education about benzodiazepine use and driving and change to traffic policy and enforcement measures are warranted.
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Affiliation(s)
- Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathleen Macnabb
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Wilson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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22
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Betz ME, Hyde H, DiGuiseppi C, Platts-Mills TF, Hoppe J, Strogatz D, Andrews HF, Mielenz TJ, Hill LL, Jones V, Molnar LJ, Eby DW, Li G. Self-Reported Opioid Use and Driving Outcomes among Older Adults: The AAA LongROAD Study. J Am Board Fam Med 2020; 33:521-528. [PMID: 32675263 PMCID: PMC9478563 DOI: 10.3122/jabfm.2020.04.190429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Opioid medications are important therapeutic options to mitigate the harmful effects of pain but can also impair driving ability. We sought to explore opioid use, pain levels, and driving experiences among older drivers. METHODS Cognitively intact drivers ages 65 to 79 years were recruited for the multisite AAA Longitudinal Research on Aging Drivers (LongROAD) study (n = 2990). This cross-sectional analysis used data from the baseline questionnaire and "brown-bag" medication review. RESULTS Among LongROAD participants (47% male, 88% white, 41% aged 65 to 69 years), 169 (5.7%) reported currently taking an opioid, with a median daily dose of 20 morphine milligram equivalents. Participants did not differ significantly in opioid use by age, gender, race, or ethnicity (P > .05). After adjustment for age, gender, race and ethnicity, participants who were taking opioids (vs not) were significantly more likely to report self-regulated driving reduction and reduced driving ability. However, these effects became nonsignificant when hospitalization, impaired physical function and other factors associated with opioid use were controlled. CONCLUSIONS In this study from a large, geographically diverse sample of older adults, there was an association between opioid use and several self-reported measures of driving behavior and ability. However, future work should clarify the effects on driving of opioid use from the effects of the painful medical conditions for which the opioids are being taken. Clinicians should continue to discuss the risks and benefits of opioid medications with patients, including risks related to driving safety.
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Affiliation(s)
- Marian E Betz
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI).
| | - Hailey Hyde
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Carolyn DiGuiseppi
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Timothy F Platts-Mills
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Jason Hoppe
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - David Strogatz
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Howard F Andrews
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Thelma J Mielenz
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Linda L Hill
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Vanya Jones
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Lisa J Molnar
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - David W Eby
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
| | - Guohua Li
- From the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (MEB, JH); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora (HH, CD); Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (TFPM); Bassett Research Institute, Cooperstown, NY (DS); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY (HFA); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (HFA); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (TJM, GI); Department of Family Medicine and Public Health, University of California-San Diego, La Jolla (LLH); Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (VJ); University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor (LJM, DWE); Department of Anesthesiology, Columbia University-Vagelos College of Physicians and Surgeons, New York, NY (GI)
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ApoE Genotype-Dependent Response to Antioxidant and Exercise Interventions on Brain Function. Antioxidants (Basel) 2020; 9:antiox9060553. [PMID: 32630431 PMCID: PMC7346214 DOI: 10.3390/antiox9060553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022] Open
Abstract
This study determined whether antioxidant supplementation is a viable complement to exercise regimens in improving cognitive and motor performance in a mouse model of Alzheimer’s disease risk. Starting at 12 months of age, separate groups of male and female mice expressing human Apolipoprotein E3 (GFAP-ApoE3) or E4 (GFAP-ApoE4) were fed either a control diet or a diet supplemented with vitamins E and C. The mice were further separated into a sedentary group or a group that followed a daily exercise regimen. After 8 weeks on the treatments, the mice were administered a battery of functional tests including tests to measure reflex and motor, cognitive, and affective function while remaining on their treatment. Subsequently, plasma inflammatory markers and catalase activity in brain regions were measured. Overall, the GFAP-ApoE4 mice exhibited poorer motor function and spatial learning and memory. The treatments improved balance, learning, and cognitive flexibility in the GFAP-ApoE3 mice and overall the GFAP-ApoE4 mice were not responsive. The addition of antioxidants to supplement a training regimen only provided further benefits to the active avoidance task, and there was no antagonistic interaction between the two interventions. These outcomes are indicative that there is a window of opportunity for treatment and that genotype plays an important role in response to interventions.
