Diagnosed dementia and the risk of motor vehicle crash among older drivers. (April 2018)

• Record Type: Journal Article
• Authors: Fraade-Blanar, Laura A.; Hansen, Ryan N.; Chan, Kwun Chuen G.; Sears, Jeanne M.; Thompson, Hilaire J.; Crane, Paul K.; Ebel, Beth E.
• Is Part Of: Accident analysis and prevention. Volume 113(2018)
• Page Start: 47
• Page End: 53
• Publication Date: 2018-04
• Subjects: Older drivers -- Dementia -- motor vehicle crash -- Cognition -- Survival analysis -- Longitudinal study design; Accidents -- Prevention -- Periodicals; Accident Prevention -- Periodicals; Accidents -- Prévention -- Périodiques; 363.106
• DOI: 10.1016/j.aap.2017.12.021
• Languages: English
• ISSNs: 0001-4575

Abstract

Highlights: We built a dataset of 29, 730 drivers age 65–79 followed for 7 years to study the effect of dementia diagnosis on crash risk. Compared to individuals without dementia, the hazard of crash among those with dementia was almost half. This relationship held in urban areas, but not in rural and suburban areas where older drivers may have more need to drive. It is hypothesized that these study findings result from unmeasured decreases in driving after dementia diagnosis. Abstract: Older adults are an active and growing segment of drivers in the United States. We compared the risk of motor vehicle crash among older licensed drivers diagnosed with dementia to crash risk among older licensed drivers without diagnosis of dementia. This retrospective cohort study used data from Group Health (GH), a Washington State health maintenance organization. Research participants were members of GH, aged 65–79 during the study who lived in Washington State from 1999–2009. Participant health records were linked with police-reported crash and licensure records. We estimated the risk of crash for older drivers diagnosed with dementia compared to older drivers without diagnosis of dementia using a Cox proportional hazards model with robust standard errors, accounting for recurrent events (crashes). Multivariable models were adjusted for age, sex, history of alcohol abuse or depression, comorbidities, and medications. There were 29, 730 eligible individuals with an active driving license. Approximately 6% were diagnosed with dementia before or during the study. The police-reported crash rate was 14.7 per 1000 driver-years. The adjusted hazard ratio of crash among older drivers with diagnosed dementia was 0.56 (95% CI 0.33, 0.95) compared to those without diagnosed dementia. On-road and simulator-based research showed older adults with dementia demonstrated impaired driving skill and capabilities. The observed lower crash risk in our study may result from protective steps to limit driving among older adults diagnosed with dementia. Future research should examine driving risk reduction strategies at the time of dementia diagnosis and their impact on reducing crash risk.