Psychoactive medications and crash involvement requiring hospitalization for older drivers: a population-based study

OBJECTIVES: To determine the association between psychoactive medications and crash risk in drivers aged 60 and older.

DESIGN: Retrospective population-based case-crossover study.

SETTING: A database study that linked the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme.

PARTICIPANTS: Six hundred sixteen individuals aged 60 and older who were hospitalized as the result of a motor vehicle crash between 2002 and 2008 in Western Australia.

MEASUREMENTS: Hospitalization after a motor vehicle crash.

RESULTS: Greater risk for a hospitalization crash was found for older drivers prescribed benzodiazepines (odds ratio (OR)=5.3, 95% confidence interval (CI)=3.6-7.8, P<.001), antidepressants (OR=1.8, 95% CI=1.0-3.3, P=.04), and opioid analgesics (OR=1.5, 95% CI=1.0-2.3, P=.05). Crash risk was significantly greater in men prescribed a benzodiazepine (OR=6.2, 95% CI=3.2-12.2, P<.001) or an antidepressant (OR=2.7, 95% CI=1.1-6.9, P=.03). Women prescribed benzodiazepines (OR=4.9, 95% CI=3.1-7.8, P<.001) or opioid analgesics (OR=1.8, 95% CI=1.1-3.0, P=.03) also had a significantly greater crash risk. Subgroup analyses further suggested that drivers with (OR=4.0, 95% CI=2.9-8.1, P<.001) and without (OR=6.0, 95% CI=3.8-9.5, P<.001) a chronic condition who were prescribed benzodiazepines were at greater crash risk. Drivers with a chronic condition taking antidepressants (OR=3.4, 95% CI=1.3-8.5, P=.01) also had a greater crash risk.

CONCLUSION: Psychoactive medication usage was associated with greater risk of a motor vehicle crash requiring hospitalization in older drivers.