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.
Subject(s)
Accidents, Traffic , Automobile Driving , Cognition , Cognitive Dysfunction , Accidents, Traffic/prevention & control , Accidents, Traffic/statistics & numerical data , Age Factors , Aged , Automobile Driving/psychology , Automobile Driving/statistics & numerical data , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Comorbidity , Female , Geriatric Assessment/methods , Humans , Longitudinal Studies , Male , Risk Assessment/methods , Risk Factors , WashingtonABSTRACT
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.
Subject(s)
Accidents, Traffic/statistics & numerical data , Automobile Driving , Dementia , Accidents, Traffic/prevention & control , Age Factors , Aged , Comorbidity , Dementia/complications , Dementia/epidemiology , Female , Humans , Licensure , Male , Motor Vehicles , Pharmaceutical Preparations , Police , Proportional Hazards Models , Retrospective Studies , Risk , Risk Reduction Behavior , United States , Washington/epidemiologyABSTRACT
OBJECTIVE: We examined the association between job demand and occupational injury among older workers. METHODS: Participants were workers aged 50+ enrolled in the Health and Retirement Study, 2010 to 2014. Participants reported physical ability within three domains: physical effort, stooping/kneeling/crouching, and lifting. To measure subjective job demand, participants rated their job's demands within domains. We generated objective job demand measures through the Occupational Information Network (ONET). Using Poisson regression, we modeled the association between physical ability, job demand, and self-reported occupational injury. A second model explored interaction between job demand and physical ability. RESULTS: The injury rate was 22/1000 worker-years. Higher job demand was associated with increased injury risk. Within high job demands, lower physical ability was associated with increased injury risk. CONCLUSIONS: Older workers whose physical abilities do not meet job demands face increased injury risk.
