Predictors of injury among younger and older adults in fatal motor vehicle crashes

With 2003 Fatality Analysis Reporting System data, we examined relationships among predictors of motor vehicle injury/fatality outcomes for younger (35–54 years) and older (65 years and older) drivers. Using the Precede-Proceed Model of Health Promotion as an organizing framework, we classified variables into person, vehicle and environment domains and conducted a multinomial logistic regression.Significant risk factors for older driver injuries were impact crashes at 1–3 o’clock (OR = 1.65; CI: 1.05–2.59), 7–9 o’clock angles (OR = 2.59; CI = 1.45–4.63), and driving with one passenger (OR = 2.25; CI: 1.58–3.20). Previous other motor vehicle convictions were significantly associated with reduced risk of injury (OR = 0.55; CI = 0.34–0.90). The 7–9 o’clock angle (OR = 3.06; CI: 1.83–5.12), and driving in daylight hours were risk factors for fatality among older drivers.Many risk factors (e.g., female gender, non-seatbelt use, rollover crashes, and vehicle body type), and protective factors (e.g., number of lanes and non-airbag deployment) were relevant for younger and older drivers. Findings showed relevant factors for drivers from both age groups, with some pointing to older adults, and set the stage for further research to develop injury and fatality prevention programs.     

汽车驾驶员注意品质与行车安全性关系的研究

借助心理测验方法，分析了事故与无事故汽车驾驶员在注意品质方面存在的差异。结果表明，事故驾驶员比无事故驾驶员的注意范围小，注意转移分配的能力差并且注意力不易集中。此外，驾驶员的注意品质受年龄因素的影响。     

Driving experience,crashes and traffic citations of teenage beginning drivers

Teenagers were surveyed by telephone every 6 months from their freshman to senior high school years (N=911). Self-reported crash involvements and citations were examined for each teenager's first year of licensure and first 3500 miles driven. Based on survival analysis, the risk of a first crash during the first month of licensure (0.053) was substantially higher than during any of the next 11 months (mean risk per month: 0.025). The likelihood of a first citation during the first month of licensure (0.023) also was higher than during any of the subsequent 11 months (mean risk per month: 0.012). Similarly, when viewed as a function of cumulative miles driven, the risk of a first crash or citation was highest during the first 500 miles driven after licensure. Fewer parental restrictions (e.g. no nighttime curfew) and a lower grade point average (GPA) were associated with a higher crash risk. Male gender, a lower GPA and living in a rural area were associated with a higher citation rate.     

Effect of population density on mortality after motor vehicle collisions

The objective of this study was to evaluate the effect of population density on mortality after traffic crashes. Subjects were the drivers of vehicles requiring towing after collisions, sampled by NASS-GES during 1994–1998. Cases were classified by population of crash location (greater or lesser than 25,000) and by population density of the driver’s county of residence (using ZIP code and Census data). Cases were also categorized by age, belt use and vehicle speed. Analytic methods for weighted, stratified survey data were used to estimate effects on mortality. A total of 190,721 cases with a specified crash location were identified in the sample, of which 93.7% had a specified population at the crash location, and 94.1% could be linked to the driver’s county data. Mortality was higher in locations with populations less than 25,000 and was inversely proportional to the driver’s county population density. Age, belt use, and vehicle speed also affected mortality significantly, but the effect of rural location remained after controlling for these factors (O.R. 2.10, 95% C.I. 1.62–2.73). The excess risk for residents of rural areas to die in traffic crashes can be attributed in part to post-crash factors.     

Driving with pets as a risk factor for motor vehicle collisions among older drivers

Increasing rates of distraction-related motor vehicle collisions (MVCs) continue to raise concerns regarding driving safety. This study sought to evaluate a novel driving-related distraction, driving with a pet, as a risk factor for MVCs among older, community dwelling adults. Two thousand licensed drivers aged 70 and older were identified, of whom 691 reported pet ownership. Comparing pet owners who did and did not drive with their pets, neither overall MVC rates (rate ratio [RR] 0.97, 95% confidence interval [CI] 0.75–1.26) nor at-fault MVC rates (RR 0.84, 95% CI 0.57–1.24) were elevated. However, those who reported always driving with a pet in the vehicle had an elevated MVC rate (RR 1.89, 95% CI 1.10–3.25), as compared to those who did not drive with a pet. The MVC rate was not increased for those reporting only sometimes or rarely driving with a pet in the vehicle. The current study demonstrates an increased risk of MVC involvement in those older drivers who always take a pet with them when they drive a vehicle. When confronted with an increased cognitive or physical workload while driving, elderly drivers in prior studies have exhibited slower cognitive performance and delayed response times in comparison to younger age groups. Further study of pet-related distracted driving behaviors among older drivers as well as younger populations with respect to driver safety and performance is warranted to appropriately inform the need for policy regulation on this issue.     

