Table e-1: Driving Behavior and Age
AuthorYear / Class / Cohort Assembly / Subjects / Test / Outcome / Results
Relative Risk (RR) 95% CI
Ball, K.
2006 / I / Prospective, drivers recruited from three Motor Vehicle Administration offices in MD / N=2114 / NP and physiological battery / Future motor vehicle crashes / 85%ile for age (78 years) OR 2.11 for future at fault crashes in 4.18-5.13 years
MVR:
Age > 78 OR 1.26 (1.01,1.57)
Duchek
2003 / I / Longitudinal study of cohort from Hunt, 1997 / CDR 0 = 58
CDR 0.5 = 36
CDR 1 = 29 / WURT repeated every 6 m / Safe vs. marginal + unsafe / Cox proportional hazard ratio: Age HR 1.06 (1.02,1.09) for each year increase in age
Janke MK
1998 / II / Single DMV test site, referrals needed to pass test to resume driving / Referrals=75
Volunteers=31 / NP battery / On-the-road test pass/fail (first at DMV, the next day in the subject’s neighborhood / Age strongly correlated with group and NP battery
Antsey
2006 / II / Australian longitudinal study of aging / N=1466 / Yearly NP testing and driving questionnaire
(waves 1-5_ / Driving or not driving based on answer to questionnaire / age was weakly but consistently associated with driving
cessation at the three subsequent waves
MLR:
Wave 2 OR 1.11, (95% CI 1.02,
1.20)
Wave 3 OR 1.21, (1.13,1.31)
Wave 4 OR 1.19, (1.13,1.26)
Wave 5 NS
For increase in age by one year
Carr, D. B.
1992 / II / Prospective cohort through advertisements / 18-19yo=20
25-35=20
>65 =20 / Standardized on the road test / score / Elder drivers had fewer mistakes
Grace
2005 / II / Dementia and Movement disorders clinic / PD=21
AD=21
Controls=21 / NP battery / On-the-road driving test performance (modeled on WURST) / Age did not differ between fit and unfit drivers in the three cohorts
Odenheimer
1994 / III / Prospective driving study, referrals from dementia clinics and community / n=30 / NP battery / On-the-road test by driving instructor blinded to NP results / Poorer performance on driving tests and NP battery with increasing age
Vance DE
2006 / II / Prospective cohort recruited at license renewal stations in Maryland, age > 55y / n=2171 (out of 4234 approached) / NP battery using UFOV / Subset n=815 f/up telephone interview using driving habits questionnaire / Only 1050 forms returned, 836 approached for telephone interview
Age strongly predicted health status, functioning, driving avoidance and driving exposure
Whelihan WM
2005 / II / Referral to dementia clinic (AD), advertisements (controls) / CDR -.5 = 23
Control=23 / NP battery / On-the-road test (Based on WURT) / Older age of control subjects correlated with poorer driving score (p=0.05)
Adler
2003 / III / VA Dementia clinic / n=53 / Age, NP battery / Follow-up questionnaire 39 m later / ULR:
OR 0.88 (0.77,0.99) risk of continuing to drive for each increase in age by one year
Di Stefano M
2003 / III / Retrospective cohort of drivers reported to government for fitness to drive evaluation / n=496 / Analysis of errors from on-the-road test in the subject’s home neighborhood / Pass / fail / Age related changes associated (though poorly) with failure rate
Foley, DJ
2000 / III / Retrospective cohort study, Honolulu Heart Program / n=464 / Self report / Self reported driving cessation 3 years after last assessment / MLR for continued driving (compared to 75-79yo):
80-84yo OR 0.7 (0.38,1.30)
85 OR 0.54 (0.24, 1.10)
Kim, K.
1998 / III / Retrospective analysis of at fault collisions in Hawaii 1991-2 / n=69,077 / Log-linear modeling of causative factors / Investigating officer determination of fault / Increased collisions for youngest and oldest driver
Langford J
2006 / III / Retrospective cohort analysis of fatal motor vehicle crashes 1996-9 / 6,338 fatal crashes investigated / Descriptive statistics compared to younger drivers / Drivers > 75 had more collisions with other vehicles (74%) than middle-aged drivers (60%)
Intersection problems more frequent for older than for middle aged drivers:
Stop lights
Stop or yield signs
(but not for round-abouts)
Oncoming traffic turning in front of elder (opposing through right) and turning into adjacent road (adjacent through-through)
Fewer fatalities explained by low speed limit zones
Older drivers also avoided night time and highway driving
Lee HC
2003b / III / Retrospective analysis of crashes looking for association with driving simulator performance, in volunteers age > 60 years / n=129
same populations as in Lee 2003a / Driving simulator (STISIM) / Reported accidents in prior 12 months / MLR for prior crash
Age OR 1.13 (1.00,1.17)
for each increase in age by one year
Li G
2003 / II / Retrospective analysis of crash fatality data:
FARS 1993-7
GES 1993-7
NPTS 1995 / Groups:
Older (>60 years)
Middle 320-69 years)
Young (20-29)
Youngest (16-19) / Analysis of crash types, travel imputed through national estimates / For older drivers fragility rather than over-involvement accounts for fatalities. For the youngest drivers it is over involvement that explains the fatalities.
U shaped curve for deaths / 10^8 VMT
Walker N
1997 / III / Not specified / 18-24y=33
64-80=30 / Computerized route finding task / Optimal decision making / Time to make decision increased with age.
Flexibility in route varying route and confidence about their decisions increased with age.
