A new report in the Journal of the American Medical Association Network Open provided some information on which medications are most likely to lead to motor vehicle classes.
Washington University in St. Louis–led researchers sought to determine whether specific medication classes were associated with performance decline as assessed by a standardized road test in a community sample of cognitively healthy older adults, to evaluate additional associations of poor road test performance with comorbid medical conditions and demographic characteristics, and to test the hypothesis that specific medication classes would be associated with an increase in risk of impaired driving performance over time.
They specifically looked at antidepressants, benzodiazepines, sedatives or hypnotics, anticholinergics, antihistamines, nonsteroidal anti-inflammatory drugs, and acetaminophen.
The prospective cohort study involved 198 cognitively healthy adults aged 65 years and older with a valid driver’s license who were followed up annually, with rolling enrollment. The researchers collected data from participants in St. Louis and neighboring Illinois who were enrolled in the Knight Alzheimer’s Disease Research Center. The study team collected data from August 28, 2012, to March 14, 2023, and did analysis from April 1 to April 25, 2023. The study included participants with healthy cognition—defined as a Clinical Dementia Rating score of 0 at baseline and subsequent visits—who had available clinical, neuropsychological, road tests, and self-reported medication data.
The goal was to uncover potentially driver–impairing medication use, with the primary outcome measure being performance on the Washington University Road Test (pass or marginal/fail).
“Of the 198 included adults (mean [SD] baseline age, 72.6 [4.6] years; 87 female [43.9%]), 70 (35%) received a marginal/fail rating on the road test over a mean (SD) follow-up of 5.70 (2.45) years,” the authors reported. “Any use of antidepressants (adjusted hazard ratio [aHR], 2.68; 95% CI, 1.69-4.71), serotonin and norepinephrine reuptake inhibitors (aHR, 2.68; 95% CI, 1.54-4.64), sedatives or hypnotics (aHR, 2.70; 95% CI, 1.40-5.19), or nonsteroidal anti-inflammatory drugs (aHR, 2.72; 95% CI, 1.31-5.63) was associated with an increase in risk of receiving a marginal/fail rating on the road test compared with control individuals.”
On the other hand, the study team noted that participants taking lipid-lowering agents had a lower risk of receiving a marginal/fail rating compared with control individuals. No statistically significant associations were found between anticholinergic or antihistamine use and poor performance.
“In this prospective cohort study, specific medication classes were associated with an increase in risk of poor road test performance over time,” the researchers wrote. “Clinicians should consider this information and counsel patients accordingly when prescribing these medications.”
With nearly 17% of the U.S. population aged 65 years and older, according to background information in the article, more than 48 million are licensed drivers. “By 2050, 25% of all licensed drivers are estimated to be 70 years and older,” the authors advised. “Drivers 70 years and older are retaining their driver licenses longer and driving more miles than ever. A driver 65 years or older has an average driving life expectancy of 10 or more years. The ability to drive independently supports community mobility, social connectedness, and critical access to health care.”
Yet, they pointed out that adults aged 65 years and older have an increased risk of automotive crashes compared with middle-aged drivers when accounting for exposure or miles driven annually and that motor vehicle crashes remain a leading cause of injury and death in older adults. In 2020, a daily average of 20 older adults were killed and 540 injured in motor vehicle crashes nationwide, the researchers wrote.
The U.S. Department of Transportation and National Highway Traffic Safety Administration reported that more than 90 medication classes are associated with motor vehicle crashes among older drivers. Medications commonly associated with driving impairment cause sedation, drowsiness, reduced motor coordination, hypoglycemia, blurred vision, hypotension, syncope, and ataxia, according to the article.
“Given the projected growth of the aging population, number of crashes and injuries among older drivers, and risk of polypharmacy and multimorbidity, driving ability and safety remain top public health priorities,” according to study authors.
The authors added that the findings in their study “suggest that physicians and pharmacists should be aware of potential driving risks in older drivers who are prescribed psychotropic drugs and pain medications and provide consultation accordingly.”
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