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PubMed2002

Vision impairment and older drivers: who's driving?

AIM: To establish the association between impaired vision and drivers' decisions to stop driving, voluntarily restrict driving, and motor vehicle accidents. METHODS: Driving related questions were included in a population based study that determined the prevalence and incidence of eye disease. Stratified random cluster samples based on census collector districts were selected from the Melbourne Statistical Division. Eligible participants aged 44 years and over were interviewed and underwent a comprehensive ophthalmic examination. The outcomes of interest were the decision to stop driving, limiting driving in specified conditions, and driving accidents. The associations between these outcomes and the legally prescribed visual acuity (<6/12) for a driver's licence were investigated. RESULTS: The mean age of the 2594/3040 (85%) eligible participants was 62.5 (range 44-101). People with visual acuity less than 6/12 were no more likely to have an accident than those with better vision (chi(2) = 0.175, p>0.9). Older drivers with impaired vision, more so than younger adults, restrict their driving in visually demanding situations (p<0.05). Of the current drivers, 2.6% have vision less than that required to obtain a driver's licence. The risk of having an accident increased with distance driven (OR 2.57, CL 1.63, 4.04 for distance >31 000 km) but not with age. CONCLUSION: There was no greater likelihood of self reported driving accidents for drivers with impaired vision than those with good vision. While many older drivers with impaired vision limit their driving in adverse conditions and some drivers with impaired vision stop driving, there are a significant number of current drivers with impaired vision.

Accidents, Traffic↗
PubMed2002

Promoting parental management of teen driving.

OBJECTIVE: Parenting may be an important protective factor against teen driving risk; however, parents do not limit teen driving as much as might be expected. The Checkpoint Program was designed to promote parental management of teen driving through the use of staged persuasive communications. METHODS: Parent-teen dyads (n = 452) were recruited when teens received learner's permits and interviewed over the telephone at baseline, licensure, and three months post-licensure. After baseline, families were randomized to either the intervention group that received persuasive communications or to the comparison group that received general information about driving safety. RESULTS: Both parents and teens in the intervention group reported significantly greater limits on teen driving at licensure and three months post-licensure. In multivariate analyses, intervention and baseline driving expectations had significant effects on driving limits at licensure. Intervention and driving limits established at licensure were associated with three month driving limits. CONCLUSION: The findings indicate that exposure to the Checkpoints Program increased parental limits on teen driving.

Accidents, Traffic↗
PubMed2005

Quantitative assessment of driving performance in Parkinson's disease.

OBJECTIVES: The primary aim of this study was to determine how Parkinson's disease (PD) affects driving performance. It also examined whether changes in driver safety were related to specific clinical disease markers or an individual's self rating of driving ability. METHODS: The driving performance of 25 patients with idiopathic PD and 21 age matched controls was assessed on a standardised open road route by an occupational therapist and driving instructor, to provide overall safety ratings and specific driving error scores. RESULTS: The drivers with PD were rated as significantly less safe (p<0.05) than controls, and more than half of the drivers with PD would not have passed a state based driving test. The driver safety ratings were more strongly related to disease duration (r = -0.60) than to their on time Unified Parkinson's Disease Rating Scale (r = -0.24). Drivers with PD made significantly more errors than the control group during manoeuvres that involved changing lanes and lane keeping, monitoring their blind spot, reversing, car parking, and traffic light controlled intersections. The driving instructor also had to intervene to avoid an incident significantly more often for drivers with PD than for controls. Interestingly, driver safety ratings were unrelated to an individual's rating of their own driving performance, and this was the case for all participants. CONCLUSIONS: As a group, drivers with PD are less safe to drive than age matched controls. Standard clinical markers cannot reliably predict driver safety. Further studies are required to ascertain whether the identified driving difficulties can be ameliorated.

Aged↗
PubMed2002

Teen driving risk: the promise of parental influence and public policy.

