Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 5;6(9):e2335651.
doi: 10.1001/jamanetworkopen.2023.35651.

Medication and Road Test Performance Among Cognitively Healthy Older Adults

David B Carr  1   2 , Kebede Beyene  3 , Jason Doherty  2 , Samantha A Murphy  2 , Ann M Johnson  4 , Hailee Domash  2 , Noah Riley  2 , Alexis Walker  2 , Ashwin Sabapathy  2 , John C Morris  2 , Ganesh M Babulal  2   5   6   7
Affiliations

Medication and Road Test Performance Among Cognitively Healthy Older Adults

David B Carr et al. JAMA Netw Open. .

Erratum in

  • Error in Table.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Oct 2;6(10):e2342461. doi: 10.1001/jamanetworkopen.2023.42461. JAMA Netw Open. 2023. PMID: 37878316 Free PMC article. No abstract available.

Abstract

Importance: Older adults are increasingly prescribed medications that have adverse effects. Prior studies have found a higher risk of motor vehicle crashes to be associated with certain medication use.

Objective: To determine whether specific medication classes were associated with performance decline as assessed by a standardized road test in a community sample of cognitively healthy older adults, to evaluate additional associations of poor road test performance with comorbid medical conditions and demographic characteristics, and to test the hypothesis that specific medication classes (ie, antidepressants, benzodiazepines, sedatives or hypnotics, anticholinergics, antihistamines, and nonsteroidal anti-inflammatory drugs or acetaminophen) would be associated with an increase in risk of impaired driving performance over time.

Design, setting, and participants: This was a prospective cohort study of 198 cognitively healthy adults 65 years and older with a valid driver's license who were followed up annually, with rolling enrollment. Data were collected from participants in St Louis, Missouri, and neighboring Illinois who were enrolled in the Knight Alzheimer's Disease Research Center. Data were collected from August 28, 2012, to March 14, 2023, and analyzed from April 1 to 25, 2023. Participants with healthy cognition, defined as a Clinical Dementia Rating score of 0 at baseline and subsequent visits, who had available clinical, neuropsychological, road tests, and self-reported medication data were included.

Exposure: Potentially driver-impairing medication use.

Main outcomes and measures: The primary outcome measure was performance on the Washington University Road Test (pass or marginal/fail). Multivariable Cox proportional hazards models were used to evaluate associations between potentially driver-impairing medication use and road test performance.

Results: Of the 198 included adults (mean [SD] baseline age, 72.6 [4.6] years; 87 female [43.9%]), 70 (35%) received a marginal/fail rating on the road test over a mean (SD) follow-up of 5.70 (2.45) years. Any use of antidepressants (adjusted hazard ratio [aHR], 2.68; 95% CI, 1.69-4.71), serotonin and norepinephrine reuptake inhibitors (aHR, 2.68; 95% CI, 1.54-4.64), sedatives or hypnotics (aHR, 2.70; 95% CI, 1.40-5.19), or nonsteroidal anti-inflammatory drugs (aHR, 2.72; 95% CI, 1.31-5.63) was associated with an increase in risk of receiving a marginal/fail rating on the road test compared with control individuals. Conversely, participants taking lipid-lowering agents had a lower risk of receiving a marginal/fail rating compared to control individuals. There were no statistically significant associations found between anticholinergic or antihistamines and poor performance.

Conclusions and relevance: In this prospective cohort study, specific medication classes were associated with an increase in risk of poor road test performance over time. Clinicians should consider this information and counsel patients accordingly when prescribing these medications.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Carr reported other from the Traffic Injury Research Foundation (consulting for funded studies), Medscape (consultant and author of educational content on older drivers), and UpToDate (coauthor for chapter on older drivers) and grants from the Missouri Department of Transportation. Drs Domash and Babulal reported grants from the National Institute on Aging to Washington University School of Medicine and from the Bright Focus Foundation to Washington University School of Medicine during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Four Potentially Impairing Drug Categories and Road Test Outcome Probabilities
NSAID indicates nonsteroidal anti-inflammatory drugs; SNRI, serotonin and norepinephrine reuptake inhibitors; SSRI, selective serotonin reuptake inhibitors.
Figure 2.
Figure 2.. Lipid-Lowering Drug and Anticholinergic/Antihistamines Classes and Road Test Outcome Probabilities
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Medication Changes Among Older Drivers Involved in Motor Vehicle Crashes.
    Zullo AR, Riester MR, D'Amico AM, Reddy Bhuma M, Khan MA, Curry AE, Pfeiffer MR, Margolis SA, Ott BR, Bayer T, Joyce NR. Zullo AR, et al. JAMA Netw Open. 2024 Oct 1;7(10):e2438338. doi: 10.1001/jamanetworkopen.2024.38338. JAMA Netw Open. 2024. PMID: 39382896 Free PMC article.
  • Error in Table.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Oct 2;6(10):e2342461. doi: 10.1001/jamanetworkopen.2023.42461. JAMA Netw Open. 2023. PMID: 37878316 Free PMC article. No abstract available.

References

    1. Aggarwal P, Woolford SJ, Patel HP. Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice. Geriatrics (Basel). 2020;5(4):85. doi:10.3390/geriatrics5040085 - DOI - PMC - PubMed
    1. Insurance Institute for Highway Safety . Older drivers. Accessed August 29, 2023. https://www.iihs.org/topics/older-drivers
    1. Palumbo AJ, Pfeiffer MR, Metzger KB, Curry AE. Driver licensing, motor-vehicle crashes, and moving violations among older adults. J Safety Res. 2019;71:87-93. doi:10.1016/j.jsr.2019.09.019 - DOI - PMC - PubMed
    1. Babulal GM, Vivoda J, Harmon A, Carr DB, Roe CM, Zikmund-Fisher B. Older adults’ expectations about mortality, driving life and years left without driving. J Gerontol Soc Work. 2019;62(8):912-929. doi:10.1080/01634372.2019.1663460 - DOI - PMC - PubMed
    1. American Automobile Association Foundation for Traffic Safety . Rates of motor vehicle crashes, injuries and deaths in relation to driver age, United States, 2014-2015. Accessed August 29, 2023. https://aaafoundation.org/rates-motor-vehicle-crashes-injuries-deaths-re...

Publication types