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Feasibility and Validity of a Low-Cost Racing Simulator in Driving Assessment after Stroke. Geriatrics (Basel) 2020; 5:geriatrics5020035. [PMID: 32485824 PMCID: PMC7345038 DOI: 10.3390/geriatrics5020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
There is a myriad of methodologies to assess driving performance after a stroke. These include psychometric tests, driving simulation, questionnaires, and/or road tests. Research-based driving simulators have emerged as a safe, convenient way to assess driving performance after a stroke. Such traditional research simulators are useful in recreating street traffic scenarios, but are often expensive, with limited physics models and graphics rendering. In contrast, racing simulators developed for motorsport professionals and enthusiasts offer high levels of realism, run on consumer-grade hardware, and can provide rich telemetric data. However, most offer limited simulation of traffic scenarios. This pilot study compares the feasibility of research simulation and racing simulation in a sample with minor stroke. We determine that the racing simulator is tolerated well in subjects with a minor stroke. There were correlations between research and racing simulator outcomes with psychometric tests associated with driving performance, such as the Trails Making Test Part A, Snellgrove Maze Task, and the Motricity Index. We found correlations between measures of driving speed on a complex research simulator scenario and racing simulator lap time and maximum tires off track. Finally, we present two models, using outcomes from either the research or racing simulator, predicting road test failure as linked to a previously published fitness-to-drive calculator that uses psychometric screening.
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25
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Tepper SJ, Silberstein SD, Rosen NL, Lipton RB, Dennehy EB, Dowsett SA, Doty E. The Influence of Migraine on Driving: Current Understanding, Future Directions, and Potential Implications of Findings. Headache 2020; 60:178-189. [PMID: 31792964 PMCID: PMC7004171 DOI: 10.1111/head.13716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients. BACKGROUND Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have the potential to negatively influence driving ability. METHODS We reviewed the published findings related to migraine and driving performance. Study findings relevant to symptoms of migraine and their potential effect on driving were also reviewed. This required a more expansive exploration of the literature beyond migraine, for example, review of the literature relating to the effect of pain, sleepiness, visual disturbances, or vertigo on driving. Finally, the potential effects of treatment for migraine on driving were reviewed. RESULTS Literature on the effect of migraine on driving performance is sparse and, in general published studies on the topic have a number of limitations. Based on review of the literature pertaining to other disorders, it seems feasible that some symptoms occurring as part of the migraine attack could impact driving performance, although formal study in this area is lacking. Many of the approved treatments for migraine have the potential to impact driving, yet this has not been specifically studied, and the extent to which these risks are communicated to patients is not clear. CONCLUSION The impact of migraine on driving performance has been largely neglected, with few studies specifically designed to address the topic, and relevant studies were generally small with limited control of confounders. This area requires more focus, given a potential for impact on road safety.
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Affiliation(s)
| | | | - Noah L. Rosen
- Northwell Health Physician Partners Neuroscience InstituteGreat NeckNYUSA
| | - Richard B. Lipton
- Montefiore Headache CenterAlbert Einstein School of MedicineThe BronxNYUSA
| | - Ellen B. Dennehy
- Eli Lilly and CompanyIndianapolisINUSA
- Department of Psychological SciencesPurdue UniversityWest LafayetteINUSA
| | | | - Erin Doty
- Eli Lilly and CompanyIndianapolisINUSA
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Ma S, Zhang J, Zeng X, Wu C, Zhao G, Lv C, Sun X. Type 2 diabetes can undermine driving performance of middle-aged male drivers through its deterioration of perceptual and cognitive functions. ACCIDENT; ANALYSIS AND PREVENTION 2020; 134:105334. [PMID: 31689573 DOI: 10.1016/j.aap.2019.105334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 05/12/2023]
Abstract
It has been widely agreed that it is risky for patients with diabetes to drive during hypoglycemia. However, driving during non-hypoglycemia may also bring certain safety hazards for some patients with diabetes. Based on previous studies on diabetes-related to early aging effect, as well as gender differences in health belief and driving behavior, we have hypothesized that middle-aged male drivers with type 2 diabetes, compared with the control healthy ones, may experience a decline in driving performance without awareness. And the decline is caused by impaired perceptual and cognitive driving-related functions. To verify these hypotheses, we recruited 56 non-professional male drivers aged between 40 and 60 (27 patients with type 2 diabetes and 29 healthy controls) to perform a simulated car-following task and finish behavioral tests of proprioception, visual search, and working memory abilities during non-hypoglycemia. They also reported their hypoglycemia experience and perceived driving skills. We found that the patients had equal confidence in their driving skills but worse driving performance as shown in larger centerline deviation (t = 2.83, p = .006), longer brake reaction time (t = 3.77, p = .001) and shorter minimum time-to-collision (t = -3.27, p = .002). Such between-group differences in driving performance could be fully mediated by proprioception, visual search ability, and working memory capacity but not by hypoglycemia experience. Regarding the effect sizes of the mediation, the visual search ability played the most important role, and then followed the working memory and the proprioception. This initial study provides original and first-hand evidence demonstrating that the middle-aged male drivers with type 2 diabetes have deteriorated driving performance, but they are unaware of it. We will also discuss the possible measures to identify people of the highest risk and improve their safety awareness by using the findings of the current study.