Analysis and prediction of traffic fatalities resulting from angle collisions including the effect of vehicles' configuration and compatibility

Although the rapid growth in light truck vehicle (LTV) sales, including minivans, sports utility vehicles (SUVs), and light-duty trucks, has not been associated with an overall increase in collisions or traffic deaths in the US, there is a need for a research program to determine whether particular types of collisions have become more frequent or injurious because of the increase in the percent of LTVs in traffic. This paper presents an analysis of the effect of the increasing number of LTV registrations on fatal angle collision trends in the US. The analysis investigates the number of annual fatalities that result from angle collisions as well as collision configuration (car-car, car-LTV, LTV-car, and LTV-LTV). The analysis uses the Fatality Analysis Reporting System (FARS) crash databases covering the period 1975-2000. Results showed that death rates differ based on the collision configuration. Time series modeling results showed that fatalities in angle collisions will increase in the next 10 years, and that they are affected by the expected increase in the percentage of LTVs in traffic. Forecast showed that the total number of annual deaths is expected to reach 6300 deaths by the year 2010 (an increase of 12% over 2000). Analysis into the configuration of the collision indicated the seriousness of angle collisions involving an LTV striking a common passenger car (LTV-car). A time series model illustrated the significance of time lag and percent of LTVs in traffic on the increase of this type of fatal collisions. Forecasts from the time series model indicated a 32% increase in deaths due to this type of collisions in the next 10 years.     

Traumatic brain injury,driver aggression and motor vehicle collisions in Canadian adults

ObjectiveThis study examines the associations between lifetime traumatic brain injury (TBI), driver aggression, and motor vehicle collisions among a population sample of adults who reside in the province of Ontario, Canada.MethodA cross-sectional sample of 3993 Ontario adults, aged 18–97 were surveyed by telephone in 2011 and 2012 as part of Center for Addiction and Mental Health’s ongoing representative survey of adult mental health and substance use in Canada. TBI was defined as trauma to the head that resulted in loss of consciousness for at least five minutes or overnight hospitalization.ResultsAn estimated 91% (95% CI: 90.0, 91.9) of individuals in this sample held a valid Ontario driver’s license at the time of testing. Among those, 16.7% reported a history of lifetime TBI and 83.3% reported no TBI. The prevalence of TBI was higher among men than women. Relative to licensed adults without TBI, adults with a history of TBI had significantly higher odds of engaging in serious driver aggression in the past 12 months, such as making threats to hurt another driver, passenger or their vehicle (AOR = 4.39). These individuals also reported significantly higher odds (AOR = 1.74) of being involved in a motor vehicle collision that resulted in hurting themselves, their passenger(s) or their vehicle.ConclusionThis is the first population-based study to demonstrate a relationship between a history of TBI and higher rates of serious driver aggression and collision involvement. Given the large proportion of adult drivers with a history of TBI, these individuals may account for a disproportion burden of all traffic safety problems. Whether the increased road safety risk of adults with a history of TBI is reflective of neurocognitive deficits or is merely evidence of a cluster of unsafe activities produced by a higher risk lifestyles requires further research attention.     

