Census data indicates that in 2012 people 65 and older represented 13.7% of the population of the United States, and this group has been projected to account for more than 20% of the U.S. population by 2035 (U.S. Census Bureau, 2013). As the size of the older population increases, one can reasonably expect a parallel increase in the number of older people on the road. Physical, cognitive and perceptual abilities may decline with age and make the task of driving more challenging. Many older drivers are aware of these changes, and some report avoiding potentially risky conditions such as driving at night, in heavy or high-speed traffic, in bad weather, or in unfamiliar areas (see Braitman & Williams, 2011; Jones et al., 2011; Naumann, Dellinger, & Cresnow, 2011). Despite these self-regulating behaviors, older drivers and occupants tend to be overrepresented in serious injury and fatal motor vehicle crashes. A report by the Organisation for Economic Co-operation and Development (OECD, 2001) notes safety risks resulting from older adults’ fragility or increased likelihood of being injured in a crash. Older drivers tend to have a higher death rate per mile traveled than do their younger counterparts. Crash forces that result in non-fatal injuries in a younger driver may be fatal for a driver over 65 (Li, Braver, & Chen, 2003; see Koppel, Bohensky, Langford, & Taranto, 2011 for a review). Li et al. (2003) examined age differences in fatalities per mile driven to tease apart the contributing roles of fragility and higher crash involvement in older drivers. They reported that fragility, assessed by the rate of driver death per crash involvement, was stable until age 60 and then increased steadily. The rate of increase accelerated beyond age 80. The crash involvement rate per unit of vehicle miles traveled was stable through age 69, started to increase among drivers 70 to 74, and continued to rise with increasing age. It is generally accepted that older adults have an elevated risk of injury or death from vehicle crashes; however, little is known about the long-term medical outcomes for older adults who survive more than 30 days after a crash. An occupant older than 65 is likely to experience more severe injuries than a younger occupant experiencing a crash of comparable severity. Cook et al. (2000) reported that drivers age 70 and older were 3 times more likely to be hospitalized or killed in a crash than were drivers 30 to 39 years old. In crashes where both younger and older drivers were wearing seat belts, the ratio increased to seven-to-one. Connecticut’s crash database shows that 22% of crash-involved drivers 70 and older were reported by police to have injuries that were at least moderate, compared to 18% among crash-involved drivers 35-49 years old (CT DOT, 2009). Conversely, data for 2009 indicates that for all injury and tow-away crashes in the United States, 17% of motor vehicle occupants age 65 and older suffered injury as compared to 18% of occupants 40 to 55 years old (NHTSA, General Estimate System). Evidence strongly indicates that older adults have an elevated risk of injury or death from vehicle crashes. Moreover, they are much more likely to be hospitalized, though some of this increased hospitalization may be prophylactic. The older person may be more fragile and frail (less able to recover from crash injuries and resume a pre-injury functional level), so should be monitored more closely following trauma. Andersen et al., 2010, reported long-term health consequences for older (65+) and younger (18-64) people who were seriously injured in a motor vehicle crash. Six months following the crash, both age groups showed substantial declines in physical function, vitality and mental health as measured by the Short Form 36 Health Survey (SF-36), a standardized self-report instrument used to measure health status.1 Conditions improved at 12 months, though not to pre-crash levels. One surprising finding from this study was that while older people had poorer baseline scores on measures of Physical Function and Vitality, the course of decline and recovery was virtually parallel in the younger and older groups. The same pattern was seen with respect to Mental Health, though older people started and ended with better scores. The current project further examined the extent of long-term consequences suffered by occupants injured in motor vehicles. Specifically, the study evaluated whether (1) older occupants injured in a motor vehicle crash suffered more long-term health consequences compared to an age- and crash-history-equivalent uninjured control group, and (2) whether older occupants injured in a motor vehicle crash suffered long-term health consequences more so than middle-age occupants. The study was retrospective; occupants were contacted one to two years after a crash event in two States: Connecticut and Indiana. For the Connecticut sample, analyses compared injured older adults and similarly exposed yet uninjured occupants of similar age. In Indiana, analyses compared hospitalized and non-hospitalized injured older adults, and hospitalized and non-hospitalized middle-age injured occupants. (Author/publisher)
Samenvatting