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Affiliation(s)
- Shu Ma
- Department of Psychology, Zhejiang Sci-Tech University, 928 2nd Street, Xiasha Higher Education Park, Hangzhou, 310016, China; CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Jingyu Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China.
| | - Xianzhong Zeng
- Department of Endocrinology, Ganzhou People's Hospital, China
| | - Changxu Wu
- Department of Systems and Industrial Engineering, University of Arizona, United States
| | - Guozhen Zhao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Chunhui Lv
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Xianghong Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
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Abstract
Harmful alcohol use and alcohol use disorders (AUD) result in major health and community burden worldwide, yet treatment options are limited. Novel pharmacotherapies are urgently required, and treatments involving GABAB receptors have been used in treating alcohol-related disorders. This chapter will review the clinical evidence of GABAB pharmacotherapies, such as baclofen and γ-hydroxybutyric acid. This includes the use of these treatments in individuals experiencing alcohol withdrawal symptoms and outlining the outcomes of studies of alcohol relapse prevention relapse including case studies, comparative studies and randomised controlled trials. Laboratory research investigating biobehavioural effects of baclofen will also be summarised and polymorphisms associated with baclofen treatment, and safety concerns of GABAB treatments will be addressed. In summary, pharmacological treatments targeting GABAB receptors such as baclofen may be modestly effective in the management of alcohol use disorder, but safety concerns limit the widespread applicability of the currently available agents.
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28
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Kudrimoti AM. Selected Problems of Aging. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_23-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barone R, Pelletti G, Garagnani M, Giusti A, Marzi M, Rossi F, Roffi R, Fais P, Pelotti S. Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study. Forensic Sci Int 2019; 305:110004. [PMID: 31707239 DOI: 10.1016/j.forsciint.2019.110004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.
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Affiliation(s)
- Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Alessio Giusti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Mattia Marzi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Raffaella Roffi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
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30
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Jones VC, Johnson RM, Borkoski C, Rebok GW, Gielen AC, Soderstrom C, Molnar LJ, Pitts SI, DiGuiseppi C, Hill L, Strogatz D, Mielenz TJ, Betz ME, Kelley-Baker T, Eby DW, Li G. Social Support Moderates the Negative Association Between Reduced Driving and Life Satisfaction in Older Adults. J Appl Gerontol 2019; 39:1258-1262. [PMID: 31690172 DOI: 10.1177/0733464819884266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
When older adults reduce their driving, there can be subsequent decreases in life satisfaction. In this cross-sectional study, we used baseline data from the multi-site Longitudinal Research on Aging Drivers (LongROAD) study to examine whether social support moderates the negative association between reduced driving and life satisfaction. The outcome variable was life satisfaction, and the main predictor variable was past-year reduced driving (yes/no). Emotional, instrumental, and informational social support were measured using PROMIS v2.0 (Patient-Reported Outcomes Measurement Information System) items. We used generalized linear regression models to examine how social support moderated the association between reduced driving and life satisfaction. Statistical adjustment for social support attenuated the negative effect of reduced driving on life satisfaction by ~10% for all three types of social support.
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Affiliation(s)
- Vanya C Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee M Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - George W Rebok
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea C Gielen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Soderstrom
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Samantha I Pitts
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Linda Hill
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Marian E Betz
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Guohua Li
- Columbia University, New York City, NY, USA
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31
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Recent Medico-Legal Developments on the Issue of Epilepsy and Driver's License Requirements in the Italian and European Legislation. Behav Neurol 2019; 2019:7127956. [PMID: 31662804 PMCID: PMC6791238 DOI: 10.1155/2019/7127956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/25/2019] [Accepted: 09/07/2019] [Indexed: 01/26/2023] Open
Abstract
Epilepsy is a condition that comprises a group of neurological disorders characterized by seizures. Forms of epilepsy that produce abrupt bouts that cause lapses in consciousness may pose a major road safety problem for drivers who, while going through a seizure, could seriously harm themselves as well as others. A fundamental strategy for the purpose of reducing the risk of car accidents caused by epileptic drivers is constituted by prevention, in addition to adequate pharmacological therapies. In that respect, forensic medicine plays a pivotal role, since it deals with the set of requirements that must be met by those who have been diagnosed with epilepsy in order to get a driver's license, and with the obligation to signal such individuals to the national Driver and Vehicle Licensing Agency (in Italian: Motorizzazione Civile). In that regard, the Italian legislative framework is partly hazy in some respects, which the authors have set out to analyze herein, taking into account recently issued European norms. The aim of this paper was to better understand the current Italian legislation in the matter of epilepsy and driver's license requirements, especially regarding the medical criteria that must be met in order to obtain the driving license. The importance of those criteria is underlined by the fact that they directly influence (and are influenced by) the safety for the drivers and for the persons involved in car accidents. Thus, we can consider the issue not only strictly of medico-legal relevance but also from the standpoint of primary prevention. The analysis was conducted by reviewing the most recent documents of medico-legal relevance, in the light of European Union legislation. The authors have ultimately stressed the need for clearer and straightforward regulations, given that professional liability may arise whenever a driver's license is issued, in disregard of legal norms, to an individual who then causes a road accident.
