title: A preliminary assessment of the medical and functional factors associated with vehicle crashes by older adults.
abstract: OBJECTIVE
  To examine associations between medical and functional variables and at-fault car crashes in a cohort of older drivers.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  A tertiary care medical center.
  
  
  METHODS
  Older drivers (ages 55-90 years) residing in Jefferson County, Alabama (n = 174). Cases were drivers who had at least one at-fault crash in the previous 6 years; controls were crash-free during the same period.
  
  
  METHODS
  Self-reported medical conditions, reported and observed functional measures, and urinary drug screens. The occurrence of one or more at-fault car crashes in the 6 years preceding the 1991 assessment date represented the outcome measure.
  
  
  RESULTS
  Ninety-nine older drivers experienced between one and seven at-fault vehicle crashes during the period 1985 through 1991, whereas 75 drivers did not. Logistic regression models indicated that the following variables were independently associated with crash involvement: A 40% or greater reduction in the useful field of view (OR = 6.1; 95% CI, 2.9 to 12.7; P < 0.001), black race (OR = 6.6; 95% CI, 1.7 to 26.2; P = .007), a history of falling in the previous 2 years (OR = 2.6; CI, 1.1 to 6.1; P = .025), and not taking a beta-blocking drug (OR = 4.3; CI, 1.2 to 15.0; P = .023).
  
  
  CONCLUSIONS
  Functional assessments, such as a comprehensive test of visual processing, a falls history, and a review of current medications may be of greater relevance than specific medical conditions in the identification of older at-risk drivers. If prospective studies determine that falling and crashing share risk factors, a unified approach to the prevention of these mobility disorders could result. The finding of an independent association of black race with at-fault crashing is in need of further clarification because of the low representation of black drivers in this sample.
authors.affiliation: Department of Medicine, Center for Aging, University of Alabama at Birmingham, Birmingham Department of Veterans Affairs Medical Center, USA.
authors.forename: R V
authors.initials: RV
authors.lastname: Sims
authors.forename: C
authors.initials: C
authors.lastname: Owsley
authors.forename: R M
authors.initials: RM
authors.lastname: Allman
authors.forename: K
authors.initials: K
authors.lastname: Ball
authors.forename: T M
authors.initials: TM
authors.lastname: Smoot
mesh_terms: D000063:Accidents, Traffic; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving; D016022:Case-Control Studies; D004358:Drug Therapy; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012307:Risk Factors; D014792:Visual Acuity