An analysis is presented of adolescent driving risk, the advantages of graduated licensing programs, and the potential for parent-based programs to moderate teen driving risks. Risk factors associated with youthful driving illustrate the potential importance and benefits of limiting the amount and conditions under which teens can drive. State policies, such as graduated driver licensing systems that formalize restrictions on youthful driving. have been shown to be effective. However, teen driving risks remain elevated. Parents are in a prime position to extend the benefits of state restrictions by developing and implementing their own tailored family policies on adolescent driving. Unfortunately, parents of adolescent drivers are often under-aware of the need to do so and fail to impose effective driving restrictions. An ongoing parent-based intervention to increase parental restriction on teen driving is described, and issues involved in implementing and evaluating family-centered approaches to reduce teen driving risk are raised.

Adolescent↗
PubMed2000

Driving in adults with refractory localization-related epilepsy. Multi-Center Study of Epilepsy Surgery.

OBJECTIVE: To examine the frequency of driving an automobile and characteristics associated with driving in individuals with refractory localization-related epilepsy. BACKGROUND: Driving is generally restricted and monitored in people with epilepsy. Little is known about the frequency of driving and subsequent accidents specifically in individuals with uncontrolled epilepsy. METHODS: In an ongoing, prospective, multicenter study of resective epilepsy surgery, individuals were interviewed when they presented for surgical evaluation. Analyses were conducted using chi-square, t-tests, and multiple logistic regression. RESULTS: Of 367 eligible participants, 115 (31.3%) had driven in the last year, most on at least a weekly basis. In a multivariable analysis, factors associated with an increased likelihood of driving were having a current license (OR = 10.71, p < 0.001) and ever having had a license (OR = 3.86, p = 0.003). Younger individuals were also more likely to drive. Lower levels of driving were found in women (OR = 0.31, p < 0.001), individuals who were self-described as disabled (OR = 0.20, p < 0.001), and those who were employed full-time (OR = 0.43, p = 0.03) or part-time (OR = 0.15, p = 0.005). At some point in the past, 144 individuals experienced one or more seizures while driving, and 98 experienced at least one accident because of a seizure. Of those who had accidents, 94% reported property damage, 32% had an injury, and 20% caused injury to others. CONCLUSION: Despite restrictions, almost one third of individuals with refractory epilepsy drive. Understanding why they do may help identify means of modifying this behavior or identifying services that, if provided, would help people with uncontrolled epilepsy forego driving.

Adult↗
PubMed2006

Holding on and letting go: the perspectives of pre-seniors and seniors on driving self-regulation in later life.

Although decisions related to driving are vital to well-being in later life, little is known about how aging drivers who do not experience a medical condition that requires driving cessation regulate their driving. This exploratory, qualitative study used focus groups with 79 such community-dwelling individuals to examine driving self-regulation from the perspective of pre-senior (aged 55-64) drivers, senior (aged 65 years or over) drivers, and senior ex-drivers. Themes resulting from inductive analysis addressed the importance of driving, mechanisms of self-monitoring and self-regulation, people who influenced decision making, and opinions regarding licensing regulations. A preliminary model of the process of self-regulation that highlights intrapersonal, interpersonal, and environmental influences on why, how, and when aging drivers adapt or cease driving is presented. The model identifies areas for future research to enhance understanding of this process, including the effectiveness of self-regulation. Findings suggest that increased public awareness of issues related to driving and aging could assist aging drivers, their families, and their family physicians in optimizing driving safety for this population. Since a near accident or accident was seen as the only factor that would lead many informants to stop driving and few informants planned for driving cessation, there is a need for interventions that help aging drivers make the transition to ex-driver in a timely and personally acceptable way.

Accidents, Traffic↗
PubMed1995

Behavior and perceptions related to drink-driving among an international sample of company vehicle drivers.