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32
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Scherer M, Romano E, Voas R, Taylor E. Latent Classes of Polydrug Users as a Predictor of Crash Involvement and Alcohol Consumption. J Stud Alcohol Drugs 2019; 79:481-489. [PMID: 29885157 DOI: 10.15288/jsad.2018.79.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Polydrug users have been shown to be at higher risk for alcohol consumption and crash involvement. However, research has shown that polydrug groups differ in some important ways. It is currently unknown how polydrug-using groups differ in terms of crash involvement and alcohol consumption. METHOD The current study used latent class analysis to examine subgroups of polydrug users (n = 384) among a sample of drivers in Virginia Beach, Virginia (N = 10,512). A series of logistic regression analyses were conducted to determine the relationship between polydrug use categories and crash involvement and alcohol consumption. RESULTS Four distinct subclasses of users were identified among polydrug-using drivers: Class 1 is the "marijuana-amphetamines class" and accounts for 21.6% of polydrug users. Class 2 is the "benzo-antidepressant class" and accounts for 39.0% of polydrug users. Class 3 is the "opioid-benzo class" and accounts for 32.7% of polydrug users. Finally, Class 4 is the "marijuana-cocaine class" and accounts for 6.7% of the study sample. Drivers in the opioid-benzo class were significantly more likely than those in any other class as well as non-drug users and single-drug users to be involved in a crash and were more likely than those in most other conditions to consume alcohol. No significant difference was found between marijuana-amphetamine users or benzo-antidepressant users and non-drug users on crash risk. CONCLUSIONS Some polydrug users are indeed at greater risk for crash involvement and alcohol consumption; however, not all polydrug users are significantly worse than single-drug users and/or non-drug users, and the practice of lumping polydrug users together when predicting crash risk runs the risk of inaccurately attributing crash involvement to certain drivers.
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Affiliation(s)
- Michael Scherer
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Robert Voas
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Eileen Taylor
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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Antipsychotics in the general population and the driver population: comparisons from a population-based registry study. Int Clin Psychopharmacol 2019; 34:184-188. [PMID: 30998595 DOI: 10.1097/yic.0000000000000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antipsychotics are considered driving-impairing medicines. A population-based registry study design was conceived to assess the year-2016 antipsychotic dispensation in Castile and León, Spain. Weighting was performed to obtain the adjusted antipsychotic consumption for licensed drivers according to age and gender using the Spanish national drivers' license census data. In 2016, antipsychotics were dispensed to 3.86% of the general population and 2.71% of licensed drivers. Antipsychotic use was higher in females (4.72%) than in males (2.98%), and increased as age increased, but women drivers used less antipsychotics after 60 years old. Chronic antipsychotic use (≥30 days) accounted for 1.62%. Typical antipsychotics predominated among acute users (1.60% versus 0.09%), while atypical antipsychotics were the rule in chronic use (1.41% versus 0.36%). A concomitant use of antipsychotics with other driving-impairing medicines was also common. This study is intended for updating the epidemiological knowledge of all involved in the control of use of antipsychotics and other driving-impairing medicines (healthcare providers, patients, authorities, and drug developers) in order to improve prescribing/dispensing and a well tolerated use of all driving-impairing medicines by the population. Awareness is needed to improve safety on driving, and there is a need worldwide to improve interventions in the field of medicines and driving.
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Kandasamy D, Betz ME, DiGuiseppi C, Mielenz TJ, Eby DW, Molnar LJ, Hill L, Strogatz D, Li G. Self-reported health conditions and related driving reduction in older drivers. Occup Ther Health Care 2018; 32:363-379. [PMID: 30380951 DOI: 10.1080/07380577.2018.1522681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study's baseline assessment. Those reporting reduced driving (n = 337) largely attributed reduction to musculoskeletal (29%), neurologic (13%), and ophthalmologic (10%) conditions. Women reported health condition-related driving reduction more often than men (14% versus 8%, p<.001). Mobility affects well-being; health professionals should consider that health conditions may cause older adults to reduce driving. Gender differences deserve attention in future research and education efforts.
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Affiliation(s)
- Deepika Kandasamy
- a Department of Emergency Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Marian E Betz
- a Department of Emergency Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Carolyn DiGuiseppi
- b Department of Epidemiology Colorado School of Public Health , Aurora , CO , USA
| | - T J Mielenz
- c Department of Epidemiology Mailman School of Public Health , Columbia University , New York , NY , USA.,d Center for Injury Epidemiology and Prevention, Columbia University Medical Center , New York , NY , USA
| | - David W Eby
- e Transportation Research Institute , University of Michigan , Ann Arbor , MI , USA
| | - Lisa J Molnar
- e Transportation Research Institute , University of Michigan , Ann Arbor , MI , USA
| | - Linda Hill
- f Department of Family Medicine and Public Health , University of California , San Diego , CA , USA
| | - David Strogatz
- g Bassett Healthcare Network , Bassett Research Institute , Cooperstown , NY , USA
| | - Guohua Li
- c Department of Epidemiology Mailman School of Public Health , Columbia University , New York , NY , USA.,d Center for Injury Epidemiology and Prevention, Columbia University Medical Center , New York , NY , USA.,h Department of Anesthesiology , Columbia University College of Physicians and Surgeons , New York , NY , USA
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Penzel S, Graw M. [Influence of illness, age and medication: examination of fitness to drive]. MMW Fortschr Med 2018; 160:38-43. [PMID: 30105693 DOI: 10.1007/s15006-018-0823-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Saskia Penzel
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, Nussbaumstraße 26, D-80336, München, Deutschland.
