Driving Patterns of Older Adults: Results from the Second Injury Control and Risk Survey

OBJECTIVES: To describe older adults' driving patterns, including self‐imposed driving restrictions and motor vehicle crashes (MVCs). DESIGN: The Second Injury Control and Risk Survey (ICARIS‐2) was a national, random‐digit‐dial telephone survey conducted by the Centers for Disease Control and Prevention in 2001 to 2003. ICARIS‐2 sampled 113,476 English‐ and Spanish‐speaking households, using weighting variables to generate national estimates. RESULTS: The response rate was 48% (N=9,684). Six percent (n=728) of respondents were aged 75 and older. Of these, 85.6% (n=613) were aged 75 to 84, and 14.4% (n=115) were aged 85 and older; 59.2% were female. Three‐fourths (74.9%, 95% confidence interval (CI)=70.4–79.4%) of adults aged 75 to 84 and 69.9% (95% CI=48.2–71.6%) aged 85 and older were current drivers. Most (81.9%; 95% CI=77.6–86.2%) older drivers limited their driving, usually in bad weather (59.0%), at night (57.0%), on long trips (49.6%), in traffic (49.0%), or at high speeds (33.6%); only 15.4% limited driving for medical reasons. Women were more likely to self‐limit driving (odds ratio (OR)=1.83, 95% CI=0.99–3.39). Few (4.2%, 95% CI=2.4–6.1%) older adults reported MVC involvement in the past year as a driver or passenger. In multivariate analysis, drivers living alone (OR=3.93, 95% CI=1.55–9.95) and men (OR=2.59, 95% CI=1.18–5.67) were more likely to report a recent crash; drivers who self‐limited were less likely (OR=0.55, 95% CI=0.18–1.60). CONCLUSION: Large majorities of older adults, including those aged 85 and older, are current drivers. Although many limit driving in hazardous conditions, fewer do for medical reasons. Men and older adults who live alone are more likely to report a recent MVC; those who self‐limit their driving are less likely to report crash involvement.     

Should Patients with Implantable Cardioverter-Defibrillators Be Allowed to Drive? Observations in 291 Patients from a Single Center over an 11-year Period

Motor-vehicle driving restrictions for patients with implantable cardioverter-defibrillators (ICDs) vary widely throughout the world because safety concerns have never been adequately resolved in this patient population. To address this issue, we examined the driving behavior of 291 ICD patients to correlate the frequency of device therapy during driving, the occurrence of syncopal symptoms, and the incidence of traffic accidents. Fifty of the 291 patients had never driven. Of the remaining 241 patients, 171 (59%) continued driving postimplant and 70 (24%) elected to stop prior to (n = 30) or at the time of ICD implantation (n = 40). Patients were followed for a mean of 38 ± 26 months (range <1–124). During this period, no patients died while driving. Of 11 accidents involving 11 driving patients (6%), only 1 was caused by the driver, and none was related to syncopal symptoms or ICD therapy. Although 2 accidents (8%) occurred within 12 months postimplant, the majority (50%) took place after more than 36 months. ICD therapy was delivered in 8 patients (5%) while driving: 13% (1 episode) of the discharges occurred within the first year postimplant, 13% (1 episode) occurred between 1–2 years, and 74% (6 episodes) occurred >2 years. None of these patients experienced syncope before or during these episodes. A multivariate analysis was unable to identify any variables that might predict increased risk of ICD therapy (with or without sudden death) while driving and consequent motor vehicle accidents. Our data suggest that such events occur only rarely     

Fit to Drive: A Pilot Study to Improve the Physical Fitness of Older Drivers

This pilot study aimed to explore whether maintaining a driver's license could motivate older adults to participate in a regular fitness program, and determine whether gains in fitness could result in self-perceived improvements in driving. Physical measures and questionnaires were collected from 19 participants and 5 controls. For the intervention group, men showed significant gains in one measure of endurance, while women showed gains in strength, endurance, agility, flexibility, and hand reaction time. Half of the participants felt their driving skills had improved, and 40% reported an increase in driving confidence. Controls showed some improvements in endurance and foot reaction time but no self-reported improvements in driving. This study contributes to the understanding of older adults' motivation for activity participation, and suggests that improvements in physical conditioning may have a positive impact on driver safety.     