OBJECTIVE: The study examined reported behavior, perceptions and attitudes related to drink-driving among company vehicle drivers located across eight countries. An additional aim of the research was to identify important predictors of drink-driving. METHOD: A cross-sectional mailshot questionnaire survey was undertaken on all drivers of company vehicle identified by the collaborating companies. Responses to items concerning reported drink-driving, perceived consumption limits, perceived risk and reported restraint were examined for a total of 600 male drivers, representing an overall response rate of 55%. RESULTS: Driving after any alcohol consumption was found to be relatively common across most of the sample, while driving when over the legal limit at least once in the previous 12 months was reported by approximately one-third of the drivers. Multiple regression analysis indicated that the strongest predictors of reported drink-driving behavior were associated with perceived limits of personal alcohol consumption and a "moral attachment" to non-drink-driving associated with alcohol consumption restraint. This general prediction model seemed to be relatively consistent across the different national groups. CONCLUSIONS: The results suggest that longer term cognitive components of decision making such as "moral attachment" may form fundamental elements in the decision to drive after excessive drinking. It was suggested that company-based policies and programs may have a useful role in promoting safer driving practices, particularly in relation to driving after drinking.

Accidents, Traffic↗
PubMed2004

How can repeat drunk drivers be influenced to change? Analysis of the association between drunk driving and DUI recidivists' attitudes and beliefs.

OBJECTIVE: Public policy interventions designed to deter or prevent drunk driving depend, in part, on modifying beliefs concerning the riskiness, social acceptability and immorality of driving under the influence of alcohol. The current study examines the association of these beliefs with the incidence of alcohol-impaired driving. METHOD: Interviews were conducted with 273 people with multiple driving under the influence (DUI) offenses. Data included self-reported frequency of driving after drinking in the past year, as well as measures of moral and prescriptive beliefs concerning alcohol-impaired driving (internal behavioral controls), perceived risks of criminal punishment and accidents associated with alcohol-impaired driving (external behavioral controls) and perceived peer group attitudes toward alcohol-impaired driving (social controls). RESULTS: Logit regression modeling showed significant, unique protective associations with behavioral control items in each category. CONCLUSIONS: Behavioral controls may protect against alcohol-impaired driving behavior even in a high-risk sample of repeat DUI offenders. Policy interventions designed to curtail drunk driving might seek to enhance these sorts of behavioral controls among DUI offenders.

Alcoholic Intoxication↗
PubMed2006

Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder.

OBJECTIVE: Automobile accidents are the leading cause of death among adolescents, and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder. Studies have demonstrated that stimulants improve driving performance. This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations. METHODS: Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylphenidate, 30 mg of mixed amphetamine salts extended release, or placebo in a randomized, double-blind, placebo-controlled, crossover study design. During laboratory testing, adolescents drove a driving simulator at 5:00 pm, 8:00 pm, and 11:00 pm. Driving performance was rated by adolescents and investigators. RESULTS: The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder (19 boys/16 girls). The mean age was 17.8 years. The overall Impaired Driving Score demonstrated that OROS methylphenidate led to better driving performance compared with placebo and mixed amphetamine salts extended release, whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo. Specifically, relative to placebo, OROS methylphenidate resulted in less time driving off the road, fewer instances of speeding, less erratic speed control, more time executing left turns, and less inappropriate use of brakes. OROS methylphenidate and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder. CONCLUSIONS: This study validates the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder. In the study, OROS methylphenidate promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release.

Accidents, Traffic↗
PubMedDate not supplied

Controlled-release methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with a 3- to 4-fold increase in both driving-related accidents and associated injuries. Methylphenidate (MPH) is the most commonly prescribed psychostimulant medication for ADHD. It has been demonstrated to improve performance on a driving simulator. This study investigated whether a once-daily, long-acting, osmotic, controlled-release MPH formulation improves the driving performance of ADHD adolescents while driving their own car on an actual road segment. METHODS: Twelve ADHD-diagnosed male adolescent drivers (mean age, 17.8 years) prescribed a standard dose of 1.0 mg/kg (if they were not already taking methylphenidate) of controlled-release MPH participated in this repeated-measures crossover study. On 2 separate occasions (off/on medication randomized), participants drove a standard 16-mile road course incorporating rural, highway, and urban streets. A rater, blind to medication conditions, sat in the back seat and rated impulsive (eg, "cutting off" another driver) and inattentive (eg, drove past designated turn) driving errors. RESULTS: Impulsive driving errors were observed to occur rarely under both medication and no medication conditions. Inattentive driving errors were more common and were significantly reduced while the subject was on medication (4.6 versus 7.8; P <.01). The improvement in driving performance (change in number of errors recorded) from first to second testing was positively correlated with medication dosage (r = 0.60; P <.01). CONCLUSIONS: Once-daily controlled-release MPH improves real-life driving performance of adolescent males diagnosed with ADHD. In particular, it significantly reduces driving errors arising from inattention.