| | - Matthias Graw
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, Nussbaumstraße 26, D-80336, München, Deutschland
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Boland JW, Johnson M, Ferreira D, Berry DJ. In silico (computed) modelling of doses and dosing regimens associated with morphine levels above international legal driving limits. Palliat Med 2018; 32:1222-1232. [PMID: 29724154 PMCID: PMC6041735 DOI: 10.1177/0269216318773956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Morphine can cause central nervous system side effects which impair driving skills. The legal blood morphine concentration limit for driving is 20 µg/L in France/Poland/Netherlands and 80 µg/L in England/Wales. There is no guidance as to the morphine dose leading to this concentration. AIM The in silico (computed) relationship of oral morphine dose and plasma concentration was modelled to provide dose estimates for a morphine plasma concentration above 20 and 80 µg/L in different patient groups. DESIGN A dose-concentration model for different genders, ages and oral morphine formulations, validated against clinical pharmacokinetic data, was generated using Simcyp®, a population-based pharmacokinetic simulator. SETTING/PARTICIPANTS Healthy Northern European population parameters were used with age, gender and renal function being varied in the different simulation groups. In total, 36,000 simulated human subjects (100 per modelled group of different ages and gender) received repeated simulated morphine dosing with modified-release or immediate-release formulations. RESULTS Older age, women, modified-release formulation and worse renal function were associated with higher plasma concentrations. Across all groups, morphine doses below 20 mg/day were unlikely to result in a morphine plasma concentration above 20 µg/L; this was 80 mg/day with the 80 µg/L limit. CONCLUSION This novel study provides predictions of the in silico (computed) dose-concentration relationship for international application. Individualised morphine prescribing decisions by clinicians must be informed by clinical judgement considering the individual patient's level of impairment and insight irrespective of the blood morphine concentration as people who have impaired driving will be breaking the law. Taking into account expected morphine concentrations enables improved individualised decision making.
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Affiliation(s)
- Jason W Boland
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam Johnson
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D 2018; 17:493-507. [PMID: 28865038 PMCID: PMC5694420 DOI: 10.1007/s40268-017-0207-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Various adverse events resulting from, or associated with, benzodiazepine and/or Z-drug use have been extensively reported on and discussed in great detail within the biomedical literature. It is widely accepted that motor vehicle accidents and falls leading to fractures in older adults are major adverse events that have been shown to occur more frequently in users of sedative-hypnotic medication, especially of the benzodiazepine and related Z-drug variety. However, the last few years have seen increasing reports in the literature raising the issue of benzodiazepine and Z-drug exposure in the development of other serious medical issues including dementia, infections, respiratory disease exacerbation, pancreatitis, and cancer. This article provides an overview and interpretation on the current state of evidence regarding each of these associations and proposes what gaps in the evidence for drug-exposure–harm associations need to be addressed in the future for the purpose of evaluating causality of harm as it relates to these drugs.
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Dickerson A, Schold Davis E, Carr DB. Driving Decisions: Distinguishing Evaluations, Providers and Outcomes. Geriatrics (Basel) 2018; 3:E25. [PMID: 31011063 PMCID: PMC6319243 DOI: 10.3390/geriatrics3020025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
Abstract
Driving is a highly valued instrumental activity of daily living on which many older adults depend for access to their community. The demand to address driving is changing as older adults experience increasing longevity while facing medical conditions that often affect their fitness to drive. As one of the most complex of daily tasks, driving is a multifaceted issue that involves the older driver, family members, state licensing and health care practitioners. This commentary discusses potential options and strategies for making evidence-based fitness to drive decisions by differentiating between driving skills and driving capacities, and how these differences are manifested on the road. Typical service options are described using an algorithm format that suggests decision points with options and referrals for service based on the individual's experiences and/or needs.
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Affiliation(s)
- Anne Dickerson
- Department of Occupational Therapy, East Carolina University, Greenville, NC 27858, USA.
| | | | - David B Carr
- Department of Medicine and Neurology, Washington University, St. Louis, MO 63110, USA.