Reducing older driver motor vehicle collisions via earlier cataract surgery

Older adults who undergo cataract extraction have roughly half the rate of motor vehicle collision (MVC) involvement per mile driven compared to cataract patients who do not elect cataract surgery. Currently in the U.S., most insurers do not allow payment for cataract surgery based upon the findings of a vision exam unless accompanied by an individual's complaint of visual difficulties that seriously interfere with driving or other daily activities and individuals themselves may be slow or reluctant to complain and seek relief. As a consequence, surgery tends to occur after significant vision problems have emerged. We hypothesize that a proactive policy encouraging cataract surgery earlier for a lesser level of complaint would significantly reduce MVCs among older drivers. We used a Monte Carlo model to simulate the MVC experience of the U.S. population from age 60 to 89 under alternative protocols for the timing of cataract surgery which we call “Current Practice” (CP) and “Earlier Surgery” (ES). Our base model finds, from a societal perspective with undiscounted 2010 dollars, that switching to ES from CP reduces by about 21% the average number of MVCs, fatalities, and MVC cost per person. The net effect on total cost – all MVC costs plus cataract surgery expenditures – is a reduction of about 16%. Quality Adjusted Life Years would increase by about 5%. From the perspective of payers for healthcare, the switch would increase cataract surgery expenditure for ages 65+ by about 8% and for ages 60–64 by about 47% but these expenditures are substantially offset after age 65 by reductions in the medical and emergency services component of MVC cost. Similar results occur with discounting at 3% and with various sensitivity analyses. We conclude that a policy of ES would significantly reduce MVCs and their associated consequences.     

Drugs related to motor vehicle crashes in northern European countries: a study of fatally injured drivers

The aim of this study was to find which drugs and drug combinations were most common in drivers who died, in particular, in single vehicle crashes where the responsibility for the crash would be referred to the driver killed. The study included all available blood samples from drivers, who died within 24 h of the accident, in the years 2001 and 2002 in the five Nordic countries (total population about 24 million inhabitants). The samples were analysed for more than 200 different drugs in addition to alcohol, using a similar analytical programme and cut-off limits in all countries. In three countries (Finland, Norway and Sweden) blood samples were available for more than 70% of the drivers, allowing representative prevalence data to be collected. 60% of the drivers in single vehicle crashes had alcohol and/or drug in their blood samples, compared with 30% of drivers killed in collisions with other vehicles. In single vehicle accidents, 66% of the drivers under 30 years of age had alcohol and/or drugs in their blood (alcohol only – 40%; drugs only – 12%; alcohol and drugs – 14%). The drugs found were mostly illicit drugs and psychoactive medicinal drugs with warning labels (in 57% and 58% respectively of the drivers under 30 with drugs present). Similar findings were obtained for drivers 30–49 years of age (63% with alcohol and/or drugs). In drivers aged 50 years and above, killed in single vehicle crashes (48% with alcohol and/or drugs) illicit drugs were found in only one case, and psychoactive medicinal drugs were detected less frequently than in younger age groups. In 75% of single vehicle crashes, the driver was under 50 years. Thus, the majority of accidents where the drivers must be considered responsible, occurred with drivers who had recently used alcohol, or drugs, alone or in combination. The drugs involved were often illicit and/or psychoactive drugs with warning labels. Therefore a large proportion of single vehicle accidents appear to be preventable, if more effective measures against driving after intake of alcohol and drugs can be implemented.     

Acceptability and concurrent validity of measures to predict older driver involvement in motor vehicle crashes: an Emergency Department pilot case-control study

INTRODUCTION: Older drivers have one of the highest motor vehicle crash (MVC) rates per kilometer driven, largely due to the functional effects of the accumulation, and progression of age-associated medical conditions that eventually impact on fitness-to-drive. Consequently, physicians in many jurisdictions are legally mandated to report to licensing authorities patients who are judged to be medically at risk for MVCs. Unfortunately, physicians lack evidence-based tools to assess the fitness-to-drive of their older patients. This paper reports on a pilot study that examines the acceptability and association with MVC of components of a comprehensive clinical assessment battery. OBJECTIVES: To evaluate the acceptability to participants of components of a comprehensive assessment battery, and to explore potential predictors of MVC that can be employed in front-line clinical settings. METHODS: Case-control study of 10 older drivers presenting to a tertiary care hospital emergency department after involvement in an MVC and 20 age-matched controls. RESULTS: The measures tested were generally found to be acceptable to participants. Positive associations (p相似文献   

Attributions of responsibility for motor vehicle crashes

A sample of 321 motor vehicle crash survivors completed a survey in which they provided attribution ratings of the extent to which they were responsible for their crashes, other people (drivers) were responsible, or road/weather conditions were responsible. The attribution ratings were consistent with the predictions of defensive attribution theory (DAT; [Walster, E., 1966. Assignment of responsibility for an accident. J. Pers. Soc. Psychol. 3, 73-79]) in that people who experienced crashes of greater severity (necessitating medical treatment for injuries) attributed greater responsibility to other drivers than to self or to weather/road conditions. People who were in crashes of lesser severity attributed approximately the same amount of responsibility to themselves as they did to others. An actor-observer effect also appeared in survivors' attribution ratings in that self-acceptance of responsibility for the crash was positively correlated with attributions to the situation (road/weather conditions) whereas such attributions to the situation were negatively correlated with attributions of responsibility to other drivers. Consistent with results of prior research, survivors who assigned crash responsibility to other drivers reported increased levels of driving and riding avoidance compared to people who accepted responsibility for their crashes.     