MLR = multivariate linear regression
MMSE = Mini-mental state examination
TSRT = Traffic Sign Recognition Test
WURST = Washington University Road Safety Rest
ULR = Univariate linear regression
Table e-2. Driving Behavior and MMSE Score
AuthorYear / Class / Cohort Assembly / Subjects / Test / Outcome / Results
Relative Risk (RR) 95% CI
Fitten
1995 / II / VA Dementia clinic (AD and VascD) / AD=13
VascD=12
Older controls=24
Young controls=16 / On-the-road course on VA grounds
MMSE / Pass/fail of driving test / MMSE relatively insensitive to driving performance at the upper limit
Antsey
2006 / II / Australian longitudinal study of aging / N=1466 / Yearly NP testing and driving questionnaire / Driving or not driving based on answer to questionnaire / MMSE 24 increased odds of driving cessation at year 2 OR=3.34 (95% CI 1.14,9.84)
Cotrell
1998 / III / Dementia clinic / AD=35
19 still driving / MMSE / Driving or not / MMSE not predictive of driving status
De Raedt
2001 / III / Referrals to Belgian fitness-to-drive assessment center / 84 drivers / NP battery / Fit or not fit-to-drive as determined by instructor / By itself MMSE was not predictive, but as part of a battery was useful in discriminating between safe and unsafe drivers
Grace
2005 / II / Dementia and Movement disorders clinic / PD=21
AD=21
Controls=21 / NP battery / On-the-road driving test performance (modeled on WURST) / MMSE range overlapped between safe and unsafe drivers.
AD drivers had more errors than PD
Johannsen
1996 / III / Swedish drivers > age 65 whose license suspended for crashes or traffic offenses / Suspended=37
Matched controls=37 / NP and clinical assessment by blinded clinician / Driving status predicted by NP results? / 49% of suspended drivers had AD compared to 11% of controls
Lower MMSE in drivers with crashes
Kantor
2004 / III / Elderly driving assessment clinic, MMSE < 23 not allowed to drive / n=573 / NP battery / On-the-road test by blinded driving instructor / A battery, including MMSE was predictive of fitness to drive
Lesikar
2002 / II / Primary practice clinic / n=107 / NP battery / Driving status determined after two years by a questionnaire / high drop out,
MMSE increased risk of crashes comparting lowest tertile of MMSE (< 25) RR of crash 1.36(0.26,7.09)
MacGregor
2001 / III / Retrospective case control study of drivers involved in crashes / Cash=60
Matched control=60 / MMSE and TSRT / Ability to discriminate between groups / TSRT but not MMSE could identify groups
Odenheimer
1994 / III / Prospective driving study, referrals from dementia clinics and community / n=30 / NP battery / On-the-road test by driving instructor blinded to NP results / High correlation (r=0.72) between NP tests (including MMSE) and in-traffic test score
Richardson
2003 / II / Prospective study of driving ability in community dwelling elders, age > 72 / n=35 / NP battery / On-the-road diving test / Association for MMSE not reported
Stolwyk
2005 / II / Movement disorders clinic / PD=18
Control=18 / NP battery looking at cueing, internal vs external / Simulator (STISIM) / MMSE had no effect of driving performance in PD subjects
Zuin
2002 / II / Dementia registry / PD=51
Control=31 / NP battery / Aberrant driving behaviors as determined by interview / While MMSE was significantly different between groups, overlap prevented using MMSE to determine driving safety
MMSE = Mini-mental state examination
WURST = Washington University Road Safety Rest
TSRT = Traffic Sign Recognition Test
Table e-3: Driving Behavior and CDR Score
AuthorYear / Class / Cohort Assembly / Subjects / Test* / Outcome / Results
Relative Risk (RR) 95% CI
Hunt
1997 / II / Memory clinic and longitudinal study of aging, cross sectional testing / CDR 0 = 58
CDR 0.5 = 36
CDR 1 = 29 / WURT / Safe vs marginal + unsafe / CDR 0.5 vs CDR 0, RR = 9.67 (2.3,40.7)
CDR 1 vs CDR 0, RR = 12 (2.8, 50.1)
Duchek
2003 / I / Longitudinal study of cohort from Hunt, 1997 / CDR 0 = 58
CDR 0.5 = 36
CDR 1 = 29 / WURT repeated every 6 m / Safe vs marginal + unsafe / Cox proportional hazard ration CDR 1 vs 0 = 2.68 (1.5, 4.8)
CDR .5 vs 0 and 1 vs .5 were NS
Brown LB
2005 / I / Cross section, geriatric clinic / CDR 0 = 25
CDR 0.5 = 33
CDR 1 = 17 / WURT / Safe vs marginal vs impaired / CDR 0 = 0 impaired
CDR 0.5 = 31% marginal, 15% impaired
CDR 1 = 35% marginal, 24% impaired
Snellgrove
/ IV / Cross sectional study of elderly, demented drivers,
Memory clinic / CDR 0.5 = 23
CDR 1 = 92 / On-road driving test / Safe vs. unsafe / No comparison to normal drivers
RR CDR 1 compared to 0.5 = 1.45 (0.97, 2.19)
Grace
2005 / I / Cross sectional study comparing AD, PD to normal controls. AD subjects presumably recruited from a dementia clinic / CDR 0 = 21
CDR 0.5 or 1 = 20 / On-road driving test / Safe vs marginal or unsafe / Unsafe or marginal driver:
CDR 0 (0/21)
CDR 0.5 or 1 (9/20)
RR of unsafe driver: 25 (1.5-384)
Foley, DJ
2000 / III / Retrospective cohort study, Honolulu Heart Program / CDR 0 = 162
CDR 0.5 = 96
CDR 1 = 98
CDR > 1 / Self report / Self reported driving cessation 3 years after last assessment / CDR 0 78% still drove
CDR 0.5 46% still drive
CDR 1 22% still drove
CDR >1 4.3%
* WURT = Washington University Road test, a validated fixed course on-the-road test