Adolescent↗
PubMed2005

Towards a better understanding of First Nations communities and drinking and driving.

OBJECTIVES: First Nations young people are over-represented in fatal alcohol-related crashes, necessitating culturally sensitive data that sheds light on this major health issue. The objective of this study was to understand why young First Nations drivers, aged 18 to 29 years old, become involved in drinking and driving as normal behavior displayed through socio-cultural patterns. STUDY DESIGN AND METHODS: Sixty-five First Nations respondents were individually interviewed in nine Alberta locations. Semi-structured interviews, focusing on socio-cultural patterns, norms and community ethos affecting alcohol consumption, drinking and driving, and drinking and driving interventions, were used. RESULTS: Community norms play a significant role in the drinking and driving behaviors of First Nations people. First Nations communities experience reckless driving, neighbors with alcohol and drug abuse problems, violence, economic disparity, boredom and racism, all of which contribute to responses of alcohol abuse and drinking and driving. Both are considered to be normal, community-endorsed behaviors, reflecting situational needs and ready-at-hand usage. Furthermore, the grid of rural roadways is an important contributor to drinking and driving and a community sense of practical living. Also of importance was the finding that young people embraced their parents' alcohol-related problem behaviors on the basis that "what is okay for the parents is okay for me." Finally, First Nations young people believe in personally stopping a drunken person from driving, but the risk of community censure, social discomfort and risk of physical and verbal abuse mitigate against them taking action. CONCLUSIONS: Living in First Nations communities is socially complex, highly emotionally charged, and peer-pressured. Drinking and driving and alcohol abuse amongst First Nations people reflect the community social structure, daily pressures and norms of behavior. Hence, to reduce drinking and driving casualties amongst First Nations young people, intervention strategies must address systemic issues, namely local people's social realities, norms, as well as local and peer relationships.

Adolescent↗
PubMed2005

[Useful assessment for identifying unsafe driving].

Ability to drive safely is the resultant of interactions between the individual (the driver), the vector (the car) and the environment (the state of the road). For some aged drivers, an important decline of visual, musculosquelettic and cognitive performances, may affect the ability to drive and increase the rate of crashes per vehicle-kilometer-driven, and the morbidity and mortality related to crash. Therefore, each holder of a driving licence should be medically suited to control his driving ability. In case of transitory or lasting driving incapacity, drivers must, of their own initiative, stop driving according to the Highway code and the contractual obligations appearing in their vehicle insurance contract. A medical examination for aptitude to driving requires a standardized, reliable, reproducible procedure based on consensual assessment tools to avoid arbitrary decisions for driving cessation. We propose a multidisciplinary approach to detect important decline of visuospatial and motor skills, paroxystic drops of attention and vigilance, and decreased cognitive capacity to anticipate and adapt driving at every moment. This assessment is based on a semi-directed interview and simple diagnostic tests. According to the present French law, only twelve medical conditions or functional deficits are inconsistent with the retain of the driving licence for a light vehicle.

Accidents, Traffic↗
PubMed2005

[Physicians' control of driving after stroke attacks].

