Assisting the older driver - SWOV

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Physical and mental characteristics of the older driver 2.3.5. Cardiovascular diseases Cardiovascular diseases include diseases such as angina pectoris (chest pain), cardiac arrhythmias, heart failure and hypertension (abnormally high blood pressure). Studies that have separated out these different conditions have indicated that only cardiac arrhythmias and angina pectoris increase crash risk (see e.g., Foley, Wallace & Eberhard, 1995; Gresset & Meyer, 1994). Metaanalyses of 14 and 3 studies that examined the relative risk of being involved in a crash due to arrhythmia and angina respectively showed that drivers that have the respective diseases have a 27% and 52% higher crash rate than drivers without any medical condition (Vaa, 2003). 2.3.6. Diabetes Mellitus Diabetes is a disorder that is characterized by high blood sugar levels, especially after eating. The incidence of diabetes becomes much more common with increasing age, with 17‐20% of 70 year olds having difficulty regulating glucose as compared with 1.5% of 20 year olds (Holland, Handley & Feetam, 2003). There are two types of diabetes: insulin dependent (type I) and non‐insulin dependent (type II). The former are dependent on insulin injections, the latter can control blood sugar levels by diet, weight reduction, exercise and oral medication. Estimates of the crash risk associated with diabetes used to be as high as twice the rate of average drivers. However, improved medications, better monitoring by diabetic patients of their own blood glucose levels, and improved understanding of diabetic control seem to have reduced the crash risk (Hansotia, 1993, cited in Holland, Handley & Feetam, 2003). An important drawback of tighter control of blood glucose levels is that hypoglycaemic episodes are now much more common. During these episodes with low blood sugar levels, cognitive functions are degraded. Even with only modest levels of hypoglycaemia at times when individuals may be totally unaware that they are hypoglycaemic (Waller, 1992). All in all, serious diabetes (treated with oral drugs or with insulin) is still one of the strongest predictors of crashes, showing a stronger relationship than other illnesses examined (Holland, Handley & Feetam, 2003). Persons with diabetes are also at higher risk of developing the eye disorders cataract, glaucoma and abnormalities that affect the retinal blood vessels (diabetic retinopathy), all affecting visual acuity and visual field (see Section 2.3.1). 41
Assisting the older driver 2.3.7. Comorbidity Many older adults suffer from more than one disease. In a study by Holte & Albrecht (2004) it was found that two out of three persons aged 60 years and above suffer from at least one illness. Nearly every second person suffers from more than one illness. Suffering from more than one disorder can reduce the driver’s possibility to compensate for the effects of these disorders. In addition, suffering from more than one disease often means that multiple medication has to be prescribed (polypharmacy), which increases the likelihood of pharmacokinetic or pharmacological interactions (see Section 2.4). 2.4. Medication Several studies have indicated that certain prescribed drugs increase the crash rate of drivers. These are, among others, benzodiazepines, tricyclic and ‘second generation’ antidepressants, painkillers (analgesics), and first generation antihistamines (Holland, Handley & Feetam, 2003). Older adults, however, are likely to exhibit altered sensitivity to medication. This altered sensitivity is most often in the direction of an increased effect, including side effects and adverse reactions, and the duration of action of a drug may be significantly prolonged due to a reduced clearance of the drug and its active metabolites (Holland, Handley & Feetam, 2003). Since many older adults suffer from more than one disease, they are also more likely to be prescribed multiple medication. The more different medicines that are being taken, the greater the likelihood of pharmacokinetic or pharmacological interactions. Medicines which are not prescribed but that can be obtained over‐thecounter can add to this effect (Becker, 2000; Holland, Handley & Feetam, 2003). In evaluating the possible impact of medication on driving, it should be taken into account that medication is prescribed for an illness, and that the illness may itself affect driving‐related abilities. A particular medication could affect driving independently, it could worsen any deterioration in driving ability caused by the illness, but it could also act to reduce the risk to the patient caused by the illness. The vital point is not whether the specific drug has an effect on driving performance, but rather, whether the individual is capable of functioning safely having used it (Holland, Handley & Feetam, 2003). 42
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Samenvatting Samenvatting Dit proef
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Samenvatting Verkeersveiligheidsmaa
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Samenvatting jongere automobilisten
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Curriculum Vitae Curriculum Vitae R
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Assisting the older driver Nottingh
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