Interventions to reduce the adverse psychosocial impact of driving cessation on older adults

As a result of our aging population, the coming years will see increasing numbers of older adults faced with the prospect of giving up driving due to poor health or functional limitations. Driving cessation has been associated with negative psychosocial outcomes for older adults including restricted mobility and depression. While several studies report evaluations of interventions designed to help older adults to drive safely for longer, there is a paucity of published research concerned with the design or implementation of intervention programs intended to reduce the negative consequences of driving cessation. This paper reviews cognitive and educational interventions designed to promote older driver safety, and discusses possible approaches to the design and implementation of clinical interventions for older adults who have ceased driving. A broad framework for adaptable interventions based on the theoretical tenets of social cognitive theory, with an emphasis on planning for cessation, problem-solving and the involvement of friends and family members is proposed.     

Screening for diabetic retinopathy: a cause for concern in people who drive.

AIMS: To report a case of a road traffic accident in a lady driving home from a diabetes clinic after pupillary dilatation. We also present the findings of a questionnaire survey of health professionals to elicit their practice in dealing with such patients. METHODS: We present the case report of a lady having a road traffic accident on her way back from a retinal screening appointment after having had pupillary dilatation. A subsequent postal questionnaire survey was undertaken to find out current practice in screening patients who drive on the day of their retinal screening. RESULTS: A lady was involved in a road traffic accident whilst returning home after retinal screening. Her motor insurance company refused to cover subsequent claims for damage because her pupils had been dilated. She was also prosecuted by the police for driving without valid motor insurance. We conducted a postal survey of 500 health care workers including ophthalmologists, optometrists, diabetologists and general practitioners regarding the use of dilating drops in people with diabetes who intend to drive. Analysis of 320 valid responses confirmed that there is no consistent practice with regard to either the use of dilating drops in drivers or in ensuring that arrangements are made for subsequent adequate visual inspection in those whom dilatory drops are not instilled. CONCLUSIONS: Guidelines, for use by health care professionals and people with diabetes, are clearly required regarding the use of pupillary dilating drops in drivers.     

Blow and Go: The Breath-Analyzed Ignition Interlock Device as a Technological Response to DWI

Driving while intoxicated rates have declined substantially in the last 20 years. This is as a result of public opinion combined with increased law enforcement efforts. A recent tool has been the Breath Analyzed Ignition Interlock Device. This new technology is designed to prevent persons with excessive blood alcohol levels from operating the interlocked vehicle. This 3-year recidivism study of the ignition interlock revealed 17.5% recidivism rates for the interlock group compared to 25.3% recidivism rates for the non-interlock group, a 31% decrease. Multiple offenders and younger (under 30) offenders had significantly lower rates of subsequent arrests. The multi-offenders in the comparison group were more than twice as likely as the interlock group to have a subsequent conviction within 3 years. The difference was nearly the same for the under 30 age group. There was almost no difference for first offenders. Accordingly, the ignition interlock appears to significantly reduce recidivism for repeat and younger DWI offenders but offers almost no improvement for first offenders. One driver of 315 (0.32%) was charged with DWI with an interlock in place. This offender had a child provide the breath sample while she drove the vehicle.     

Effectiveness of interventions for convicted DUI offenders in reducing recidivism: a systematic review of the peer-reviewed scientific literature

Background: Driving under the influence (DUI) is a major cause of death and disability. Although a broad array of programs designed to curb DUI incidents are currently offered to both first-time and recidivist DUI offenders, existing evaluations of the effectiveness of these programs have reported mixed results. Objective: To synthesize the results of DUI program evaluations and determine the strength of the available evidence for reducing recidivism for different types of programs. Methods: A systematic review of all EBSCO databases, EMBASE, PubMed, ProQuest, Sociological Abstracts and TRIS was conducted to identify evaluations of treatments/interventions to prevent DUI offenses. Additional articles were identified from reference lists of relevant articles. Results: A total of 42 relevant studies were identified by the search strategy. Of these, 33 utilized non-experimental evaluation designs or reported insufficient data to allow effect sizes to be calculated, making meta-analysis unfeasible. Evaluations of several different program types reported evidence of some level of effectiveness. Conclusion: Because of the general lack of high quality evidence assessing the effectiveness of DUI prevention programs, it is not possible to make conclusive statements about the types of programs that are likely to be most effective. Nonetheless, there was some evidence to support the effectiveness of programs that utilize intensive supervision and education. There is a need for future evaluations to adopt more scientifically rigorous research designs to establish the effects of these programs.