Medication Changes Among Older Drivers Involved in Motor Vehicle Crashes

Abstract

Importance: Although older adults may use potentially driver-impairing (PDI) medications that can produce psychomotor impairment, little is known about changes to PDI medication use among older adults from the time before to the time after a motor vehicle crash (MVC).

Objective: To quantify use of and changes in PDI medications among older adults before and after an MVC.

Design, setting, and participants: This cohort study used linked Medicare claims and police-reported MVC data on 154 096 person-crashes among 121 846 older drivers. Eligible persons were drivers aged 66 years or older, involved in a police-reported MVC in New Jersey from May 1, 2007, through December 31, 2017, and with continuous enrollment in Medicare fee-for-service Parts A and B for at least 12 months and Part D for at least 120 days prior to the MVC. Data were analyzed from January 2022 to May 2024.

Main outcomes and measures: Use of benzodiazepines, nonbenzodiazepine hypnotics, opioid analgesics, and other PDI medications in the 120 days before and 120 days after the MVC. Because each person could contribute multiple MVCs during the study period if they met eligibility criteria, the unit of analysis was the number of person-crashes. The proportion of person-crashes after which PDI medications were started, discontinued, or continued was quantified as well.

Results: Among 154 096 eligible person-crashes, the mean (SD) age of the drivers was 75.2 (6.7) years at the time of the MVC. Of 121 846 unique persons, 51.6% were women. In 80.0% of the person-crashes, drivers used 1 or more PDI medications before the crash, and in 81.0% of the person-crashes, drivers used 1 or more PDI medications after the crash. Use of benzodiazepines (8.1% before the crash and 8.8% after the crash), nonbenzodiazepine hypnotics (5.9% before the crash and 6.0% after the crash), and opioid analgesics (15.4% before the crash and 17.5% after the crash) was slightly higher after the MVC. After the MVC, drivers in 2.1% of person-crashes started benzodiazepines and 1.4% stopped benzodiazepines, drivers in 1.2% of person-crashes started nonbenzodiazepine hypnotics and 1.2% stopped nonbenzodiazepine hypnotics, and drivers in 8.4% of person-crashes started opioid analgesics and 6.3% stopped opioid analgesics.

Conclusions and relevance: This cohort study suggests that most older drivers involved in MVCs did not use fewer PDI medications after crashes than before crashes. Qualitative research of perceived risks vs benefits of PDI medications is necessary to understand the reasons why MVCs do not appear to motivate clinicians to deprescribe PDI medications as a strategy to avert potential harms, including additional MVCs.

Figure 1.. Initiation and Discontinuation of Benzodiazepines, Nonbenzodiazepine Hypnotics, and Opioid Analgesics After Motor Vehicle Crash

Comparison of medication use in the precrash period (120 days before the crash date) with the postcrash period (120 days after) among older drivers involved in motor vehicle crashes (N = 154 096 person-crashes). “Before” indicates users who discontinued the drug prior to or after the crash, “before and after” indicates users who continued the drug after the crash, and “after” indicates nonusers before the crash who started the drug only after the crash.

Figure 2.. Probability of Using Benzodiazepines, Nonbenzodiazepine Hypnotics, and Opioid Analgesics Before and After Motor Vehicle Crash

Probability of having medication available on any given day in the 120 days before to the 120 days after the crash date among older drivers involved in motor vehicle crashes (N = 154 096 person-crashes).