Crash Risk For Older Drivers Research Articles

Can strategic and tactical compensation reduce crash risk in older drivers?

to determine whether the use of strategic and tactical compensation can successfully improve safety in older drivers. 84 healthy subjects aged between 65 and 96 were referred for a fitness-to-drive evaluation. Using ANOVA and contrast analysis, we tested the hypothesis that bad drivers who have had no car accidents use more active compensation strategies than bad drivers who have caused accidents in the previous 12 months. We classified drivers as bad, average or good, based on a structured road test. drivers who select driving tasks below their capacities and compensate by adapting their driving style cause fewer accidents than those who do not apply these strategies. fitness-to-drive screening procedures need a broader perspective to prevent an over-emphasis on procedures which focus more on deficit than on capacities.

New test predicts crash risk of older drivers

To this date, studies regarding the use of prophylactic cranial irradiation (PCI) versus standard of care (SoC) for patients with non-small cell lung cancer have shown limited benefit in survival outcomes, in addition to the potential effects on quality of life (QoL) and neurocognitive function (NCF). This randomized, phase II study evaluated the role of PCI in QoL and NCF, in a population comprised of subjects at a high risk for development of brain metastases (BM).Eligible patients had histologically confirmed non-small cell lung cancer without baseline BM, harboring epidermal growth factor receptor mutations, anaplastic lymphoma kinase rearrangements, or elevated carcinoembryonic antigen (CEA) at diagnosis. Participants were assigned to receive SoC or SoC plus PCI (25 Gy in 10 fractions). Primary endpoint was BM at 24 months (BM-24), for which the study was powered. Secondary endpoints included QoL assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the Lung Cancer module (LC13) and NCF assessed using the Mini Mental State Examination (MMSE). Patients were followed every 3 months for a year for QoL and NCF.From May 2012 to December 2017, 84 patients were enrolled in the study, 41 were allocated to PCI while 43 received SoC. Efficacy outcomes are discussed in a separate article. The global health-QoL scores were similar at 3, 6, 9, and 12 months after randomization between both study arms, with no significant differences when comparing by groups. At 1-year postrandomization, median global health QoL scores were 83 (p25-p75: 75-83) and 83 (p25-p75: 75-83) in the control and experimental arms, respectively. There were no significant changes in terms of the mean differences between subjects in either study arm when analyzing the change between baseline and 12-month scores (16.4 ± 19.9 vs 12.9 ± 14.7; P = .385). Seventeen patients were alive at database lockdown in February 2020, without significant differences in median MMSE (30 [p25-75: 29-30] vs 30 [p25-75: 28-30]) or QLQ-C30 scores (75.0 [p25-75: 50-87.2] vs 67.0 [p25-75: 50.0-100.0]).Among a selected high-risk population for developing BM, PCI did not significantly decrease QoL or neurocognitive function as assessed using the MMSE. Future studies are warranted to assess this observation, using more varied and sensitive tools available to date.

Visual processing impairment and risk of motor vehicle crash among older adults.

Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills. To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers. Prospective cohort study with 3 years of follow-up, 1990-1993. Ophthalmology clinic assessment of community-based sample. A total of 294 drivers aged 55 to 87 years at enrollment. Motor vehicle crash occurrence. Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations. Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.

Fatal crash risk for older drivers at intersections

Risk of fatal crash involvement was calculated for older drivers relative to drivers aged 40–49 in the United States during the years 1994–1995. The results indicated that drivers ages 65–69 were 2.26 times more at risk for multiple-vehicle involvements at intersections compared with 1.29 times more at risk in all other situations. The comparable figures for drivers aged 85 and older were 10.62 for multiple-vehicle involvements at intersections compared with 3.74 for all other situations. The relative crash risk was particularly high for older drivers at uncontrolled and stop sign-controlled locations; when traveling straight or when just starting to enter the intersection; and when the specific behavioral error in the crash was failure to yield. Countermeasures will likely involve reducing or simplifying the need to detect and evaluate moving traffic coming from the left and right when at intersections. This can be accomplished by traffic signals with protected left turns, four-way stop signs, and one-way streets. Whereas such devices involve significant cost in terms of dollars and travel delay, their cost-effectiveness may have to be revisited as the United States population continues to age.

Dementia and driving: an attempt at consensus.

The number of older drivers in Sweden will be rapidly increasing during the next decades. A possible relationship exists between the increased relative crash risk of older drivers and the prevalence of age-related diseases such as dementia. However, a clear-cut policy for evaluating driving competence in demented persons is still lacking. In recognition of this fact, the Swedish National Road Administration invited a group of researchers to formulate a consensus on the issue of driving and dementia. This consensus document is aimed at providing primary care physicians with practical advice concerning the assessment of cognitive status in relation to driving. Suggestions are based on a review of existing research and discuss the use of general and driving-specific sources of information available to the physician. Consensus was reached on the statement that a diagnosis of moderate to severe dementia precludes driving and that certain individuals with mild dementia should be considered for a specialized assessment of their driving competence.

Isolating Risk Factors for Crash Frequency among Older Drivers

By the year 2024, 25% of drivers in the U.S. will be over the age of 65. Older drivers have more crashes and fatalities per mile driven than any other adult age group. Although driving is a highly visual task and vision impairment is more prevalent in the elderly, previous research has failed to identify visual factors which are strongly associated with increased crashes in the elderly. Using a comprehensive approach to assess several aspects of visual processing in a large sample of older drivers, this study has identified a measure of visual attention that had high sensitivity (89%) and specificity (85%) in predicting which older drivers had a history of crash problems, a level of predictability unprecedented in research on crash risk in older drivers. The “useful field of view”, as it is called, measures the spatial area within which an individual can be rapidly alerted to visual stimuli. Older adults with substantial shrinkage in the useful field of view were six times more likely to have incurred one or more crashes in the previous five year period. By comparison, visual sensory function, cognitive status, and chronological age were poor predictors of crash involvement. This study suggests that policies which restrict driving privileges based solely on age or on stereotypes of age-related declines in vision and cognition are scientifically unfounded. With the identification of a visual attention measure highly predictive of crash problems in the elderly, decisions on the suitability of licensure in the older adult population can be based on objective, visual-performance-based criteria.