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J Am Geriatr Soc. 2018 Jul;66(6):1075-1081. doi: 10.1111/jgs.15378. Epub 2018 Apr 17.

Cognitive Decline and Older Driver Crash Risk.

Author information

1
Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.
2
Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington.
3
Department of Epidemiology, University of Washington, Seattle, Washington.
4
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
5
Harborview Injury Prevention and Research Center, Seattle, Washington.
6
Institute for Work and Health, Seattle, Washington.
7
Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.
8
Department of Biostatistics, University of Washington, Seattle, Washington.
9
Department of Medicine, University of Washington, Seattle, Washington.

Abstract

OBJECTIVES:

To examine automobile crash risk associated with cognition in older drivers without dementia.

DESIGN:

Retrospective secondary analysis of longitudinal cohort study.

SETTING:

Our study used data from the Adult Changes in Thought (ACT) Study merged with Washington State crash reports and licensure records. Data were available from 2002 to 2015.

PARTICIPANTS:

Group Health enrollees from Washington State aged 65 and older with active driver's licenses (N=2,615).

MEASUREMENTS:

Cognitive function was assessed using the Cognitive Abilities Screening Instrument scored using item response theory (CASI-IRT). The study outcome was police-reported motor vehicle crash. We used a negative binomial mixed-effects model with robust standard errors clustered on the individual and considered associations between crash risk, level of cognition, and amount of decline since the previous study visit. Covariates included age, sex, education, alcohol, depression, medical comorbidities, eyesight, hearing, and physical function. Individuals were censored at dementia diagnosis, death, or failure to renew their license.

RESULTS:

Over an average of 7 years of follow-up, 350 (13%) people had at least one crash. A 1-unit lower CASI-IRT score was associated with a higher adjusted incidence rate ratio of crash of 1.26 (95% confidence interval=1.08-1.51). Beyond level of cognition, amount of cognitive decline between study visits was not associated with crash risk.

CONCLUSION:

This study suggests that, in older drivers, poorer performance on the CASI-IRT may be a risk factor for motor vehicle crashes, even in individuals without diagnosed dementia. Further research is needed to understand driving behavior and inform driving decisions for older adults with poor cognitive function.

KEYWORDS:

cognition; cognitive measurement; dementia; motor vehicle crash; older drivers

PMID:
29667168
DOI:
10.1111/jgs.15378

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