Multiple medications and vehicle crashes : analysis of databases.

LeRoy, A.A. Morse, P.D. & Morse, M.L.

The number of older adults is expected to increase dramatically in the next 25 years and with it, an increase in both the number of older drivers and the amount of driving within this age group. With the aging of the American population, concern arises regarding potential increases in rates of crash involvement and injury. Age-related factors may impair driving ability, such as age-related decrements in cognitive and physical functioning, increased prevalence of medical conditions or age-related medical conditions, and increased use of multiple medications. Using population databases, this study analyzed the association of the impairing effects of multiple medication use, drug interactions, and drug disease interactions on motor vehicle crashes (MVC) in individuals age 50 years and greater. The main objectives of this study were to determine the relative frequency of various combinations of medications used by those who have experienced a MVC and those who have not by analyzing proprietary and non-proprietary databases; and to conduct a case-control study of possible associations between the use of medications (and combinations thereof) and MVCs amongst older drivers. The results of the study revealed an association between the kinds and number of medications used by older adults and the risk of involvement in a MVC. The study showed that the drugs known to have an impairing effect on the driving ability of older drivers were the most commonly used by older adults involved in MVCs. The Case Control Analysis suggested an association between MVCs and many potentially driver impairing (PDI) medications, PDI diseases, and various combinations of drugs and diseases. Thirty-five of the ninety PDI drug classes had odds ratios over 1.2 (p < .05). Many of the medication classes with the highest odds ratios were classes that have been reported to be especially problematic in older patients. Seventy-nine of 200 PDI disease classes had statistically significant odds ratios over 1.4. Study subjects taking any medication were found to be 1.43 times more likely to be involved in a MVC than older adults taking no medications. Compared to patients taking no PDI medications, those taking one or two PDI medications were 1.29 times more likely to be involved in a MVC and that risk increased to 1.87 more likely in patients taking three or more PDI medications. The risk for patients with one or two PDI diseases was 1.49 times greater than that for older adults without any PDI diseases. Three or more PDI diseases further increased the risk for MVCs to 2.20 times that of older adults with no PDI diseases. Drug interactions were also associated with a statistically significant increased risk of MVCs (odds ratio of 1.47 for 1-2 drug interactions and 1.92 for patients with 3 or more drug interactions). The risk for MVCs among study subjects with at least one drug-disease conflict was 1.2 times that for older adults without any drug-disease conflicts. The results of this analysis suggest that both the kinds and number of medication exposures, and the characteristics of diseases/disorders present among study subjects may predict an increase in risk for MVCs among older adults. By demonstrating a potential link between multiple drug therapies and MVCs, this study serves to highlight the need for a more thorough examination of the relationships between drugs, diseases and the older driver. This study suggests the need for further research to elucidate the complex interplay of factors affecting aging adults and driving ability. The results of this research support the intentions of NHTSA to promote the development of educational programs to increase awareness among health care providers and older drivers regarding the potential driver impairing effects of pharmaceutical use. (Author/publisher)

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20091121 ST [electronic version only]

Washington, D.C., U.S. Department of Transportation DOT, National Highway Traffic Safety Administration NHTSA, 2008, IX + 48 p. + app.; DOT HS 810 858

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