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Cognitive Decline and Older Driver Crash Risk
Author(s) -
FraadeBlanar Laura A.,
Ebel Beth E.,
Larson Eric B.,
Sears Jeanne M.,
Thompson Hilaire J.,
Chan Kwun Chuen G.,
Crane Paul K.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15378
Subject(s) - medicine , crash , cognition , dementia , poison control , cognitive decline , gerontology , injury prevention , confidence interval , cohort study , demography , psychiatry , medical emergency , disease , pathology , sociology , computer science , programming language
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.