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Scott KA, Rogers E, Betz ME, Hoffecker L, Li G, DiGuiseppi C. Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2017; 65:2596-2602. [PMID: 28873218 PMCID: PMC5729077 DOI: 10.1111/jgs.15047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine associations between falls and subsequent motor vehicle crashes (MVCs), crash-related injuries, driving performance, and driving behavior. DESIGN Systematic review and metaanalysis. PARTICIPANTS Observational studies including drivers aged 55 and older or with a mean age of 65 and older. MEASUREMENTS Two authors independently extracted study and participant characteristics, exposures, and outcomes and assessed risk of bias. Pooled risk estimates for MVCs and MVC-related injuries were calculated using random-effects models. Other results were synthesized narratively. RESULTS From 3,286 potentially eligible records, 15 studies (N = 27-17,349 subjects) met inclusion criteria. Risk of bias was low to moderate, except for cross-sectional studies (n = 3), which all had a high potential for bias. A fall history was associated with a significantly greater risk of subsequent MVC (summary risk estimate = 1.40, 95% confidence interval (CI) = 1.20-1.63; I2 = 28%, N = 5 studies). One study found a significantly greater risk of MVC-related hospitalizations and deaths after a fall (hazard ratio = 3.12, 95% CI = 1.71-5.69). Evidence was inconclusive regarding an association between falls and driving cessation and showed no association between falls and driving performance or behavior. CONCLUSION Falls in older adults appear to be a risk marker for subsequent MVCs and MVC-related injury. Given the nature of the evidence, which is limited to observational studies, the identified associations may also result at least partly from confounding or bias. Further research is needed to clarify the mechanisms linking falls to crash risk and to develop effective interventions to ensure driving safety in older adults with a history of falls.
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Affiliation(s)
- Kenneth A. Scott
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eli Rogers
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lilian Hoffecker
- Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Guohua Li
- Center for Injury Epidemiology and Prevention; Department of Anesthesiology, College of Physicians and Surgeons; and Department of Epidemiology, Mailman School of Public Health; Columbia University, New York City, NY, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Toxicological findings in suspected drug-impaired drivers in Norway — Trends during 1990–2015. Forensic Sci Int 2017; 280:15-24. [DOI: 10.1016/j.forsciint.2017.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/03/2017] [Accepted: 09/08/2017] [Indexed: 01/13/2023]
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Pollini RA, Waehrer G, Kelley-Baker T. Receipt of Warnings Regarding Potentially Impairing Prescription Medications and Associated Risk Perceptions in a National Sample of U.S. Drivers. J Stud Alcohol Drugs 2017; 78:805-813. [PMID: 29087813 PMCID: PMC5668990 DOI: 10.15288/jsad.2017.78.805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Reducing drug-involved driving is a national policy priority, but little is known about the extent to which drivers receive warnings about the impairment potential of their prescribed medications. We used data from the 2013-2014 National Roadside Survey (NRS) to quantify the proportion of drivers who received warnings regarding potentially impairing medications and the association with driving-related risk perceptions. METHOD Drivers randomly selected at 60 sites completed the self-administered survey, which contained questions on their use of prescription medications. RESULTS Overall, 7,405 drivers completed the prescription drug portion of the NRS. Of these, 19.7% reported recent use (within the past 2 days) of a potentially impairing prescription drug, and 78.2% said the drug had been prescribed for their use. Users of prescribed sedatives (85.8%) and narcotics (85.1%) were most likely to report receiving information about potential impairment, compared with only 57.7% and 62.6% of users of prescribed stimulant and antidepressant medications, respectively. Receipt of warnings varied by sex, race/ethnicity, income, geographic region, and time of day. For a majority of drug categories, drivers who reported receiving warnings had significantly higher odds of perceived risk of impaired driving/crash and criminal justice involvement. CONCLUSIONS Most users of prescription medications reported that the drug was prescribed for their use, but not all reported receiving warnings about driving impairment. Our study provides evidence of missed opportunities for information provision on impaired driving, identifies subgroups that may warrant enhanced interventions, and provides preliminary evidence that receipt of impairment warnings is associated with increased perceptions of driving-related risk.
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Affiliation(s)
- Robin A. Pollini
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia
| | - Geetha Waehrer
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Tara Kelley-Baker
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- AAA Foundation for Traffic Safety, Washington, DC
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Kelley-Baker T, Waehrer G, Pollini RA. Prevalence of Self-Reported Prescription Drug Use in a National Sample of U.S. Drivers. J Stud Alcohol Drugs 2017; 78:30-38. [PMID: 27936362 DOI: 10.15288/jsad.2017.78.30] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Drug-involved driving has become an increasing concern. Although the focus has been on illegal drugs, there is evidence that prescribed medications can impair driving ability. The purpose of this study was to determine the self-reported prevalence of prescription drug use, including medical and nonmedical use, among a nationally representative sample of drivers and to report related driver characteristics. METHOD As part of the 2013-2014 National Roadside Survey, drivers from 60 sites were randomly recruited and asked to complete a survey on prescription drug use. RESULTS Almost 20% of drivers reported using a prescription drug within the past 2 days, with the most common drug class being sedatives (8.0%), followed by antidepressants (7.7%), narcotics (7.5%), and stimulants (3.9%). Drivers who reported prescription drug use were significantly more likely to be female, older, non-Hispanic White, and report disability. Three of four drivers who reported medication use (78.2%) said the drug was prescribed for their use; the odds of using without a prescription were significantly higher for males, Black/African American, and Hispanic drivers, and lower for older drivers. Among those with a prescription, taking more than prescribed was most common for narcotics (6.8%), followed by sedatives (4.8%), stimulants (3.8%), and antidepressants (1.5%). CONCLUSIONS These findings help to identify drivers using potentially impairing prescription drugs, both medically and nonmedically, and may inform the targeting of interventions to reduce impaired driving related to medications.
