Diagnosed dementia and the risk of motor vehicle crash among older drivers

Laura A. Fraade-Blanar, Ryan N. Hansen, Kwun Chuen G. Chan, Jeanne M. Sears, Hilaire J. Thompson, Paul K. Crane, Beth E. Ebel

Older adults are an active and growing segment of drivers in the United States. We compared the risk of motor vehicle crash among older licensed drivers diagnosed with dementia to crash risk among older licensed drivers without diagnosis of dementia. This retrospective cohort study used data from Group Health (GH), a Washington State health maintenance organization. Research participants were members of GH, aged 65-79 during the study who lived in Washington State from 1999-2009. Participant health records were linked with police-reported crash and licensure records. We estimated the risk of crash for older drivers diagnosed with dementia compared to older drivers without diagnosis of dementia using a Cox proportional hazards model with robust standard errors, accounting for recurrent events (crashes). Multivariable models were adjusted for age, sex, history of alcohol abuse or depression, comorbidities, and medications. There were 29,730 eligible individuals with an active driving license. Approximately 6% were diagnosed with dementia before or during the study. The police-reported crash rate was 14.7 per 1000 driver-years. The adjusted hazard ratio of crash among older drivers with diagnosed dementia was 0.56 (95% CI 0.33, 0.95) compared to those without diagnosed dementia. On-road and simulator-based research showed older adults with dementia demonstrated impaired driving skill and capabilities. The observed lower crash risk in our study may result from protective steps to limit driving among older adults diagnosed with dementia. Future research should examine driving risk reduction strategies at the time of dementia diagnosis and their impact on reducing crash risk.