Zachary Lenz, student pharmacist
With Karen L. Kier, Pharmacist on behalf of the ONU Healthwise Team

In 1967, Steppenwolf wrote their hit Born to Be Wild. The song begins by telling listeners to “Get your motor runnin’/Head out on the highway/Lookin' for adventure” and we have an image in our head; cruising down an open road in our dream car, radio playing our favorite tune and feeling the freedom of adventure. We even go back to the excitement of passing our driving test, obtaining that coveted driver’s license and gaining the independence of exploration. For some of us, it opens a conversation if it is safer to leave the car in the garage and take a ride in the passenger seat due to the use of some medications.

In September, the Journal of the American Medical Association (JAMA) released a study focusing on medications that alter road test performances among healthy older adults with good cognitive function. Based on previous literature, older adults are at a greater risk of being involved in an automotive accident compared to middle-aged adults. There could be multiple factors contributing to this claim, including being frail and having more cognitive impairment.

Do medications play a role in motor vehicle accidents in those over the age of 65?

The importance of the findings from this study is the significance of drivers in the United States who are older adults. It is estimated that nearly 17% of the United States population is older than 65, which equates to 50 million people. Of this group, more than 48 million are licensed drivers and by the year 2050, it is estimated that 25% of all licensed drivers will be 70 years of age or older. 

Even though there are more older adults driving on the road, it does not necessarily mean this group needs to hand over the keys. Drivers 70 years and older are retaining their driver licenses longer and driving more miles than ever before. By possessing this ability to explore the open roads independently, the opportunities of maintaining social connectedness, accessing critical health care and enjoying lifelong hobbies are not hindered.

Across the nation in 2020, a daily average of 20 older adults were killed and 540 were injured in motor vehicle crashes. While the U.S. Department of Transportation and the National Highway Traffic Safety Administration has reported more than 90 different medication classes being associated with motor vehicle accidents in older adults, it is difficult to determine whether a higher crash risk is due to medication adverse effects, the medical conditions being treated or other health conditions. 

Some of the most common medications reported and the ones examined in this JAMA study include anticholinergics, antidepressants, antihistamines, lipid-lowering agents (statins), nonsteroidal anti-inflammatory drugs (NSAIDs) and sedatives or hypnotics. 

Anticholinergics would include medications for bladder control, stomach cramping or spasms, motion sickness, inhalers for COPD, and some antihistamines or antidepressants. The antihistamine class would include diphenhydramine (commonly known as Benadryl®) and the antidepressants would include medications such as amitriptyline (Elavil®). NSAIDs include ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and meloxicam (Mobic®).  

Sedatives or hypnotics are a large class of medications, which can decrease cognition and reaction times. These medications could be prescribed for sleep, seizures, or pain management. Opioids and other prescription pain relievers can be included in this group. Medications used to manage anxiety can have sedative effects on the body such as diazepam (Valium®) or alprazolam (Xanax®). Some popular herbal products can increase the risk of sedation such as valerian, chamomile, lavender, and passionflower.

The JAMA study included 198 adults over 65 years who completed a standardized driving test, which was assessed on a scale of pass, marginal, or fail based on the severity of safety concerns occurring during the assessment. After participants completed their driving tests, analyzers reviewed their medication lists and categorized their driving test score with the drug classes. 

The results indicated participants who were taking antidepressants, NSAIDs, and/or sedatives/hypnotics had an increased risk of receiving a marginal/fail rating on the road test compared to participants who did not use those medications. They were 2.7 times more likely to receive a lower driving score. Participants who were taking anticholinergics and/or antihistamines were no more likely to receive a marginal/fail score than nonusers. Interestingly, participants who were taking statins such as atorvastatin (Lipitor®) or rosuvastatin (Crestor®) were less frequently to receive a marginal/fail outcome than nonusers. They actually drove better if they were on a statin. 

While the study could not definitively conclude these medications caused a decline in driving performance, it does raise a concern about the potential impact on driving performance. This is a good time to talk to your pharmacist or healthcare provider about medication options and the impact on driving. 

“Like a true nature’s child/We were born, born to be wild”...safely and responsibly while driving!