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Affiliation(s)
| | - Geetha Waehrer
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Robin A Pollini
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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Tippin J, Dyken ME. Driving Safety and Fitness to Drive in Sleep Disorders. Continuum (Minneap Minn) 2017; 23:1156-1161. [PMID: 28777182 DOI: 10.1212/con.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Driving an automobile while sleepy increases the risk of crash-related injury and death. Neurologists see patients with sleepiness due to obstructive sleep apnea, narcolepsy, and a wide variety of neurologic disorders. When addressing fitness to drive, the physician must weigh patient and societal health risks and regional legal mandates. The Driver Fitness Medical Guidelines published by the National Highway Traffic Safety Administration (NHTSA) and the American Association of Motor Vehicle Administrators (AAMVA) provide assistance to clinicians. Drivers with obstructive sleep apnea may continue to drive if they have no excessive daytime sleepiness and their apnea-hypopnea index is less than 20 per hour. Those with excessive daytime sleepiness or an apnea-hypopnea index of 20 per hour or more may not drive until their condition is effectively treated. Drivers with sleep disorders amenable to pharmaceutical treatment (eg, narcolepsy) may resume driving as long as the therapy has eliminated excessive daytime sleepiness. Following these guidelines, documenting compliance to recommended therapy, and using the Epworth Sleepiness Scale to assess subjective sleepiness can be helpful in determining patients' fitness to drive.
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Weir N, Fischer A, Good P. Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease? Intern Med J 2017; 47:1161-1165. [PMID: 28762600 DOI: 10.1111/imj.13571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is little research and no clear guidelines for clinicians to follow when instructing patients with advanced disease about driving. AIMS To investigate current practice in providing advice to patients with advanced disease and identify areas of consensus or variation with the Australian driving guidelines. METHODS An online survey was distributed to Australian members of the Australian and New Zealand Society of Palliative Medicine. Responses were analysed using descriptive statistics. RESULTS The survey was distributed to 322 Australian and New Zealand Society of Palliative Medicine members and received 92 responses (29% response rate). Most respondents were aware of the driving guidelines (76%) and about half of the respondents had read the driving guidelines (55%). The majority of respondents had been asked to provide advice about driving to their patient or patient's caregiver (91%). Most respondents had asked a patient to stop driving (94%), but only 27% had reported a patient to the Driver Licensing Authority. Only 14% of respondents were in consensus with the guidelines in providing driving advice to a patient with asymptomatic brain metastases. Most doctors (64%) advise patients to refrain temporarily from driving post-short-acting oral morphine, with 4 h (36%) being the most common time period for not driving. CONCLUSIONS This is the first survey investigating the practice of Australian doctors in assessing fitness to drive of patients with advanced disease. The survey found wide variability in practice and substantial discordance with current driving guidelines.
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Affiliation(s)
- Nashringi Weir
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Amanda Fischer
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia
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Li G, Eby DW, Santos R, Mielenz TJ, Molnar LJ, Strogatz D, Betz ME, DiGuiseppi C, Ryan LH, Jones V, Pitts SI, Hill LL, DiMaggio CJ, LeBlanc D, Andrews HF. Longitudinal Research on Aging Drivers (LongROAD): study design and methods. Inj Epidemiol 2017; 4:22. [PMID: 28736796 PMCID: PMC5537138 DOI: 10.1186/s40621-017-0121-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. METHODS The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging. RESULTS A total of 2990 active drivers aged 65-79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and "brown-bag review" of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March-May 2015. Recruitment and enrollment were completed between July 2015 and March 2017. CONCLUSIONS Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults.
