Medication use and driving patterns in older drivers: preliminary findings from the LongROAD study

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Abstract

Background

The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors.

Methods

Data for this study came from the five-site Longitudinal Research on Aging Drivers (LongROAD) project. Participants were active drivers, age 65–79 years at enrollment, and patients at one of the 5 participating sites. Medication names and doses were obtained at baseline based on the “brown-bag review” method. Medications were coded using the American Hospital Formulary Service system. Driving data were collected by a GPS accelerometer installed in the study participants’ main vehicles.

Results

Medication data were available for 2949 (98.6%) of the 2990 participants, and 2898 (96.9% of all participants) had both medication data and at least 30 recorded days of driving. The median number of medications taken per study participant was seven, with a range of 0–51. Total number of medications was significantly associated with a higher rapid deceleration rate. Certain medication classes were significantly associated with other driving outcomes, including central nervous system agents (more speeding events), hormones and gastrointestinal medications (more rapid decelerations), electrolytes (fewer rapid decelerations), and antihistamines (greater right to left turn ratio).

Conclusions

Older adult drivers are taking large quantities of prescription and non-prescription medications that may affect their driving safety. Certain medication classes are associated with potentially adverse driving patterns, such as speeding and rapid decelerations, while others are associated with potentially protective maneuvers, such as right hand turning. Further research is warranted to identify and mitigate potential adverse effects of such medications on driving safety in older adults.

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Most cited references 34

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Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

Jerry Gurwitz (2003)

Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting. To assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting. Cohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors. Number of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable. There were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events. Adverse drug events are common and often preventable among older persons in the ambulatory clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.

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A drug burden index to define the functional burden of medications in older people.

Sarah N Hilmer, Donald E. Mager, Eleanor M. Simonsick … (2007)

Older people carry a high burden of illness for which medications are indicated, along with increased risk of adverse drug reactions. We developed an index to determine drug burden based on pharmacologic principles. We evaluated the relationship of this index to physical and cognitive performance apart from disease indication. Data from the Health, Aging, and Body Composition Study on 3075 well-functioning community-dwelling persons aged 70 to 79 years were analyzed by multiple linear regression to assess the cross-sectional association of drug burden index with a validated composite continuous measure for physical function, and with the Digit Symbol Substitution Test for cognitive performance. Use of anticholinergic and sedative medications was associated with poorer physical performance score (anticholinergic exposure, 2.08 vs 2.21, P<.001; sedative exposure, 2.09 vs 2.19, P<.001) and cognitive performance on the Digit Symbol Substitution Test (anticholinergic exposure, 34.5 vs 35.5, P = .045; sedative exposure, 34.0 vs 35.5, P = .01). Associations were strengthened when exposure was calculated by principles of dose response. An increase of 1 U in drug burden index was associated with a deficit of 0.15 point (P<.001) on the physical function scale and 1.5 points (P = .01) on the Digit Symbol Substitution Test. These values were more than 3 times those associated with a single comorbid illness. The drug burden index demonstrates that anticholinergic and sedative drug exposure is associated with poorer function in community-dwelling older people. This pharmacologic approach provides a useful evidence-based tool for assessing the functional effect of exposure to medications in this population.

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Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey.

David Kaufman, Judith P. Kelly, Lynn Rosenberg … (2002)

Data on the range of prescription and over-the-counter drug use in the United States are not available. To provide recent population-based information on use of all medications, including prescription and over-the-counter drugs, vitamins and minerals, and herbal preparations/natural supplements in the United States. Ongoing telephone survey of a random sample of the noninstitutionalized US population in the 48 continental states and the District of Columbia; data analyzed here were collected from February 1998 through December 1999. Use of medications, by type, during the preceding week, compared by demographic characteristics. Among 2590 participants aged at least 18 years, 81% used at least 1 medication in the preceding week; 50% took at least 1 prescription drug; and 7% took 5 or more. The highest overall prevalence of medication use was among women aged at least 65 years, of whom 12% took at least 10 medications and 23% took at least 5 prescription drugs. Herbals/supplements were taken by 14% of the population. Among prescription drug users, 16% also took an herbal/supplement; the rate of concurrent use was highest for fluoxetine users, at 22%. Reasons for drug use varied widely, with hypertension and headache mentioned most often (9% for each). Vitamins/minerals were frequently used for nonspecific reasons such as "health" (35%); herbals/supplements were also most commonly used for "health" (16%). In any given week, most US adults take at least 1 medication, and many take multiple agents. The substantial overlap between use of prescription medications and herbals/supplements raises concern about unintended interactions. Documentation of usage patterns can provide a basis for improving the safety of medication use.