Driving with pets and motor vehicle collision involvement among older drivers: A prospective population-based study

ObjectiveDistracted driving is a major cause of motor vehicle collision (MVC) involvement. Pets have been identified as potential distraction to drivers, particularly in the front. This type of distraction could be worse for those with impairment in the cognitive aspects of visual processing. The purpose of this study is to evaluate the association between driving with pets and rates of motor vehicle collision involvement in a cohort of older drivers.MethodsA three-year prospective study was conducted in a population-based sample of 2000 licensed drivers aged 70 years and older. At the baseline visit, a trained interviewer asked participants about pet ownership, whether they drive with pets, how frequently, and where the pet sits in the vehicle. Motor vehicle collision (MVC) involvement during the three-year study period was obtained from the Alabama Department of Public Safety. At-fault status was determined by the police officer who arrived on the scene. Participants were followed until the earliest of death, driving cessation, or end of the study period. Poisson regression was used to calculate crude and adjusted rate ratios (RR) examining the association between pet ownership, presence of a pet in a vehicle, frequency of driving with a pet, and location of the pet inside with vehicle with any and at-fault MVC involvement. We examined whether the associations differed by higher order visual processing impairment status, as measured by Useful Field of View, Trails B, and Motor-free Visual Perception Test.ResultsRates of crash involvement were similar for older adults who have ever driven with a pet compared to those who never drove with their pet (RR = 1.15, 95% CI 0.76–1.75). Drivers who reported always or sometimes driving with their pet had higher MVC rates compared to pet owners who never drive with a pet, but this association was not statistically significant (RR = 1.39, 95% CI 0.86–2.24). In terms of location, those reporting having a pet frequently ride in the front of the vehicle had similar rates of MVC involvement compared to those who did not drive with a pet in the front. A similar pattern of results was observed for at-fault MVCs. This association was not modified by visual processing impairment status.ConclusionThe current study demonstrates a positive but non-significant association between frequently driving with pets and MVC involvement. More research is needed, particularly on restraint use and whether the pet was in the car at the time of the crash, to help characterize the public safety benefit of regulations on driving with pets.     

Defining the "older" crash victim: the relationship between age and serious injury in motor vehicle crashes

OBJECTIVE: Age is often used as a predictor of injury and mortality in motor vehicle crashes (MVCs), however, the age that defines an "older" occupant in terms of injury-risk remains unclear, as do specific injury patterns associated with increasing age. The objective of this study was to evaluate the relationship between age and serious injury (including injury patterns) for occupants involved in MVCs. METHODS: This was a retrospective cohort study using a national population-based cohort of adult front-seat occupants involved in MVCs and included in the National Automotive Sampling System Crashworthiness Data System database from 1995 to 2006. The primary outcome was serious injury, defined as an abbreviated injury scale (AIS) score >/=3 in any body region. Anatomic injury patterns were also assessed by age. RESULTS: One hundred thousand one hundred and fifty-six adult front-seat occupants were included in the analysis, of which 14,128 (2%) were seriously injured. Age was a strong predictor of serious injury using a variety of different age covariates (categorical, continuous, and polynomial) in multivariable regression models (p<0.0001 for all). There was evidence of a strong non-linear relationship between age and serious injury (p<0.001 for comparison of non-linear to linear representation of age). There was no age that clearly defined an "older" occupant by injury risk, as the odds of injury increased with increasing age across all age groups. The proportion of serious head and extremity injuries gradually increased with increasing age, while serious chest injuries markedly increased after 60 years. CONCLUSIONS: Age is a strong predictor of serious injury from motor vehicle trauma, the risk of which increases in non-linear fashion as age increases. There is no specific age that clearly defines an "older" occupant by injury risk.     

Driver seat belt use indicates decreased risk for child passengers in a motor vehicle crash

Study objective

We examined the association between driver restraint use and child emergency department (ED) evaluation following a motor vehicle crash (MVC).

