Objectives: To determine what effect driving cessation may have on subsequent health and well‐being in older adults. Design: Systematic review of the evidence in the research literature on the consequences of driving cessation in older adults. Setting: Community. Participants: Drivers aged 55 and older. Measurements: Studies pertinent to the health consequences of driving cessation were identified through a comprehensive search of bibliographic databases. Studies that presented quantitative data for drivers aged 55 and older; used a cross‐sectional, cohort, or case–control design; and had a comparison group of current drivers were included in the review. Results: Sixteen studies met the inclusion criteria. Driving cessation was reported to be associated with declines in general health and physical, social, and cognitive function and with greater risks of admission to long‐term care facilities and mortality. A meta‐analysis based on pooled data from five studies examining the association between driving cessation and depression revealed that driving cessation almost doubled the risk of depressive symptoms in older adults (summary odds ratio = 1.91, 95% confidence interval = 1.61–2.27). Conclusion: Driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. These adverse health consequences should be considered in making the decision to cease driving. Intervention programs ensuring mobility and social functions may be needed to mitigate the potential adverse effects of driving cessation on health and well‐being in older adults.

Objective: To assess fall-related injury risk and risk factors in people with lower limb amputation....

Concurrent use of marijuana and alcohol in drivers is of increasing concern but its role in crash causation has not been well understood. Using a case–control design, we assessed the individual and joint effects of marijuana and alcohol use on fatal crash risk. Cases (n = 1944) were drivers fatally injured in motor vehicle crashes in the United States at specific times in 2006, 2007 and 2008. Controls (n = 7719) were drivers who participated in the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Overall, cases were significantly more likely than controls to test positive for marijuana (12.2% vs. 5.9%, p < 0.0001), alcohol (57.8% vs. 7.7%, p < 0.0001) and both marijuana and alcohol (8.9% vs. 0.8%, p < 0.0001). Compared to drivers testing negative for alcohol and marijuana, the adjusted odds ratios of fatal crash involvement were 16.33 [95% confidence interval (CI): 14.23, 18.75] for those testing positive for alcohol and negative for marijuana, 1.54 (95% CI: 1.16, 2.03) for those testing positive for marijuana and negative for alcohol, and 25.09 (95% CI: 17.97, 35.03) for those testing positive for both alcohol and marijuana. Alcohol use and marijuana use are each associated with significantly increased risks of fatal crash involvement. When alcohol and marijuana are used together, there exists a positive synergistic effect on fatal crash risk on the additive scale.

The purpose of this study was to review the reported associations of depression and antidepressants with motor vehicle crashes. A literature search for material published in the English language between January, 1995, and October, 2015, in bibliographic databases was combined with a search for other relevant material referenced in the retrieved articles. Retrieved articles were systematically reviewed for inclusion criteria: 19 epidemiological studies (17 case-control and 2 cohort studies) fulfilled the inclusion criteria by estimating the crash risk associated with depression and/or psychotropic medications in naturalistic settings. The estimates of the odds ratio (OR) of crash involvement associated with depression ranged from 1.78 to 3.99. All classes of antidepressants were reported to have side effects with the potential to affect driving safety. The majority of studies of antidepressant effects on driving reported an elevated crash risk, and ORs ranged from 1.19 to 2.03 for all crashes, and 3.19 for fatal crashes. In meta-analysis, depression was associated with approximately 2-fold increased crash risk (summary OR = 1.90; 95% CI, 1.06 to 3.39), and antidepressants were associated with approximately 40% increased crash risk (summary OR = 1.40; 95%CI, 1.18 to 1.66). Based on the findings of the studies reviewed, depression, antidepressants or the combination of depression and antidepressants may pose a potential hazard to driving safety. More research is needed to understand the individual contributions of depression and the medications used to treat depression.

Driving under the influence of drugs is a public health concern in the United States and around the world.^1-5 In the United States, motor vehicle crashes are the second leading cause of unintentional injury deaths after drug overdose.⁶ Reversing the longstanding downward trend, death rates per 100 million vehicle miles traveled increased 2.6% from years 2015 to 2016.⁷ Concern about drugged driving has heightened in recent years due in part to increasing permissibility and availability of marijuana, excess consumption of prescription opioids,^5,8-10 and highly publicized driving under the influence of drugs–related crashes.^11,12 Opioid use may result in dizziness, drowsiness, and sedation, which may impair the requisite psychomotor and cognitive skills necessary for safe driving.^4,5,13-15 In addition, opioid use may also impair concentration and attention, decrease alertness, and increase reaction time.