title: Seat belt use and fit among drivers aged 75 years and older in their own vehicles.
abstract: OBJECTIVE
  This article aims to describe seat belt wearing patterns and quality of seat belt fit among drivers aged 75 years and older. A secondary aim is to explore associations between body shape, comfort, and seat belt use patterns.
  
  
  METHODS
  This is an observation and survey study of a cohort of 380 drivers aged 75 years and over. During home visits, photographs were taken of the drivers in their vehicles for later analysis of belt fit and a short survey was also administered to collect demographic data and information about seat belt use and comfort. Seat belt fit and use of belt and seat accessories were analyzed from the photographs.
  
  
  RESULTS
  Data from 367 participants with photographs were analyzed. Whereas 97% reported using a seat belt and 90% reported their seat belt to be comfortable, 21% reported repositioning their seat belt to improve comfort. Good sash and lap belt fit were achieved in 53 and 59% of participants, respectively, but only 35% achieved overall good fit. Both poor sash and lap belt fit were observed in 23% of participants. Drivers who were in the obese category had over twice the odds (95% confidence interval [CI], 1.2-4.1) of having a poor lap belt fit than those in the normal body mass index [BMI] range, and drivers who were overweight had 1.8 times the odds (95% CI, 1.1-2.9) of having poor lap belt fit. Older females also had twice the odds (95% CI, 1.3-3.5) of poor lap belt fit compared to older males, regardless of BMI. Sash belt fit did not vary significantly by BMI, stature, or gender. However older drivers who reported that they had not made any adjustments to the D-ring height had 1.7 times the odds of having poor sash belt fit than those who made adjustments (1.2-2.9). Females were 7.3 times more likely to report comfort problems than males (95% CI, 3.2, 16.3) but there was no association between reported comfort and BMI or seat belt fit. Drivers who reported comfort problems had 6 times the odds (3.2-13.6) of also reporting active repositioning of the belt.
  
  
  CONCLUSIONS
  The results suggest that older drivers face challenges in achieving comfortable and correct seat belt fit. This may have a negative impact on crash protection. Belt fit problems appear to be associated with body shape, particularly high BMI and gender. There is a need for further investigation of comfort accessories; in the interim, older drivers and occupants should be encouraged to use features such as D-ring adjusters to improve sash belt fit.
authors.affiliation: a Neuroscience Research Australia, University of New South Wales , Randwick , New South Wales , Australia.|b School of Medical Sciences, University of New South Wales , Randwick , New South Wales , Australia.
authors.forename: Cameron K
authors.initials: CK
authors.lastname: Fong
authors.affiliation: c The George Institute for Global Health, University of Sydney , Sydney , New South Wales , Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Keay
authors.affiliation: c The George Institute for Global Health, University of Sydney , Sydney , New South Wales , Australia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Coxon
authors.affiliation: d The Kolling Institute of Medical Research, Sydney Medical School, The University of Sydney, RNS Hospital , St. Leonards , New South Wales , Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Clarke
authors.affiliation: a Neuroscience Research Australia, University of New South Wales , Randwick , New South Wales , Australia.|b School of Medical Sciences, University of New South Wales , Randwick , New South Wales , Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Brown
mesh_terms: D000368:Aged; D001336:Automobiles; D015992:Body Mass Index; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity; D010781:Photography; D012622:Seat Belts / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: BMI; older drivers; restraint system; seat belt fit