The Association of Frailty with Driving Habits Among Older Adults: AAA LongROAD Study
This research brief examines the association of frailty status with driving habits. If frailty is associated with driving habit outcomes, interventions targeted at preventing or reducing the symptoms of frailty may lead to improved mobility among older adults.
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The present study uses data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study to describe the association of frailty status with driving habits (crashes, driving space and annual mileage). Quality of life among older adults is dependent upon safe mobility and independence (Albert et al., 2017; Bond et al., 2017; Boot et al., 2014; Chihuri et al., 2016). Crashes and driving space (i.e., how close to home a driver stays) provide objective measures of safe driving, and research shows that older adult drivers who accrue fewer than 3,000 miles per year have higher crash rates per mile driven (Antin et al., 2017). If frailty is associated with these outcomes, interventions targeted at preventing or reducing the symptoms of frailty may lead to improved mobility among older adults (Davis et al., 2011; Gill et al., 2012; Mielenz et al., 2017; Durbin et al., 2017). This study found that the frailty phenotype is associated with objectively measured low-mileage driver status, but it is not associated with self-reported crashes and driving space.
- Based on objectively measured driving data, frailty status is significantly associated with low-mileage drivers.
- The association found in the present study that those who are frail are at a higher risk of being low-mileage drivers implies that they are also at risk for increased crash rates.
LongROAD is a prospective multisite (San Diego, California; Denver, Colorado; Baltimore, Maryland; Ann Arbor, Michigan; and Cooperstown, New York) cohort study with 2,990 drivers. Details on the study methods are outlined elsewhere (Li et al., 2017).
Frailty status was measured using the frailty phenotype that was developed and validated by Fried and colleagues (Fried et al., 2001). Frailty status was measured on a scale from 0 to 5, with one point given for each of the following criteria the participant exhibited: shrinking, weakness, exhaustion, slowness, and low physical activity. Participants were classified as frail (3-5), pre-frail (1-2), or not frail (0). “DataLogger” devices (Danlaw, Inc., Novi, Michigan) were installed in participants’ vehicles after researchers received informed consent to monitor and record objective data on driving behaviors, such as distance traveled and vehicle speed. Self-reported crashes were measured based on responses to the Driving Habits Questionnaire (DHQ) question: “How many crashes have you been involved in over the past year when you were the driver?” (Owsley, Stalvey, Wells, & Sloane, 1999). Self-reported driving space was defined as the distance a participant drove from their immediate neighborhood in the past three months.
Depressive symptoms were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments, with higher scores indicative of more depressive symptoms.
Over the 2,965 drivers in the AAA LongROAD cohort who had frailty status data, more than half (55.85%) were classified as pre-frail. Only 87 participants (2.93%) were classified as frail. Almost 7% (6.75%) of the population were classified as low-mileage drivers, 11.23% reported involvement in a motor vehicle crash in the past year and 22.63% reported restricted driving space (0-3).
Frailty status was significantly associated with low mileage driver status at only one level of frailty. After adjusting for covariates, older drivers who are frail have 2.30 (95% CI: 1.40-3.78) times the risk of being low mileage drivers compared with those who are not frail. Frailty status was not significantly associated with self-reported driving space. After adjusting for covariates, older drivers who are frail have 1.52 (95% CI: 0.71-3.22) times and those who are pre-frail have 1.23 (95% CI: 0.85-1.80) times the odds of reporting restricted driving space compared with those who are not frail.
Albert, G., Lotan, T., Weiss, P., & Shiftan, Y. (2017). The challenge of safe driving among elderly drivers. Healthcare Technology Letters, 5(1), 45-58. doi:10.1049/htl.2017.0002.
Anstey, K. J., Wood, J., Caldwell, H., Kerr, G., & Lord, S. R. (2009). Comparison of self-reported crashes, state crash records and an on-road driving assessment in a population-based sample of drivers aged 69-95 years. Traffic Injury Prevention, 10(1), 84-90. doi:10.1080/15389580802486399
Antin, J.F., Guo, F., Fang, Y., Dingus, T.A., Perez, M.A., & Hankey, J.M. (2017). A validation of the low mileage bias using naturalistic driving study data. Journal of Safety Research, 63(2017), 115-120.
