REDUCING CRASH RISK IN VISUALLY IMPAIRED OLDER DRIVERS:MEDICAL-SURGICAL VERSUS EDUCATIONAL INTERVENTIONS

摘要

OBJECTIVESThe aim of this paper is to compare the effectiveness of a medical-surgical intervention and aneducational intervention in reducing the rate of crash involvement among visually impaired olderdrivers. Visual impairment is a common functional problem in older adults. Older drivers withvisual processing deficits have an increased crash risk. Interventions that reduce these risks needto be identified in order to enhance driver safety.METHODSWe have conducted two studies in an effort to examine two types of interventions to lower crashrisk in visually impaired drivers. In a prospective cohort study we focused on 277 older driverswith cataracts, about half of who elected surgery and intraocular lens implantation at baseline,and the other half who declined surgery. They were followed for police-reported crashinvolvement for four to six years. In a second study, 403 older drivers who were visuallyimpaired (acuity and/or useful field of view deficit) were randomly assigned to an individuallyadministered and tailored educational intervention plus usual care, or to usual-care-only. Theeducational intervention promoted the use of self-regulatory driving strategies and was based oncurrent models of health behavior change. Usual care was a comprehensive eye exam. In thisstudy, subjects were also followed for police-reported crash involvement.RESULTSWith respect to the study evaluating the cataract surgery intervention, patients who underwentcataract surgery had half the rate of crash involvement during follow-up compared with cataractpatients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to0.94; p<0.05). With respect to the study evaluating the educational intervention, those receivingthe intervention were similar to the usual-care-only group in terms of their crash involvementrate (RR 1.40, 95% CI 0.92 to 2.12; p>0.05).