Why have fatality rates among older drivers declined? The relative contributions of changes in survivability and crash involvement

Cicchino, Jessica B.

doi:10.1016/j.aap.2015.06.012

Cited by 58 publications

(35 citation statements)

References 15 publications

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“…These findings are consistent with past research showing that older driver crash risk appears high due to the biasing effects of their small driving exposure (Alvarez & Fierro, 2008;Antin et al, 2017;Fontaine, 2003;Hakamies-Blomqvist et al, 2002;Langford et al, 2006). Future research should include identification of age subgroups among older drivers given possible variation in their driving exposure and crash risks (Cicchino, 2015;Cicchino & McCartt, 2014).…”

Section: Discussionsupporting

confidence: 80%

Crash risk by driver age, gender, and time of day using a new exposure methodology

Regev

Rolison

Moutari

2018

Journal of Safety Research

154

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Introduction: Concerns have been raised that the nonlinear relation between crashes and travel exposure invalidates the conventional use of crash rates to control for exposure. A new metric of exposure that bears a linear association to crashes was used as basis for calculating unbiased crash risks. This study compared the two methods -conventional crash rates and new adjusted crash risk -for assessing the effect of driver age, gender, and time of day on the risk of crash involvement and crash fatality. Method: We used police reports of single-car and multi-car crashes with fatal and nonfatal driver injuries that occurred during 2002-2012 in Great Britain. Results: Conventional crash rates were highest in the youngest age group and declined steeply until age 60-69 years. The adjusted crash risk instead peaked at age 21-29 years and reduced gradually with age. The risk of nighttime driving, especially among teenage drivers, was much smaller when based on adjusted crash risks. Finally, the adjusted fatality risk incurred by elderly drivers remained constant across time of day, suggesting that their risk of sustaining a fatal injury due to a crash is more attributable to excess fragility than to crash seriousness. Conclusions: Our findings demonstrate a biasing effect of low travel exposure on conventional crash rates. This implies that conventional methods do not yield meaningful comparisons of crash risk between driver groups and driving conditions of varying exposure to risk. The excess crash rates typically associated with teenage and elderly drivers as well as nighttime driving are attributed in part to overestimation of risk at low travel exposure. Practical Applications: Greater attention should be directed toward crash involvement among drivers in their 20s and 30s as well as younger drivers. Countermeasures should focus on the role of physical vulnerability in fatality risk of elderly drivers.

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Section: Discussionsupporting

confidence: 80%

Crash risk by driver age, gender, and time of day using a new exposure methodology

Regev

Rolison

Moutari

2018

Journal of Safety Research

154

View full text Add to dashboard Cite

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“…One study reported a strong association between a fall and crash‐related death or hospitalization, providing supportive evidence that fallers have underlying health problems, such as frailty, that make them different from nonfallers …”

Section: Discussionmentioning

confidence: 99%

“…Falls and motor vehicle crashes (MVCs) share risk factors such as untreated cataracts and benzodiazepine use . MVC rates are relatively low in older adults and have been declining . Even so, older adults have high fatal crash rates, probably because of underlying health status .…”

mentioning

confidence: 99%

Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta‐Analysis

Scott

Rogers

Betz

et al. 2017

J American Geriatrics Society

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Background/Objectives Driving is an important indicator of mobility and well-being for older adults. Prior work suggests falls are associated with an increased risk of adverse driving outcomes. We examined associations between falls and subsequent motor vehicle crashes (MVCs), crash-related injuries, driving performance and driving behavior. Design Systematic review and meta-analysis. Participants Observational studies including adult drivers aged 55 and older or with mean age of at least 65. Measurements Two authors independently extracted study and participant characteristics, exposures and outcomes and assessed risk of bias. Pooled risk estimates for MVCs and MVC-related injuries were calculated using random-effects models. Other results were synthesized narratively. Results From 3286 potentially eligible records, 15 studies (N=27 to 17,349 subjects) met inclusion criteria. Risk of bias was low to moderate, except for cross-sectional studies (n=3) which all had a high potential for bias. A fall history was associated with a significantly increased risk of subsequent MVC (summary risk estimate=1.40; 95%CI: 1.20, 1.63; I2=28%, N=5 studies). One study found a significantly increased risk of MVC-related hospitalizations and deaths after a fall (hazard ratio=3.12; 95%CI: 1.71, 5.69). Evidence was inconclusive regarding an association of falls with driving cessation and showed no association with driving performance or behavior. Conclusion Falls in older adults appear to be a risk marker for subsequent MVCs and MVC-related injury. Given the nature of the evidence, which is limited to observational studies, the identified associations may also result at least partly from confounding or bias. Further research is needed to clarify the mechanisms linking falls to increased crash risk and develop effective interventions to ensure driving safety in older adults with a history of falls.

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“…Road crash statistics indicate a complex situation where changing driving abilities, combined with increasing physical frailty, and vehicles and a built environment which are not optimized for older people, lead to an increasing road toll (Cicchino, 2015;Koppel, Bohensky, Langford, & Taranto, 2011). Although legislators, community and vehicle designers, road safety researchers, and health teams focus on improving safety outcomes, there is acknowledgment that driving and driving cessation outcomes have a large and important impact on the quality of life and participation of older people and their family members (Carr, Meuser, & Morris, 2006;Curl, Stowe, Cooney, & Proulx, 2014;Liddle, Gustafsson, Bartlett, & McKenna, 2012).…”

mentioning

confidence: 99%

A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers

Liddle

Gustafsson²,

Mitchell³

et al. 2016

GERONT

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Recognizing the clinical importance and safety and well-being implications for the population, a multidisciplinary team has been researching older drivers and driving cessation issues for more than 15 years. Using empirical approaches, the team has explored quality of life and participation outcomes related to driving and nondriving for older people and has developed interventions to improve outcomes after driving cessation. The team members represent occupational therapists, medical practitioners, and clinical and neuropsychologists. While building the evidence base for driving-and driving cessation-related clinical practice, the researchers have also had first-hand experiences of interruptions to their own or parents' driving; involvement of older family members in road crashes; and provision of support during family members' driving assessment and cessation. This has led to reflection on their understandings and re-evaluation and refocusing of their perspectives in driving cessation research. This work will share the narratives of the authors and note their developing perspectives and foci within research as well as their clinical practice. Personal reflections have indicated the far-reaching implications for older drivers and family members of involvement in road crashes: the potential for interruptions to driving as a time for support and future planning and the conflicting and difficult roles of family members within the driving cessation process. Overall the lived, personal experience of the authors has reinforced the complex nature of driving and changes to driving status for the driver and their support team and the need for further research and support.

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Why have fatality rates among older drivers declined? The relative contributions of changes in survivability and crash involvement

Cited by 58 publications

References 15 publications

Crash risk by driver age, gender, and time of day using a new exposure methodology

Crash risk by driver age, gender, and time of day using a new exposure methodology

Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta‐Analysis

A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers

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