RISK-FACTORS FOR MOTOR-VEHICLE CRASHES AMONG OLDER DRIVERS IN A RURAL-COMMUNITY

OBJECTIVE: To estimate the motor vehicle crash rate in a cohort of old er drivers from a rural community and to identify health-related condi tions that increase their risk for crash involvement. DESIGN: Cohort s tudy with 5 years of crash-record surveillance. SETTING: The Iowa 65Rural Health Study, one of four Established Populations for Epidemiolo gic Studies of the Elderly (EPESE). PARTICIPANTS: A total of 1791 driv ers aged 68 years and older. MAIN MEASURES: Exposure measures of physi cal, mental, and sensory well-being from a health interview survey; ou tcome measure of police-reported crashes maintained by the Iowa Depart ment of Motor Vehicles. RESULTS: Between 1985 and 1989, 206 drivers we re involved in 245 state-recorded crashes. The estimated annual crash involvement rate for these rural older drivers (28 per 1000 driving-ye ars) was about 20% less than the national average for drivers aged 65 years and over (36 per 1,000). An increased risk for motor vehicle cra shes was associated with episodes of back pain (Relative Risk = 1.4, P < .05), use of nonsteroidal anti-inflammatory drugs (RR = 1.7, P < .0 1), and poor performance on a free-recall memory test (RR = 1.4, P < . 05). CONCLUSIONS: If these and other geriatric conditions are confirme d as risk factors for motor vehicle crashes, medical guidelines for li cense renewal may need updating and health professionals may need new instruments to detect older patients at high risk for unsafe driving.