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Car accidents in older people: are foot problems to blame?

Discussion in 'Gerontology' started by Hylton Menz, Mar 3, 2006.

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  1. Hylton Menz

    Hylton Menz Guest


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    Stumbled across this paper recently and thought it might be of interest. I've always wondered whether high-heeled footwear was a risk factor for car accidents, but this paper indicates that foot problems may be involved:

    Predictors of automobile crashes and moving violations among elderly drivers

    Marottoli RA, Cooney LM Jr, Wagner R, Doucette J, Tinetti ME

    Annals of Internal Medicine 1994 Dec 1;121(11):842-6.

    OBJECTIVE: To identify the factors associated with automobile crashes, moving violations, and being stopped by police in a cohort of elderly drivers. DESIGN: Prospective cohort study. SETTING: Urban community. PARTICIPANTS: All 283 persons who drove between 1990 and 1991, selected from a representative cohort of community-living persons aged 72 years and older in New Haven, Connecticut. MEASUREMENTS: Data on independent variables in five domains (demographic, health, psychosocial, activity, and physical performance) were collected in structured interviews before events occurred. The outcome measure was the self-report of involvement in automobile crashes, moving violations, or being stopped by police in a 1-year period. RESULTS: Of the 283 drivers, 13% reported a crash, a moving violation, or being stopped by police in 1 year. The baseline factors associated with the occurrence of adverse events in multivariable analysis (with adjustment for driving frequency and housing type) were the following: poor design copying on the Mini-Mental State Examination (relative risk, 2.7; 95% CI, 1.5 to 5.0), fewer blocks walked (relative risk, 2.3; CI, 1.3 to 4.0), and more foot abnormalities (relative risk, 1.9; CI, 1.1 to 3.3). These risk factors were combined for assessment of their ability to predict the occurrence of adverse driving events. If no factors were present, 6% of drivers had events; if 1 factor was present, 12% had events; if 2 factors were present, 26% had events; and if 3 factors were present, 47% had events. CONCLUSIONS: In this urban population, several simple clinical measures correlated with the risk for adverse driving events.​

    The odds ratio isn't particularly large, and there's some issues related to how they defined foot abnormalities (three of more of the following: nail problems, calluses, bunions or hammertoes), but to their credit they adjusted for lots of potential confounding variables. The proposed mechanism is that foot problems may interfere with the ability to maneuver between the accelerator and brake pedals.

    Any thoughts?

    Cheers,

    Hylton
     
  2. John Spina

    John Spina Active Member

    The fact that older people get into car accidents is probably not due to corns,calluses et al.
    However a few podiatric factors can come into play:1.Neuropathy.If you have no sensation in your foot,it makes sense that you cannot feel a brake or gas pedal and the result can be disastrous!2.Economic factors such as ill fitting yet cheap footgear can also contribute to accidents 3.Bunions,while probably not a direct causative factor can again lead to wearing of ill fitting footwear.4.PVD.With a cold foot,you may wear either a heavy shoe or many pairs of socks which can impair sensation.5.DJD and pain.Two things to think about here:A painful foot is of course going to cause driving problems and in addition,NSAIDs can impair mental faculties and cause drowsiness.
     
  3. DAVOhorn

    DAVOhorn Well-Known Member

    Old Duffer Syndrome

    Dear All,

    many things can affect ones ability to drive age is a factor.

    So with ones advancing years comes the following:

    Impaired Vision

    Impaired Hearing

    Slower Reactions Mental

    Slower Reactions Physical

    Inability to use neck and shoulder girdle to observe around the vehicle eg to the side behind and use of mirrors etc

    Impaired mental function leading to impaired judgement and reasoning.

    The impairmnent due to general physical mobility. eg little old lady now so short looks through the steering wheel and not over it.

    A degree of arrogance driving for 40 years never had an accident. Flew planes in the war.

    I believe that those over 60/65 should have a competency assessment to ensure that they are still fit to drive.

    I worry about my parents 78 and 80. I believe stiil fit to drive but noticed mother a bit apprehensive and father believes driving at the speed limit is dangerous. I try to convince him that if he drives at the same speed everyone else does he wont be a mobile chicane. He thinks speeding is a reckless way to drive regardless of conditons.

    regards David
     
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