The risks and consequences of a motor vehicle crash in older adults with Alzheimer's Disease and Related Dementias

项目总结 患有阿尔茨海默病(AD)和相关痴呆症的老年人患运动障碍的风险增加 由于安全驾驶所必需的认知和感觉功能受损而造成的车祸1 关于痴呆症和车祸的长期纵向数据来源很少，甚至更少 这包括AD相关痴呆的前驱阶段，称为轻度认知障碍(MCI)，很少是 了解AD过程中撞车风险如何变化，以及撞车可能如何改变临床 病程。在这里，我们建议使用与许可相关联的医疗保险保险索赔的新数据源， 引用了超过150万名老年司机13年来的碰撞数据，以评估纵向 崩溃风险的变化以及健康、卫生保健利用和长期护理轨迹的变化 撞车后的帮助，在患有AD的老年司机中。缺乏关于纵向风险和 老年阿尔茨海默病患者中撞车的后果代表了文献中的一个关键差距，原因有两个。 首先，研究表明，驾驶能力因疾病阶段的不同而有很大的个体差异。而当 一些人在疾病早期表现出不安全驾驶行为的显著增加， 甚至在被诊断之前，其他人就能够安全地驾驶MCI通过轻度到中度的 AD.2随着患有AD的老年司机数量的增加，为老年人提供服务的提供者和组织 越来越多地专注于开发干预措施，以促进“安全移动”，允许老年人驾车前往AS 在安全的情况下尽可能长时间。然而，为了有效，干预措施需要考虑到 随着时间的推移，崩溃的风险，以及这些轨迹可能如何随着个人特征的变化而变化。第二， 坠机的影响可能会产生长期的生理、心理和社会后果。目前的研究已经 确定了车祸的短期影响，5但没有研究对车祸相关的司机进行足够长时间的AD跟踪调查 以了解坠机的影响是如何随着时间的推移而显现的。患有阿尔茨海默病的人已经有更高的风险 合并症、住院和早期过渡到长期护理。因此，鉴于持有执照的司机数量的增加， AD，关键是要了解崩盘可能会如何加剧这些风险。确定以下阶段的主要障碍 高碰撞风险和促成因素是缺乏关于机动车碰撞的纵向数据。相反， 大多数研究都在疾病的特定阶段对个体进行了回顾性评估，或者跟踪了年龄较大的个体。 成年人的时间相对较短，对自己的认知状况一无所知，因此很难 确定碰撞风险的纵向模式。在这里，我们建议使用13年的联邦医疗保险索赔数据与 2007年至2019年期间新泽西州所有持有驾照的司机的执照、撞车和传票(1) 描述事故风险随时间变化的纵向轨迹(2)确定这些轨迹中的哨点 碰撞风险最高的地方，因此干预措施将是最有效的；和(3)评估 对认知受损的老年司机的健康和医疗保健结果的影响。

PROJECT SUMMARY Older adults with Alzheimer's Disease (AD) and related dementia disorders are at increased risk of a motor vehicle crash due to impairment of the cognitive and sensory functions necessary for safe driving.1 Because there are few sources of long-term longitudinal data on dementia and motor vehicle crashes, and even fewer that include the prodromal stage of AD related dementia called mild cognitive impairment (MCI), very little is known about how the risk of a crash changes over the course of AD and how a crash may change the clinical course of disease. Here, we propose to use a novel data source of Medicare insurance claims linked to licensing, citation, and crash data for more than 1.5 million older drivers over a 13-year period to evaluate longitudinal changes in the risk of a crash and changes in the trajectory of health, health care utilization, and long-term care assistance following a crash, among older drivers with AD. The lack of information on the longitudinal risks and consequences of a crash among older adults with AD represents a critical gap in the literature for two reasons. First, research suggests that there is substantial individual variation in driving ability by stage of disease. While some individuals demonstrate a significant increase in unsafe driving behaviors early in the course of disease, before they are even diagnosed, others are able to drive safely with MCI through the mild to moderate stage of AD.2 As the number of older drivers with AD grows, providers and organizations that serve older adults are increasingly focused on developing interventions to promote “safe-mobility,” allowing older adults to drive for as long as is safely possible. However, to be effective, interventions need to account for longitudinal changes in the risk of a crash over time, and how these trajectories may vary across individual characteristics. Second, the effects of a crash can have long-lasting physical, psychological and social consequences. Current studies have identified short term effects of a crash,5 but no study has followed crash-involved-drivers with AD for long enough to understand how the impact of a crash manifests over time. Individuals with AD are already at higher risk of comorbidity, hospitalization, and early transition to long term care. Thus, given the rise in licensed drivers with AD, it is critical to understand how a crash may compound these risks. A major barrier to identifying periods of high crash risk and the contributing factors is the lack of longitudinal data on motor vehicle crashes. Instead, most studies have evaluated individuals retrospectively at a particular stage of the disease or followed older adults for relatively short periods of time and without knowledge of their cognitive status, making it difficult to identify longitudinal patterns of crash risk. Here, we propose to use 13 years of Medicare claims data linked to licensing, crash and citations for all drivers with a license in New Jersey between 2007 and 2019 to (1) characterize the longitudinal trajectories of crash risk over time (2) identify sentinel points in these trajectories where the risk of crash is highest and thus interventions would be most effective and (3) evaluate the impact of a crash on the health and health care outcomes for cognitively impaired older drivers.