Xue Yuqing, Chihuri Stanford, Andrews Howard F, Betz Marian E, DiGuiseppi Carolyn, Eby David W, Hill Linda L, Jones Vanya, Mielenz Thelma J, Molnar Lisa J, Strogatz David, Lang Barbara H, Kelley-Baker Tara, Li Guohua
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University,New York, NY 10032, USA.
Geriatrics (Basel). 2021 Feb 20;6(1):20. doi: 10.3390/geriatrics6010020.
Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study came from the Longitudinal Research on Aging Drivers study, a multisite naturalistic driving study of older adults. Multivariable negative binominal modeling was used to estimate incidence rate ratios and 95% confidence intervals of hard braking events (proxies for unsafe driving behavior defined as events with a deceleration rate ≥0.4 g) associated with PIM use among older drivers. The study sample consisted of 2932 drivers aged 65-79 years at baseline, including 542 (18.5%) who used at least one PIM. These drivers were followed through an in-vehicle recording device for up to 44 months. The overall incidence of hard braking events was 1.16 per 1000 miles. Use of PIMs was associated with a 10% increased risk of hard braking events. Compared to drivers who were not using PIMs, the risk of hard braking events increased 6% for those using one PIM, and 24% for those using two or more PIMs. Use of PIMs by older adult drivers is associated in a dose-response fashion with elevated risks of hard braking events. Reducing PIM use in older adults might help improve driving safety as well as health outcomes.
美国老年医学会确定的潜在不适当用药（PIMs），老年人通常应避免使用，因为其无效或不良反应风险过高。很少有研究通过前瞻性和客观收集的驾驶数据来考察PIMs对驾驶安全的影响。本研究的数据来自老年驾驶员纵向研究，这是一项针对老年人的多地点自然驾驶研究。采用多变量负二项式模型来估计老年驾驶员中与使用PIMs相关的急刹车事件（不安全驾驶行为的指标，定义为减速率≥0.4g的事件）的发病率比和95%置信区间。研究样本包括2932名基线年龄在65 - 79岁的驾驶员，其中542名（18.5%）使用了至少一种PIMs。这些驾驶员通过车载记录设备进行了长达44个月的跟踪。急刹车事件的总体发生率为每1000英里1.16次。使用PIMs与急刹车事件风险增加10%相关。与未使用PIMs的驾驶员相比，使用一种PIMs的驾驶员急刹车事件风险增加6%，使用两种或更多PIMs的驾驶员风险增加24%。老年驾驶员使用PIMs与急刹车事件风险升高呈剂量反应关系。减少老年人使用PIMs可能有助于提高驾驶安全性以及健康结局。