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Affiliation(s)
- Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. .,Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. .,Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, NY, 10032, USA.
| | - David W Eby
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | | | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | | | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lindsay H Ryan
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Vanya Jones
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Samantha I Pitts
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Linda L Hill
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Charles J DiMaggio
- Division of Trauma, Emergency Surgery and Surgical Critical Care, New York University School of Medicine, New York, NY, USA
| | - David LeBlanc
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Howard F Andrews
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Behnood A, Mannering FL. The effects of drug and alcohol consumption on driver injury severities in single-vehicle crashes. TRAFFIC INJURY PREVENTION 2017; 18:456-462. [PMID: 27893281 DOI: 10.1080/15389588.2016.1262540] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE It is well known that alcohol and drugs influence driving behavior by affecting the central nervous system, awareness, vision, and perception/reaction times, but the resulting effect on driver injuries in car crashes is not fully understood. The purpose of this study was to identify factors affecting the injury severities of unimpaired, alcohol-impaired, and drug-impaired drivers. METHOD The current article applies a random parameters logit model to study the differences in injury severities among unimpaired, alcohol-impaired, and drug-impaired drivers. Using data from single-vehicle crashes in Cook County, Illinois, over a 9-year period from January 1, 2004, to December 31, 2012, separate models for unimpaired, alcohol-impaired, and drug-impaired drivers were estimated. A wide range of variables potentially affecting driver injury severity was considered, including roadway and environmental conditions, driver attributes, time and location of the crash, and crash-specific factors. RESULTS The estimation results show significant differences in the determinants of driver injury severities across groups of unimpaired, alcohol-impaired, and drug-impaired drivers. The findings also show that unimpaired drivers are understandably more responsive to variations in lighting, adverse weather, and road conditions, but these drivers also tend to have much more heterogeneity in their behavioral responses to these conditions, relative to impaired drivers. In addition, age and gender were found to be important determinants of injury severity, but the effects varied significantly across all drivers, particularly among alcohol-impaired drivers. CONCLUSIONS The model estimation results show that statistically significant differences exist in driver injury severities among the unimpaired, alcohol-impaired, and drug-impaired driver groups considered. Specifically, we find that unimpaired drivers tend to have more heterogeneity in their injury outcomes in the presence potentially adverse weather and road surface conditions. This makes sense because one would expect unimpaired drivers to apply their full knowledge/judgment range to deal with these conditions, and the variability of this range across the driver population (with different driving experiences, etc.) should be great. In contrast, we find, for the most part, that alcohol-impaired and drug-impaired drivers have far less heterogeneity in the factors that affect injury severity, suggesting an equalizing effect resulting from the decision-impairing substance.
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Affiliation(s)
- Ali Behnood
- a Lyles School of Civil Engineering, Purdue University , West Lafayette , Indiana
| | - Fred L Mannering
- b Department of Civil and Environmental Engineering , University of South Florida , Tampa , Florida
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Rezaee-Zavareh MS, Salamati P, Ramezani-Binabaj M, Saeidnejad M, Rousta M, Shokraneh F, Rahimi-Movaghar V. Alcohol consumption for simulated driving performance: A systematic review. Chin J Traumatol 2017; 20:166-172. [PMID: 28502603 PMCID: PMC5473736 DOI: 10.1016/j.cjtee.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/21/2016] [Accepted: 05/30/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Alcohol consumption can lead to risky driving and increase the frequency of traffic accidents, injuries and mortalities. The main purpose of our study was to compare simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, using a systematic review. METHODS In this systematic review, electronic resources and databases including Medline via Ovid SP, EMBASE via Ovid SP, PsycINFO via Ovid SP, PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL) via EBSCOhost were comprehensively and systematically searched. The randomized controlled clinical trials that compared simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, were included. Lane position standard deviation (LPSD), mean of lane position deviation (MLPD), speed, mean of speed deviation (MSD), standard deviation of speed deviation (SDSD), number of accidents (NA) and line crossing (LC) were considered as the main parameters evaluating outcomes. After title and abstract screening, the articles were enrolled for data extraction and they were evaluated for risk of biases. RESULTS Thirteen papers were included in our qualitative synthesis. All included papers were classified as high risk of biases. Alcohol consumption mostly deteriorated the following performance outcomes in descending order: SDSD, LPSD, speed, MLPD, LC and NA. Our systematic review had troublesome heterogeneity. CONCLUSION Alcohol consumption may decrease simulated driving performance in alcohol consumed people compared with non-alcohol consumed people via changes in SDSD, LPSD, speed, MLPD, LC and NA. More well-designed randomized controlled clinical trials are recommended.
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Affiliation(s)
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mina Saeidnejad
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Mansoureh Rousta
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shokraneh
- Research Center for Pharmaceutical Nanotechnology, Iranian Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Selected Problems of Aging. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kujansuu A, Rautiainen S, Hakko H, Kanamüller J, Sihvola N, Riipinen P. Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland. J Psychiatr Res 2017; 84:227-236. [PMID: 27770742 DOI: 10.1016/j.jpsychires.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 11/19/2022]
Abstract
Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.
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Affiliation(s)
- Antti Kujansuu
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, Peltolantie 17, 90014 Oulu, Finland
| | - Simo Rautiainen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, Peltolantie 17, 90014 Oulu, Finland.
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029 Oulu, Finland
| | - Juha Kanamüller
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029 Oulu, Finland
| | - Niina Sihvola
- Finnish Motor Insurers' Centre, Bulevardi 28, 00120 Helsinki, Finland
| | - Pirkko Riipinen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, Peltolantie 17, 90014 Oulu, Finland
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