Medication Changes Among Older Drivers Involved in Motor Vehicle Crashes.

Autor:	Zullo AR; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island.; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island.; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Riester MR; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island., D'Amico AM; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island., Reddy Bhuma M; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island., Khan MA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island., Curry AE; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia., Pfeiffer MR; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Margolis SA; Rhode Island Hospital, Providence.; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island., Ott BR; Department of Neurology, Alpert Medical School, Brown University, Providence, Rhode Island., Bayer T; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island.; Division of Geriatrics and Palliative Medicine, Alpert Medical School, Brown University, Providence, Rhode Island., Joyce NR; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island.; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Oct 01; Vol. 7 (10), pp. e2438338. Date of Electronic Publication: 2024 Oct 01.
DOI:	10.1001/jamanetworkopen.2024.38338
Abstrakt:	Importance: Although older adults may use potentially driver-impairing (PDI) medications that can produce psychomotor impairment, little is known about changes to PDI medication use among older adults from the time before to the time after a motor vehicle crash (MVC). Objective: To quantify use of and changes in PDI medications among older adults before and after an MVC. Design, Setting, and Participants: This cohort study used linked Medicare claims and police-reported MVC data on 154 096 person-crashes among 121 846 older drivers. Eligible persons were drivers aged 66 years or older, involved in a police-reported MVC in New Jersey from May 1, 2007, through December 31, 2017, and with continuous enrollment in Medicare fee-for-service Parts A and B for at least 12 months and Part D for at least 120 days prior to the MVC. Data were analyzed from January 2022 to May 2024. Main Outcomes and Measures: Use of benzodiazepines, nonbenzodiazepine hypnotics, opioid analgesics, and other PDI medications in the 120 days before and 120 days after the MVC. Because each person could contribute multiple MVCs during the study period if they met eligibility criteria, the unit of analysis was the number of person-crashes. The proportion of person-crashes after which PDI medications were started, discontinued, or continued was quantified as well. Results: Among 154 096 eligible person-crashes, the mean (SD) age of the drivers was 75.2 (6.7) years at the time of the MVC. Of 121 846 unique persons, 51.6% were women. In 80.0% of the person-crashes, drivers used 1 or more PDI medications before the crash, and in 81.0% of the person-crashes, drivers used 1 or more PDI medications after the crash. Use of benzodiazepines (8.1% before the crash and 8.8% after the crash), nonbenzodiazepine hypnotics (5.9% before the crash and 6.0% after the crash), and opioid analgesics (15.4% before the crash and 17.5% after the crash) was slightly higher after the MVC. After the MVC, drivers in 2.1% of person-crashes started benzodiazepines and 1.4% stopped benzodiazepines, drivers in 1.2% of person-crashes started nonbenzodiazepine hypnotics and 1.2% stopped nonbenzodiazepine hypnotics, and drivers in 8.4% of person-crashes started opioid analgesics and 6.3% stopped opioid analgesics. Conclusions and Relevance: This cohort study suggests that most older drivers involved in MVCs did not use fewer PDI medications after crashes than before crashes. Qualitative research of perceived risks vs benefits of PDI medications is necessary to understand the reasons why MVCs do not appear to motivate clinicians to deprescribe PDI medications as a strategy to avert potential harms, including additional MVCs.
Databáze:	MEDLINE
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