BACKGROUND: The Finnmark Stroke Register is an investigation of new cases of stroke in a Norwegian county between April 1998 and March 2002; 622 were first attacks. The aim of this study was to estimate how physicians deal with driving issues in these patients in the sub-acute stage and during the first year after the stroke. MATERIAL AND METHODS: Evaluations of fitness to drive were made by the author and research nurses in the sub-acute stage and through telephone interviews after three and twelve months. RESULTS: 45% of first attack survivors had a valid driving licence. Usually the medical records contained no information concerning the license; this information was obtained during the follow up. 80% of patients with a licence did not fulfill the requirements for driving in the sub-acute stage because of neurological, cognitive or ophthalmologic impairment. Less than half of these patients were told not to drive. Many of the others went on driving. One year later, about 40% of patients with a valid license did not fulfill the requirements for driving. Several cases of homonymous hemianopia escaped detection for a long time. INTERPRETATION: Physicians should note the possession of a driving licence in the medical records. If indicated, acute stroke patients should receive temporary verbal and written information not to drive. Special concern ought to be given to visual disturbances. Uniform standards concerning fitness to drive ought to be developed in Norway.

Acute Disease↗
PubMed1996

Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder.

PURPOSE: To evaluate the motor vehicle driving knowledge, skills, and negative driving outcomes of older teens and young adults with attention deficit hyperactivity disorder (ADHD). LOCATION: A university medical center clinic for adult ADHD. SUBJECTS: A total of 25 young adults with ADHD and 23 young adults without ADHD 17 to 30 years old drawn from the community and equated for age, gender, and educational level. MEASURES: Structured interview, behavior ratings by self- and others, video test of driving knowledge, computer simulated driving test, and official motor vehicle records. RESULTS: ADHD young adults were cited more often for speeding, were more likely to have had their licenses suspended, were involved in more crashes, were more likely to have had crashes causing bodily injury, and were rated by themselves and others as using poorer driving habits. Official driving records corroborated these negative outcomes. Although no group differences in driving knowledge were evident, young adults with ADHD had more crashes, scrapes, and erratic steering during the computer-stimulated driving test than did the control subjects. CONCLUSIONS: Findings supported previous research suggesting that greater driving risks are associated with ADHD and suggested that ADHD does not interfere with driving knowledge so much as with actual performance (motor control) during vehicle operation.

Accidents, Traffic↗
PubMed2001

Relationship between work of breathing provided by a ventilator and patients' inspiratory drive during pressure support ventilation; effects of inspiratory rise time.

Inspiratory drive and work of breathing provided by a ventilator (WOBv) during pressure support ventilation (PSV) were examined in 15 patients. At PSV 10 and 15 cm H2O during CPAP 5 cm H2O, patients with low P0.1 (<4.2 cm H2O, n=9) showed WOBv 0.57 and 0.92 J/l, those with high P0.1 (>4.2 cm H2O, n=6) showed 0.31 and 0.62 J/l respectively. WOBv was smaller and pressure-time product of oesophageal pressure (PTP) was significantly larger in high P0.1 patients. Peak inspiratory flow for low P0.1 patients increased as PSV level increased but high P0.1 patients showed no significant change. In a lung model, effects of inspiratory rise time (IRT) and PSV were studied at high and low inspiratory drives by using ventilators with (Servo 300) and without (Mallinckrodt 7200a) adjustable IRT. With 7200a, PSV 10 cm H2O during low drive was compared with PSV 10 and 15 cm H20 during high drive. In Servo 300, PSV 10 cm H2O (IRT 0.6 and 0.0 sec) during low drive was compared with PSV 10 cm H20 (IRT 0.6 and 0.0 sec) and PSV 15 cm H2O (IRT 0.6 sec) during high drive. Raising PSV and shortening IRT both increased peak inspiratory flow. Initial inspiratory flow increased in inverse proportion to IRT, but higher PSV had a little effect. WOBv with high drive was less than with low drive. Higher PSV preserved WOBv by increasing tidal volume. Shortening IRT recruited WOBv by increasing initial inspiratory flow without changing airway pressure and tidal volume. Compared with higher PSV, shorter IRT reduced PTP more. In conclusion, WOBv decreased as inspiratory drive increased due to inability to increase inspiratory flow. Increasing initial inspiratory flow was more effective than raising PSV to preserve inspiratory assistance of PSV at high inspiratory drive.