Methods

This cohort study included child passengers aged 0-12 years riding with an adult driver aged 21 years or older involved in a MVC in Utah from 1999 to 2004. The 6 years of Utah MVC records were probabilistically linked to statewide Utah ED records. We estimated the relative risk of ED evaluation following a MVC for children riding with restrained versus unrestrained drivers. Generalized estimating equations were used to calculate relative risks adjusted for child, driver, and crash characteristics.

Results

Six percent (6%) of children riding with restrained adult drivers were evaluated in the ED compared to twenty-two percent (22%) of children riding with unrestrained adult drivers following a MVC (relative risk 0.29, 95% confidence interval 0.26-0.32). After adjusting for child, vehicle, and crash characteristics, the relative risk of child ED evaluation associated with driver restraint remained significant (relative risk 0.82, 95% confidence interval 0.72-0.94). Driver restraint use was associated with child restraint use, less alcohol/drug involvement, and lower relative risk of severe collision types (head-on, rollover).

Conclusions

Driver seat belt use is associated with decreased risk of ED evaluation for child passengers in the event of a MVC.     

Injury risks between first- and second-generation airbags in frontal motor vehicle collisions

BACKGROUND: Airbags in vehicles manufactured after 1997 were depowered to decrease injury risks for infants/children and small adults. It is possible that compared to earlier airbags second-generation airbags provide less injury protection due to their depowered nature. METHODS: A cohort study was conducted using 1995-2004 national data. Risk ratios (RRs) and 95% confidence intervals (CIs) compared injury risks for occupants involved in frontal collisions in vehicles wherein a first- or second-generation airbag deployed by body region and injury severity using the Abbreviated Injury Scale (AIS). Associations were adjusted for crash severity, seatbelt use, seat position, occupant location, and vehicle curb weight. RESULTS: For upper extremity injuries reduced RRs were observed for AIS 1 or greater (RR=0.76, CI 0.67-0.86), AIS 2 or greater (RR=0.76, CI 0.58-1.00) and AIS 3 (RR=0.81, CI 0.64-1.03). Elevated risks were observed for AIS 5 thoracic injuries (RR=1.46, CI 1.04-2.07) but were made null when differences in age and gender were adjusted for. CONCLUSIONS: Vehicles equipped with first- and second-generation airbags appear to offer similar protection for front-seated occupants. The observed decreased risks for upper extremity injury and increased risks for severe thoracic injuries warrant further attention.     

Unsafe motor vehicle practices among substance-using college students

This study examines the relationship between substance use and behaviors that increase the risk for motor vehicle crashes and crash-related injuries. The investigation uses National College Health Risk Behavior Survey data collected in 1995 by the Centers for Disease Control and Prevention. These data are representative of 2- and 4-year undergraduate college students in private and public colleges and universities in the United States. Smokers, episodic heavy drinkers, marijuana users and users of illegal drugs in combination with alcohol were significantly more likely to drive after drinking alcohol and ride with a driver who had been drinking alcohol and significantly less likely to wear safety belts while driving or while riding in a car as a passenger. This study indicates that college students who are substance users are more likely to behave in a manner which increases their risk for motor vehicle crashes and motor vehicle crash injuries.     

Risky driving habits and motor vehicle driver injury

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16-24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.     

Pedestrian signalization and the risk of pedestrian-motor vehicle collisions in Lima,Peru

Safe walking environments are essential for protecting pedestrians and promoting physical activity. In Peru, pedestrians comprise over three-quarters of road fatality victims. Pedestrian signalization plays an important role managing pedestrian and vehicle traffic and may help improve pedestrian safety. We examined the relationship between pedestrian-motor vehicle collisions and the presence of visible traffic signals, pedestrian signals, and signal timing to determine whether these countermeasures improved pedestrian safety. A matched case-control design was used where the units of study were crossing locations. We randomly sampled 97 control-matched collisions (weighted N = 1134) at intersections occurring from October, 2010 to January, 2011 in Lima. Each case-control pair was matched on proximity, street classification, and number of lanes. Sites were visited between February, 2011 and September, 2011. Each analysis accounted for sampling weight and matching and was adjusted for vehicle and pedestrian traffic flow, crossing width, and mean vehicle speed. Collisions were more common where a phased pedestrian signal (green or red-light signal) was present compared to no signalization (odds ratio [OR] 8.88, 95% Confidence Interval [CI] 1.32–59.6). A longer pedestrian-specific signal duration was associated with collision risk (OR 5.31, 95% CI 1.02–9.60 per 15-s interval). Collisions occurred more commonly in the presence of any signalization visible to pedestrians or pedestrian-specific signalization, though these associations were not statistically significant. Signalization efforts were not associated with lower risk for pedestrians; rather, they were associated with an increased risk of pedestrian-vehicle collisions.     

