A recent cohort study found that 81% of crashes involving older drivers were associated with the use of impairing medications after the incident.
Changes in the use of potentially driver-impairing (PDI) medications, including benzodiazepines, nonbenzodiazepine hypnotics, and opioid analgesics, among older drivers following motor vehicle crashes (MVCs) were reviewed. Published in JAMA Network Open, the analysis included 154,096 person crashes involving 121,846 older adults with a mean age of 75.2 years.
"Although many clinicians may be unaware that their patients have been involved in an MVC, those who are aware might not know about the associations between certain medications and MVC risk, noted study investigators. "Even if clinicians are aware, they may have other priorities that take precedence over deprescribing efforts, such as managing other comorbidities or addressing more immediate health concerns."
The study linked Medicare claims data with police-reported crash data in New Jersey from May 1, 2007, through December 31, 2017. Participants were aged 66 years or older and continuously enrolled in Medicare Parts A, B, and D. The objective was to quantify medication changes in the 120 days before and after an MVC, particularly among those using PDI medications known to impair psychomotor function and increase crash risk.
In the 120-day pre-crash, 80% of the crashes involved drivers using at least one PDI medication, which increased slightly to 81% in the 120 days post-crash. Benzodiazepine use rose from 8.1% before the crash to 8.8% afterward. Opioid use increased from 15.4% to 17.5% post-crash. Among the cohort, 2.1% of crashes involved drivers who initiated benzodiazepines, and 1.4% discontinued them post-crash. Similarly, 8.4% of crashes involved drivers who began using opioids, while 6.3% discontinued use.
Use of nonbenzodiazepine hypnotics remained essentially unchanged, reported in 5.9% of crashes before and 6.0% afterward. Following the crash, 1.2% of crashes involved drivers who began using these medications, while 1.2% discontinued them.
In 77.6% of the crashes, drivers continued using one or more potentially driver-impairing medications both before and after the crash.
The researchers concluded that further research is needed to understand why clinicians may not be deprescribing PDI medications after crashes and to examine the effectiveness of post-MVC medication reviews in preventing subsequent crashes.
The study had limitations, including potential generalizability issues for those without Medicare fee-for-service insurance or residing outside New Jersey, and the inability to confirm actual medication adherence or assess the appropriateness of PDI prescriptions.
Full disclosures can be found in the published study.