Search

Background: Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality. Methods: This prospective two‐arm randomized trial enrolled English‐speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web‐based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self‐efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed‐effects models with adjustment for site and prerandomization scores. Results: Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non‐Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61–0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01–1.27, p = 0.038); there was no difference between groups in self‐efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations. Conclusions: The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English‐speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility. Trial registration: ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891. [ABSTRACT FROM AUTHOR]

Objectives To determine what effect driving cessation may have on subsequent health and well-being in older adults. Design Systematic review of the evidence in the research literature on the consequences of driving cessation in older adults. Setting Community. Participants Drivers aged 55 and older. Measurements Studies pertinent to the health consequences of driving cessation were identified through a comprehensive search of bibliographic databases. Studies that presented quantitative data for drivers aged 55 and older; used a cross-sectional, cohort, or case-control design; and had a comparison group of current drivers were included in the review. Results Sixteen studies met the inclusion criteria. Driving cessation was reported to be associated with declines in general health and physical, social, and cognitive function and with greater risks of admission to long-term care facilities and mortality. A meta-analysis based on pooled data from five studies examining the association between driving cessation and depression revealed that driving cessation almost doubled the risk of depressive symptoms in older adults (summary odds ratio = 1.91, 95% confidence interval = 1.61-2.27). Conclusion Driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. These adverse health consequences should be considered in making the decision to cease driving. Intervention programs ensuring mobility and social functions may be needed to mitigate the potential adverse effects of driving cessation on health and well-being in older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine injuries in older adults due to boarding (i.e., entering) and alighting from (i.e., exiting) motor vehicles, with a special emphasis on falls. DESIGN: Retrospective analysis of incident fall injuries while boarding or alighting from a motor vehicle. SETTING: 2001 to 2003 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) data from a representative sample of 500,000 injury and consumer product–related emergency department (ED) cases in the United States. PARTICIPANTS: Fourteen thousand seven hundred seventy-four persons unintentionally injured while boarding or alighting from a passenger vehicle. MEASUREMENTS: Annualized estimates and injury rates. RESULTS: There were an estimated 37,000 annual boarding and alighting injuries requiring medical care in EDs among older adults, many of these injuries (41.3%) due to falls. Fall rates were higher in women (52.8 per 100,000) than men (29.5 per 100,000) ( P<.01). The hospitalization rate was 10 times higher for those aged 65 and older than for those younger than 65 ( P<.001). Injury rates differed according to whether the person was boarding or alighting from the vehicle. Fall-related injury associated with alighting was more common (11,030) than with boarding (4,346), and the overall injury rate for alighting (31.0 per 100,000) was more than twice the rate for boarding (12.2 per 100,000). CONCLUSION: The high incidence of falls in older adults in this study points to a variety of injury circumstances that result in falls; therefore, fall prevention activities must address the underlying risks that are widespread in this population. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To understand why older drivers living in a community setting stop driving. DESIGN: A cross-sectional study within a longitudinal cohort. SETTING: A geographically defined community in southern California. PARTICIPANTS: 1,950 respondents age 55 and older who reported ever being licensed drivers. MEASUREMENTS: A mailed survey instrument of self-reported driving habits linked to prior demographic, health, and medical information. RESULTS: Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two-thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age-related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P ≤ .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P ≤ .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation. CONCLUSION: The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether a Traffic Sign Recognition Test (TSRT) can identify older drivers who recently had a motor vehicle crash (MVC). DESIGN: Retrospective, matched, case-control study. SETTING: Licensed drivers in Galveston, Texas. PARTICIPANTS: 60 crash and 60 control subjects matched for age and gender. Cases were identified from accident records. Controls were selected from a randomized list of licensed drivers in Galveston. MEASUREMENTS: Folstein Mini-Mental State Examination (MMSE) and the TSRT. RESULTS: A TSRT significantly distinguished between case and control groups (P = .01). The MMSE did not (P = .61). A TSRT predicted MVC in a multivariate analysis controlling for education, MMSE score, race/ethnicity, and mileage driven/year (odds ratio = 0.88, 95% confidence interval = 0.77–1.00). CONCLUSION: A TSRT successfully identifies older drivers with a recent MVC, but the test lacks sensitivity and specificity. A prospective study is needed to further delineate the TSRT's usefulness in predicting crash risk in older drivers. [ABSTRACT FROM AUTHOR]