Bond, E.G., Durbin, L.L., Cisewski, J.A., Qian, M., Guralnik, J.M., Kasper, J.D., & Mielenz, T.J. (2017). Association between baseline frailty and driving status over time:
a secondary analysis of The National Health and Aging Trends Study. Injury Epidemiology, 4:9.
Boot, W. R., Stothart, C. & Charness, N. (2014). Improving the safety of aging road users – A mini-review. Gerontology, 60(1), 90-96. doi:10.1159/000354212.
Chihuri, S., Mielenz, T. J., DiMaggio, C. J., Betz, M. E., DiGuiseppi, C., Jones, V. C., & Li, G. (2016). Driving cessation and health outcomes in older adults. Journal of the American Geriatrics Society, 64, 332–341. doi:10.1111/jgs.13931
Clover, K., Lambert, S.D., Oldmeadow, C., Britton, B., King, M.T., Mitchell, A.J., Carter, G. (2018). PROMIS depression measures perform similarly to legacy measures relative to a structured diagnostic interview for depression in cancer patients. Quality of Life Research, 27:1357-1367.
Davis, M.G., Fox, K.R., Hillsdon, M., Coulson, J.C., Sharp, D.J., Stathi, A., & Thompson, J.L. (2011). Getting out and about in older adults: the nature of daily trips and their association with objectively assessed physical activity. The International Journal of Behavioral Nutrition and Physical Activity, 8, 116.
Durbin, L.L., Bond, E.G., Cisewski, J.A., Qian, M., Guralnik, J.M., Kasper, J.D., & Mielenz, T.J. (2017). Frailty Phenotype, Physical Function, and Driving Status in Older Adults: LongROAD Analysis of the National Health and Aging Trends Study. (Research Brief.) Washington, D.C.: AAA Foundation for Traffic Safety.
Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W.J., Burke, G., & McBurnie, M. (2001). Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 56(3), M146-M156.
Gill, T.M., Gahbauer, E.A., Murphy, T.E., Han, L., & Allore, H.G. (2012). Risk factors and precipitants of long-term disability in community mobility: A cohort study of older persons. Annals of Internal Medicine, 156(2), 131-140.
Li, G., Eby, D.W., Santos, R., Mielenz, T.J., Molnar, L.J., Strogatz, D., Betz, M., DiGuiseppi, C., Ryan, L.H., Jones, V., Pitts, S.I., Hill, L.L., DiMaggio, C., LeBlanc, D., & Andrews, H.F. for the LongROAD Research Team. (2017). Longitudinal Research on Aging Drivers (LongROAD): Study design and methods. Injury Epidemiology, 4(1), 22.
Marattoli, R. A., Cooney, L. M., Jr., & Tinetti, M. E. (1997). Self-report versus state records for identifying crashes among older drivers. The journals of gerontology. Series A, Biological sciences and medical sciences, 52A(3), M184-M187.
McGwin, G., Jr., Owsley, C. & Ball, K. (1998). Identifying crash involvement among older drivers: Agreement between self-report and state records. Accident Analysis & Prevention, 30(6), 781-791.
Mielenz, T.J., Durbin, L.L., Cisewiski J.A., Guralnik, J.M., & Li, G. (2017). Select Physical Performance Measures and Driving Outcomes in Older Adults. Injury Epidemiology, 4(1), 14.
Owsley, C., Stalvey, B., Wells, J., & Sloane, M. E. (1999). Older drivers and cataract: Driving habits and crash risk. The journals of gerontology. Series A, Biological sciences and medical sciences, 54(4), M203-M211.
Phillips, C.B., Sprague, B.N., Freed S.A., & Ross, L.A. (2016). Longitudinal associations between changes in physical function and driving mobility behaviors in older adults. Transportation Research Record, 2584, 70-76.
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