Adult↗
PubMed2006

MDMA and alcohol effects, combined and alone, on objective and subjective measures of actual driving performance and psychomotor function.

RATIONALE: The party drug ecstasy is frequently used in combination with other drugs like marihuana and alcohol. In addition, a substantial proportion of the MDMA users has claimed to drive a car when under the influence of MDMA and/or other drugs. OBJECTIVE: To assess the effects of MDMA and alcohol, combined and alone, on actual driving performance and laboratory tasks related to driving. METHODS: Eighteen healthy subjects participated in a double-blind, placebo-controlled, six-way cross-over study. Treatments consisted of MDMA 0, 75, and 100 mg with and without alcohol, aiming at 0.06 mg/ml BAC. Laboratory tests (critical tracking task, object movement estimation task) were conducted between 1.5 and 2 h postdrug (0.5 and 1 h postalcohol). Actual driving tests (road tracking test, car-following test) were conducted between 3 and 5 h postdrug (2 and 4 h postalcohol). Subjects completed the addiction research center inventory (ARCI) and rated their driving quality and mental effort during driving. RESULTS: Alcohol alone impaired critical tracking performance, as well as a number of actual driving performance parameters [i.e., standard deviation of lateral position (SDLP), brake reaction time, and coherence]. MDMA alone reduced SDLP and standard deviation of speed. MDMA significantly moderated alcohol induced impairment of road tracking performance but did not affect alcohol impairments of car-following and laboratory task performance. Subjective data seemed to support objective data. CONCLUSION: MDMA moderated the impairing effects of a low dose of alcohol on road tracking performance but it could not overcome alcohol-induced impairment on other aspects of driving behavior or driving related performance.

Adult↗
PubMed1986

Age differences in male drivers' perception of accident risk: the role of perceived driving ability.

Young (18-25) and older (35-50) male drivers were compared in their perception of driving risk and confidence in driving ability. Both groups provided responses a questionnaire on accident risk and driving ability and further generated subjective ratings of risk to a series of videotaped sequences depicting various elements of driving behavior. Although young drivers' estimates of accident involvement in the next year were higher than those of older drivers, young drivers gave lower ratings of accident risk for specific driving situations which demanded fast driving reflexes or substantial vehicle-handling skills. Young drivers rated their own risk of an accident and driving abilities as being the same as for older drivers. However, they saw their peers as being significantly higher at risk and having poorer abilities than themselves. Young drivers were more confident in their driving abilities than the older drivers. Evidence is provided to suggest that perceived risk and self-perceived driving abilities are interrelated. Further, the data from young drivers showed two disturbing characteristics: first, a notable dissociation between perceived and actual ability and, second, a tendency to view themselves as immune from the effects of higher levels of risk, which they are prepared to ascribe to their peers but not to themselves.

Accidents, Traffic↗
PubMed1988

Occurrence and patterns of driving behavior for alcoholics in treatment.

The purpose of this study was to investigate the driving behaviors of male alcoholics. Two hundred and fifty-eight male alcoholics receiving treatment for alcoholism completed a self-administered questionnaire about their driving behaviour and official driver records were accessed. On average, the surveyed individuals drank and drove about 8.6 days per month at the legal level of impairment in Canada (i.e., 80 mg%). Evidence showed that about 88.3% of the sample had driven while impaired. The probability of being arrested for impaired driving was estimated to be about one in 1168 impaired driving events. People were divided into three groups according to their number of Driving While Impaired (DWI) arrests in the previous 10 years, as determined by self-reports and official driving records: zero DWI arrests, one DWI arrest, and multiple DWI arrests. Those with multiple DWI arrests drove while impaired more frequently and with more risky styles of driving than people with zero arrests. Those with two or more arrests also reported that they enjoyed driving under a greater variety of situations as compared to those with zero arrests. Multiple offenders had significantly more total collisions than zero time offenders; however, there were no significant differences among the three DWI groups for collisions without alcohol involvement or other types of traffic violations. Results showed that the number of DWI arrests was generally not related to worse driving when sober.

Accidents, Traffic↗