Commentary: Polypharmacy and older drivers: beyond the doors of the emergency department (ED) for patient safety.

INJURY PREVENTION/NHTSA NOTES National Highway Traffic Safety Administration (NHTSA) Notes Shahram Lotfipour, MD, MPH Federico Vaca, MD, MPH Section Editors Federico Vaca, MD, MPH Herbert G. Garrison, MD, MPH Mary Pat McKay, MD, MPH Catherine S. Gotschall, ScD From the Department of Emergency Medicine, University of California–Irvine, Center for Trauma and Injury Prevention Research, Irvine, CA Department of Emergency Medicine, University of California–Irvine, Center for Trauma and Injury Prevention Research, Irvine, CA Department of Emergency Medicine, The Brody School of Medicine, East Carolina University, Greenville, NC Department of Emergency Medicine, Center for Injury Prevention and Control, The George Washington University Medical Center, Washington, DC National Highway Traffic Safety Administration, Washington, DC Reprints not available from the editors. Literature Review of Polypharmacy and Older Drivers: Identifying Strategies to Study Drug Usage and Driving Functioning Among Older Drivers [National Highway Traffic Safety Administration. Literature review of polypharmacy and older drivers: Identifying strategies to study drug usage and driving functioning among older drivers. Ann Emerg Med. The report “Polypharmacy and Older Drivers: Identifying Strategies to Study Drug Usage and Driving Functioning Among Older Drivers” updates the state-of-the-knowledge about the effects of multiple medications on safe driving among older people. The authors identified 1,600 abstracts published between 2001 and 2004 on polypharmacy, drugs, and older drivers. These abstracts were screened, and 143 relevant articles were reviewed on the following topics: identifying medication use, measuring medication compliance, measuring driving performance, and polypharmacy and older people. The first section of the report examines physiologic changes that affect how older people metabolize their medications. The report focuses on medications most frequently used by older community- dwelling residents, such as benzodiazepines, opioids, antidepressants, and antidiabetics. In addition, the section provides a general overview of the effects of medication use and crash risk. Although prescription medications are the major focus of the review, over-the-counter (OTC) medication use by older people is included where it was reliably documented in the literature. The second section of the report reviews the relative merits of several methods used to measure compliance with medication, including clinical judgment, patient self-report, clinical response, biochemical measures, pill counts, pharmacy records, and electronic medication-monitoring devices. The section also examines the factors affecting compliance with medication regimens. Patient- related factors that correlate with low compliance include limited access to health care, financial problems, communication barriers, Volume , .  : April  and lack of social support. The prescriber-related factors that were found to correlate with low compliance include poor prescriber- patient relationship, poor prescriber communication skills, a mismatch between the prescriber and patient about health beliefs, and a lack of positive reinforcement from the health care provider. In addition, this section examines factors that affect the willingness of older persons to participate in research and offers suggestions to help in recruitment of elderly patients in research studies. The report concludes with a review of the literature on methods to measure driving performance, including on-road testing and driving simulation to measure driving performance. The relative advantages of naturalistic studies (driving in traffic) and controlled driving (driving on a closed course) are presented, along with reviews of the different levels of driving simulation measures, ranging from noninteractive computer graphic or digital video with no motion to interactive computer graphic visuals with full motion. Copies of the 104-page report Polypharmacy and Older Drivers: Identifying Strategies to Study Drug Usage and Driving Functioning Among Older Drivers can be obtained from the Office of Research and Technology, NHTSA, NTI-130, 400 Seventh Street, SW, Washington, DC 20590 or downloaded from the NHTSA Web site at: http://www.nhtsa.dot.gov/ staticfiles/DOT/NHTSA/Traffic%20Injury%20Control/ Articles/Associated%20Files/Polypharmacy.pdf. doi:10.1016/j.annemergmed.2007.02.008 COMMENTARY: POLYPHARMACY AND OLDER DRIVERS: BEYOND THE DOORS OF THE EMERGENCY DEPARTMENT (ED) FOR PATIENT SAFETY [Lotfipour S, Vaca F. Commentary: polypharmacy and older drivers: beyond the doors of the emergency department (ED) for patient safety. Ann Emerg Med. On July 16, 2003, a farmer’s market in Santa Monica, CA, was the site of a motor vehicle crash. As reported by the LA Annals of Emergency Medicine 535