Age-Related Diseases and Driving Safety

Abstract

Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson’s disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.

Prevalence of medical factors related to aging among older car drivers: a multicenter, cross-sectional, descriptive study

“…Previous literature has suggested that advanced age itself is a risk factor for road traffic crashes [ 17 ]. In addition, a wide variety of mental and physical dysfunctions inevitably observed during aging has been proven to yield a high incidence of road traffic crashes [ 6 ]. More specifically, dysfunctions in the sensory system (visual and auditory), central nervous system (stroke, depression, dementia, Parkinson’s disease, and insomnia), cardiovascular system (arterial hypertension, arrhythmia, coronary heart disease, and heart failure), musculoskeletal system (osteoarthritis and rheumatoid arthritis), diabetes mellitus, and polypharmacy as a consequence of the above potentially threatening traffic safety.…”

“…According to a Japanese observational study, pre-frailty/frailty individuals were highly at risk of experiencing road traffic crashes in the past year compared with robust individuals (OR: 3.74, 95% CI: 1.75–7.96) [ 24 ]. However, a recent review article did not show the clear relationship between road traffic crashes and sarcopenia [ 6 ]. The prevalence of medical factors in the present study was as follows: polypharmacy, 27.6%; dementia, 16.4%; and frail, 15.0%, indicating that older adults with medical factors are driving on a daily basis.…”

“…Various studies have revealed that medical factors are the underlying causes of road traffic crashes among older adults [ 4 ]. As people age, they experience multimorbidity and develop multiple diseases or conditions, which increase the risk of road traffic crashes [ 6 ]. Of the various factors, some may be preventable.…”

Improving Our Understanding of Driving Changes in Preclinical and Early Symptomatic Alzheimer’s Disease: The Role of Naturalistic Driving Studies

“…The higher rates of crashes among older adult drivers compared to younger adults are thought to be at least partially influenced by physical and cognitive changes that accompany aging, such as vision, reaction time, and attention [51][52][53]. These changes are even more pronounced among persons with early symptomatic [54] and preclinical [36,[55][56][57][58] AD and may interact with the increasingly complex in-vehicle environment.…”

Verbal Learning as a predictor of risks of accidents in elderly drivers

“…There is a growing number of individuals driving cars in urban areas, especially older adults 2 , and with the constant increase in the geriatric population, the number of older adults obtaining a driver's license has increased 3 . However, age-related cognitive decline affects driving abilities and may increase the number of traffic violations and accidents 4 .…”