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Clinician's Guide to Assessing and Counseling Older Drivers 4th edition

The main goal of the Clinician’s Guide
remains helping healthcare practitioners
prevent motor vehicle crashes and injury to
older adults. Motor vehicle injuries persist
as the leading cause of injury-related deaths
among 65- to 74-year-olds and are the
second leading cause (after falls) among 75-
to 84-year-olds. While traffic safety programs
have had partial success in reducing crash
rates for all drivers, the fatality rate for drivers
over age 65 has consistently remained high.
Increased comorbidities and frailty associated
with aging make it far more difficult to survive
a crash, and the expected massive increase
in the number of older adults on the road
is certain to lead to increased injuries and
deaths unless we can successfully intervene
to prevent harm

Keywords 
driving older drivers Accidents, Traffic Accidental Injuries Motor Vehicles

Clinician's Guide to Assessing and Counseling Older Drivers, 4th Edition

The Clinician’s Guide to Assessing and Counseling Older Drivers, 4th Edition is published by the American Geriatrics Society (AGS) as a service to healthcare providers involved in the care of older adults. This 4th edition is an update of the 3rd edition to the current state of the literature, with a continued focus on the interprofessional nature of the team caring for an older adult driver. This edition is the result of a cooperative agreement between AGS and the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA).

The Clinician’s Guide is available in two formats, a digital text accessed through your browser and a downloadable PDF.

Keywords 
Accidents, Traffic driving car accidents traffic accidents older adults older drivers

Syncope and the Risk of Subsequent Motor Vehicle Crash A Population-Based Retrospective Cohort Study

Author/s: 
Staples, J. A., Erdelyi, S., Merchant, K., Yip, C., Khan, M., Redelmeier, D. A., Chan, H., Brubacher, J. R.

Importance Medical driving restrictions are burdensome, yet syncope recurrence while driving can cause a motor vehicle crash (MVC). Few empirical data inform current driving restrictions after syncope.

Objective To examine MVC risk among patients visiting the emergency department (ED) after first-episode syncope.

Design, Setting, and Participants A population-based, retrospective observational cohort study of MVC risk after first-episode syncope was performed in British Columbia, Canada. Patients visiting any of 6 urban EDs for syncope and collapse were age- and sex-matched to 4 control patients visiting the same ED in the same month for a condition other than syncope. Patients’ ED medical records were linked to administrative health records, driving history, and detailed crash reports. Crash-free survival among individuals with syncope was then compared with that among matched control patients. Data analyses were performed from May 2020 to March 2022.

Exposures Initial ED visit for syncope.

Main Outcomes and Measures Involvement as a driver in an MVC in the year following the index ED visit. Crashes were identified using insurance claim data and police crash reports.

Results The study cohort included 43 589 patients (9223 patients with syncope and 34 366 controls; median [IQR] age, 54 [35-72] years; 22 360 [51.3%] women; 5033 [11.5%] rural residents). At baseline, crude MVC incidence rates among both the syncope and control groups were higher than among the general population (12.2, 13.2, and 8.2 crashes per 100 driver-years, respectively). In the year following index ED visit, 846 first crashes occurred in the syncope group and 3457 first crashes occurred in the control group, indicating no significant difference in subsequent MVC risk (9.2% vs 10.1%; adjusted hazard ratio [aHR], 0.93; 95% CI, 0.87-1.01; P = .07). Subsequent crash risk among patients with syncope was not significantly increased in the first 30 days after index ED visit (aHR, 1.07; 95% CI, 0.84-1.36; P = .56) or among subgroups at higher risk of adverse events after syncope (eg, age >65 years; cardiogenic syncope; Canadian Syncope Risk Score ≥1).

Conclusions and Relevance The findings of this population-based retrospective cohort study suggest that patients visiting the ED with first-episode syncope exhibit a subsequent crash risk no different than the average ED patient. More stringent driving restrictions after syncope may not be warranted.

Keywords 
middle aged Retrospective Studies middle aged motor vehicle accidents Medical driving restrictions

Disorders of Arousal in adults: new diagnostic tools for clinical practice

Author/s: 
Loddo, G, Lopez, R, Cilea, R, Dauvillers, Y, Provini, F

Disorders of Arousal  (DOA) are mental and motor behaviors arising from NREM sleep. They comprise a spectrum of manifestations of increasing intensity from confusional arousals to sleep terrors to sleepwalking.

Although DOA in childhood are usually harmless, in adulthood they are often associated with injurious or violent behaviors to the patient or others. Driving motor vehicles, suspected suicide, and even homicide or attempted homicide have been described during sleepwalking in adults. Furthermore, adult DOA need to be differentiated from other sleep disorders such as Sleep-related Hypermotor Epilepsy or REM Sleep Behavior Disorder.

Although many aspects of DOA have been clarified in the last two decades there is still a lack of objective and quantitative diagnostic criteria for DOA.

Recent advances in EEG analysis and in the semiological characterization of DOA motor patterns have provided a better definition of DOA diagnosis.

Our article focuses on the DOA diagnostic process describing accurately the newest DOA clinical, EEG and video-polysomnographic tools in order to aid clinicians in DOA assessment.

Keywords 
disorder of arousal sleepwalking sleep terrors confusional arousals EEG Video-polysomnography Diagnostic Criteria Motor Patterns Slow-wave sleep fragmentation index
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