Changes in the burden of medications that may impair driving among older adults before and after a motor vehicle crash.

Autor: Riester MR; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.; Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA., D'Amico AM; Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA., Khan MA; Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA., Joyce NR; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.; Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Pfeiffer MR; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Margolis SA; Department of Neuropsychology, Rhode Island Hospital, Providence, Rhode Island, USA.; Department of Psychiatry & Human Behavior, Brown University, Providence, Rhode Island, USA., Ott BR; Department of Neurology, Brown University, Providence, Rhode Island, USA., Curry AE; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Division of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Bayer TA; Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA., Zullo AR; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.; Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Feb; Vol. 72 (2), pp. 444-455. Date of Electronic Publication: 2023 Oct 31.
DOI: 10.1111/jgs.18643
Abstrakt: Background: Medications are one of the most easily modifiable risk factors for motor vehicle crashes (MVCs) among older adults, yet limited information exists on how the use of potentially driver-impairing (PDI) medications changes following an MVC. Therefore, we examined the number and types of PDI medication classes dispensed before and after an MVC.
Methods: This observational study included Medicare fee-for-service beneficiaries aged ≥67 years who were involved in a police-reported MVC in New Jersey as a driver between 2008 and 2017. Analyses were conducted at the "person-crash" level because participants could be involved in more than one MVC. We examined the use of 36 PDI medication classes in the 120 days before and 120 days after MVC. We described the number and prevalence of PDI medication classes in the pre-MVC and post-MVC periods as well as the most common PDI medication classes started and stopped following the MVC.
Results: Among 124,954 person-crashes, the mean (SD) age was 76.0 (6.5) years, 51.3% were female, and 83.9% were non-Hispanic White. The median (Q 1 , Q 3 ) number of PDI medication classes was 2 (1, 4) in both the pre-MVC and post-MVC periods. Overall, 20.3% had a net increase, 15.9% had a net decrease, and 63.8% had no net change in the number of PDI medication classes after MVC. Opioids, antihistamines, and thiazide diuretics were the top PDI medication classes stopped following MVC, at incidences of 6.2%, 2.1%, and 1.7%, respectively. The top medication classes started were opioids (8.3%), skeletal muscle relaxants (2.2%), and benzodiazepines (2.1%).
Conclusions: A majority of crash-involved older adults were exposed to multiple PDI medications before and after MVC. A greater proportion of person-crashes were associated with an increased rather than decreased number of PDI medications. The reasons why clinicians refrain from stopping PDI medications following an MVC remain to be elucidated.
(© 2023 The American Geriatrics Society.)
Databáze: MEDLINE
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