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Author and article information

Contributors

Linda L. Hill: llhill@ucsd.edu

Howard Andrews: Howard.Andrews@nyspi.columbia.edu

Guohua Li: gl2240@columbia.edu

Carolyn G. DiGuiseppi: Carolyn.DiGuiseppi@ucdenver.edu

Marian E. Betz: marian.betz@ucdenver.edu

David Strogatz: david.strogatz@bassett.org

Patricia Pepa: pepa.patricia@gmail.com

David W. Eby: eby@umich.edu

Tara Kelley-Baker: tkelleybaker@aaafoundation.org

Vanya Jones: vjones@jhu.edu

Samantha Pitts: spitts4@jhmi.edu

Journal

Journal ID (nlm-ta): Inj Epidemiol

Journal ID (iso-abbrev): Inj Epidemiol

Title: Injury Epidemiology

Publisher: BioMed Central (London )

ISSN (Electronic): 2197-1714

Publication date (Electronic): 3 August 2020

Publication date PMC-release: 3 August 2020

Publication date Collection: 2020

Volume: 7

Electronic Location Identifier: 38

Affiliations

[1 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Department of Family Medicine and Public Health, , University of California, ; 200 W Arbor Dr., MC 0811, San Diego, CA 92103 USA

[2 ]GRID grid.21729.3f, ISNI 0000000419368729, Department of Biostatistics, Mailman School of Public Health, , Columbia University, ; 1051 Riverside Dr. Unit 47, New York, NY 10032 USA

[3 ]GRID grid.21729.3f, ISNI 0000000419368729, Department of Epidemiology, Mailman School of Public Health, , Columbia University, ; 722 W 168th St. Rm 524, New York, NY 10032 USA

[4 ]GRID grid.239585.0, ISNI 0000 0001 2285 2675, Center for Injury Epidemiology and Prevention, , Columbia University Medical Center, ; 722 W 168th St. Rm 524, New York, NY 10032 USA

[5 ]GRID grid.21729.3f, ISNI 0000000419368729, Department of Anesthesiology, Vagelos College of Physicians and Surgeons, , Columbia University, ; 722 W 168th St. Rm 524, New York, NY 10032 USA

[6 ]GRID grid.414594.9, ISNI 0000 0004 0401 9614, Department of Epidemiology, , Colorado School of Public Health, ; 13001 E. 17th Place, Mail Stop B119, Bldg. 500, Rm. W3138, Aurora, CO 80045 USA

[7 ]GRID grid.430503.1, ISNI 0000 0001 0703 675X, Department of Emergency Medicine, , University of Colorado School of Medicine, ; Anschutz Medical Campus, Leprino Building, Campus Box B215, 12401 East 17th Ave, Aurora, CO 80045 USA

[8 ]GRID grid.281236.c, ISNI 0000 0001 0088 4617, Bassett Research Institute, Bassett Healthcare Network, ; 1 Atwell Rd, Cooperstown, NY 13326 USA

[9 ]GRID grid.280062.e, ISNI 0000 0000 9957 7758, Department of Ambulatory Care Clinical Pharmacy, , Kaiser Permanente, ; Oakland, USA

[10 ]GRID grid.214458.e, ISNI 0000000086837370, Transportation Research Institute, , University of Michigan, ; 2901 Baxter Rd, Ann Arbor, MI 48109 USA

[11 ]GRID grid.478189.b, ISNI 0000 0001 2160 4151, AAA Foundation for Traffic Safety, ; 607 14th St. NW, Ste. 201, Washington, DC 20005 USA

[12 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Johns Hopkins Bloomberg School of Public Health, ; 624 North Broadway, Hampton House, Baltimore, MD 21205 USA

[13 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Medicine, School of Medicine, , Johns Hopkins University, ; 733 North Broadway, Baltimore, MD 21205 USA

Article

Publisher ID: 265

DOI: 10.1186/s40621-020-00265-y

PMC ID: 7397667

PubMed ID: 32741358

SO-VID: 14153a7e-288e-4887-af38-a133cf2cab52

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 October 2019

Date accepted : 10 June 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100003550, AAA Foundation for Traffic Safety;

Award ID: PG005418

Award Recipient : Guohua Li

Custom metadata

Keywords: older adult,driving safety,older driver,medication,driving outcome

Data availability:

Keywords: older adult, driving safety, older driver, medication, driving outcome

Medication use and driving patterns in older drivers: preliminary findings from the LongROAD study

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Abstract

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Conclusions

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NTT Journal for Theology and the Study of Religion

Most cited references 34

Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

A drug burden index to define the functional burden of medications in older people.

Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey.

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