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.
JAMA Netw Open. 2024 Oct 1;7(10):e2438338. doi: 10.1001/jamanetworkopen.2024.38338.
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).
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.
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.
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.
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.
尽管老年人可能会使用潜在的影响驾驶能力的（PDI）药物，这些药物可能会导致精神运动障碍，但对于老年人在发生机动车碰撞（MVC）前后PDI 药物使用的变化知之甚少。
量化老年人在 MVC 前后使用和改变 PDI 药物的情况。
设计、地点和参与者：这项队列研究使用了医疗保险索赔和警察报告的碰撞数据，涉及 154096 名 121846 名老年驾驶员中的 121846 名驾驶员。合格人员为年龄在 66 岁及以上的驾驶员，2007 年 5 月 1 日至 2017 年 12 月 31 日期间在新泽西州发生警察报告的 MVC 事件，在 MVC 之前至少 12 个月连续参加医疗保险费用服务 A 和 B 部分，以及至少 120 天的部分 D。数据于 2022 年 1 月至 2024 年 5 月进行分析。
在 MVC 之前和之后的 120 天内使用苯二氮䓬类药物、非苯二氮䓬类催眠药、阿片类镇痛药和其他 PDI 药物。由于如果符合资格标准，每个参与者在研究期间可能会发生多次 MVC，因此分析的单位是参与者的数量。还量化了开始、停止或继续使用 PDI 药物的参与者数量的比例。
在 154096 名符合条件的参与者中，MVC 时驾驶员的平均（SD）年龄为 75.2（6.7）岁。在 121846 名独特的人中，51.6%是女性。在 80.0%的参与者中，司机在碰撞前使用了 1 种或多种 PDI 药物，在 81.0%的参与者中，司机在碰撞后使用了 1 种或多种 PDI 药物。苯二氮䓬类药物（碰撞前 8.1%，碰撞后 8.8%）、非苯二氮䓬类催眠药（碰撞前 5.9%，碰撞后 6.0%）和阿片类镇痛药（碰撞前 15.4%，碰撞后 17.5%）在碰撞后略有增加。在 MVC 后，2.1%的参与者开始使用苯二氮䓬类药物，1.4%的参与者停止使用苯二氮䓬类药物，1.2%的参与者开始使用非苯二氮䓬类催眠药，1.2%的参与者停止使用非苯二氮䓬类催眠药，8.4%的参与者开始使用阿片类镇痛药，6.3%的参与者停止使用阿片类镇痛药。
这项队列研究表明，大多数参与 MVC 的老年司机在碰撞后使用的 PDI 药物并不比碰撞前少。需要对 PDI 药物的潜在风险与益处进行定性研究，以了解为什么 MVC 似乎并没有促使临床医生停止开具 PDI 药物作为避免潜在伤害的策略，包括额外的 MVC。