Trends in mortality due to motor vehicle traffic accident injuries between 1987 and 2011 in a Spanish region (Comunitat Valenciana)

Objective

To analyse the time evolution of the rates of mortality due to motor vehicle traffic accidents (MVTA) injuries that occurred among the general population of Comunitat Valenciana between 1987 and 2011, as well as to identify trend changes by sex and age group.

Methods

An observational study of annual mortality trends between 1987 and 2011. We studied all deaths due to MVTA injuries that occurred during this period of time among the non-institutionalised population residing in Comunitat Valenciana (a Spanish Mediterranean region that had a population of 5,117,190 inhabitants in 2011). The rates of mortality due to MVTA injuries were calculated for each sex and year studied. These rates were standardised by age for the total population and for specific age groups using the direct method (age-standardised rate – ASR). Joinpoint regression models were used in order to detect significant trend changes. Additionally, the annual percentage change (APC) of the ASRs was calculated for each trend segment, which is reflected in statistically significant joinpoints.

Results

For all ages, ASRs decrease greatly in both men and women (70% decrease between 1990 and 2011). In 1990 and 2011, men have rates of 36.5 and 5.2 per 100,000 men/year, respectively. In the same years, women have rates of 8.0 and 0.9 per 100,000 women/year, respectively. This decrease reaches up to 90% in the age group 15–34 years in both men and women. ASR ratios for men and women increased over time for all ages: this ratio was 3.9 in 1987; 4.6 in 1990; and 5.8 in 2011. For both men and women, there is a first significant segment (p < 0.05) with an increasing trend between 1987 and 1989–1990. After 1990, there are 3 segments with a significant decreasing APC (1990–1993, 1993–2005 and 2005–2011, in the case of men; and 1989–1996, 1999–2007 and 2007–2011, in the case of women).

Conclusion

The risk of death due to motor vehicle traffic accidents injuries has decreased significantly, especially in the case of women, for the last 25 years in Comunitat Valenciana, mainly as of 2006. This may be a consequence of the road-safety measures that have been implemented in Spain and in Comunitat Valenciana since 2004. The economic crisis that this country has undergone since 2008 may have also been a contributing factor to this decrease.Despite the decrease, ASR ratios for men and women increased over time and it is still a high-risk cause of death among young men. It is thus important that the measures that helped decrease the risk of death are maintained and improved over time.     

Self-rated driving and driving safety in older adults

Many U.S. states rely on older adults to self-regulate their driving and determine when driving is no longer a safe option. However, the relationship of older adults’ self-rated driving in terms of actual driving competency outcomes is unclear. The current study investigates self-rated driving in terms of (1) systematic differences between older adults with high (good/excellent) versus low (poor/fair/average) self-ratings, and (2) the predictive nature of self-rated driving to adverse driving outcomes in older adults (n = 350; mean age 73.9, SD = 5.25, range 65–91). Adverse driving outcomes included self-reported incidences of (1) being pulled over by the police, (2) receiving a citation, (3) receiving a recommendation to cease or limit driving, (4) crashes, and (5) state-reported crashes. Results found that older drivers with low self-ratings reported more medical conditions, less driving frequency, and had been given more suggestions to stop/limit their driving; there were no other significant differences between low and high self-raters. Logistic regression revealed older drivers were more likely to have a state-reported crash and receive a suggestion to stop or limit driving. Men were more likely to report all adverse driving outcomes except for receiving a suggestion to stop or limit driving. Regarding self-rated driving, older adults with high ratings were 66% less likely (OR = 0.34, 95% CI = 0.14–0.85) to have received suggestions to limit or stop driving after accounting for demographics, health and driving frequency. Self-ratings were not predictive of other driving outcomes (being pulled over by the police, receiving a citation, self-reported crashes, or state-reported crashes, ps > 0.05). Most older drivers (85.14%) rated themselves as either good or excellent drivers regardless of their actual previous citation or crash rates. Self-rated driving is likely not related to actual driving proficiency as indicated by previous crash involvement in older adults. Suggestions from other individuals to limit or cease driving may be more influential on self-ratings.