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Medical Conditions and Driving: A Review of the Literature (1960 – 2000) Technical Report Documenta tion Page 1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. DOT HS 809 690 4. Title and Subtitle 5. Report Date Medical Conditions and Driving: A Review September 2005 of the Scientific Literature (1960 - 2000) 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No. Bonnie M. Dobbs, Ph.D. 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) Association for the Advancement of Automotive Medicine P.O. Box 4176 Barrington, Illinois 60011-4176 11. Contract or Grant No. DTNH22-94-G-05297 12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered U.S. Department of Transportation National Highway Traffic Safety Administration Office of Research and Technology 400 Seventh Street, SW. Washington, DC 20590 14. Sponsoring Agency Code 15. Supplementary Notes Dr. John Eberhard served as the NHTSA Contracting Officer's Technical Representative for the study. Ms. Elaine (Petrucelli) Wodzin of the Association for the Advancement of Automotive Medicine served as the Project Principal Investigator. Drs. Maria Vegega (NHTSA) and Bonnie Dobbs completed the final report. 16. Abstract: This report reviews the contribution of medical conditions and functional limitations (e.g., sensory, motor, or cognitive functioning) to motor vehicle crashes. It provides a comprehensive and up-to-date review of the international research literature on the effects of medical and functional conditions on driving performance. The report is divided into 15 sections (Introduction, Vision, Hearing, Cardiovascular Diseases, Cerebrovascular Diseases, Peripheral Vascular Diseases, Diseases of the Nervous System, Respiratory Diseases, Metabolic Diseases, Renal Diseases, Muscuoloskeletal Disabilities, Psychiatric Diseases, Drugs, The Aging Driver, and the Effects of Anesthesia and Surgery). Each section contains a brief overview of the condition/illness; prevalence information; a review of the medical, gerontological, and epidemiological literature relevant to the condition/illness, followed by current fitness to drive guidelines for the condition/illness from Canada and Australia. The Appendix presents preliminary guidelines for physicians to assess medical fitness-to-drive. The report is a scholarly but practical compendium that can serve as a valuable resource for physicians, rehabilitation practitioners, other allied health care professionals and educators, Department of Motor Vehicle personnel, road and traffic safety personnel, transportation planners, highway safety researchers, and public policymakers. Its value is particularly relevant as the driving population increases in size and age. 17. Key Words 18. Distribution Statement Medical conditions, functional ability, older driver No restrictions. This document is available to the safety, physician guidelines to driving. public through the National Technical Information Service, Springfield, VA 22161. 19. Security Classif. (of this report) 20. Security Classif.(of this page) 21. No. of Pages 22. Price Unclassified Unclassified Form DOT F 1700.7 (8-72) Repro duction of completed p age autho rized A Review of the Scientific Literature Foreword Acknowledgements This report provides a comprehensive review The author is indebted to a number of of past and current research on the effects of individuals who made this report possible. medical conditions on driving performance. It Dr. David Carr, Dr. John Eberhard, Dr. Richard is divided into 15 sections (Introduction, Marottoli, Ms. Maureen Malinkowski, Dr. Vision, Hearing, Cardiovascular Diseases, Germaine Odenheimer, Dr. Desmond O’Neill, Cerebrovascular Diseases, Peripheral Vascular Dr. Robert Raleigh, and Ms. Elaine (Petrucelli) Diseases, Diseases of the Nervous System, Wodzin reviewed drafts of the report and Respiratory Diseases, Metabolic Diseases, contributed to the development of the prelim- Renal Diseases, Muscuoloskeletal Disabilities, inary guidelines for physicians. Sincere Psychiatric Diseases, Drugs, The Aging Driver, thanks and appreciation are extended to them and The Effects of Anesthesia and Surgery). for their time, effort, and assistance on this Each section provides a brief overview of the project. Appreciation also is extended to the condition/illness; prevalence information; Canadian Medical Association and Austroads review of the medical, gerontological, and for allowing the reproduction of their fitness- epidemiological literature relevant to medical to-drive guidelines. Many thanks go to the conditions and driving; followed by current Association for the Advancement of fitness to drive guidelines from Australia and Automotive Medicine (AAAM) and the Canada for the condition/illness. An National Highway Traffic Safety appendix contains preliminary guidelines Administration (NHTSA) for providing developed to assist physicians in determining funding for this project. Finally, the author when patients have medical conditions that recognizes Elaine Wodzin for her support and can affect fitness-to-drive. encouragement during the life of this project. This report is a scholarly but practical Bonnie M. Dobbs, Ph.D. compendium that can serve as a valuable University of Alberta resource for physicians, rehabilitation practi- Edmonton, Alberta, Canada tioners, other allied health care professionals and educators, Department of Motor Vehicle personnel, road and traffic safety personnel, transportation planners, highway safety researchers, and public policymakers. Its value is particularly relevant as the driving population increases in size and age. i Medical Conditions and Driving: ii A Review of the Scientific Literature Section 8: Respiratory Diseases . .75 Table of Contents 8.1 Asthma . .75 Section Page 8.2 Chronic Obstructive Pulmonary Disease . .75 Section 1: Introduction . .1 8.3 Other Pulmonary Conditions . .77 Section 2: Vision . .4 Section 9: Metabolic Diseases . .80 2.1 Acuity 9.1 Diabetes Mellitus . .80 2.1a. Static Visual Acuity . .4 9.2 Thyroid Disease . .88 2.1b. Dynamic Visual Acuity . .5 9.2a. Hyperthyroidism . .88 2.1c. Low Vision and Telescopic Lens . .5 9.2b. Hypothyroidism . .88 2.2 Cataracts . .5 2.3 Color Vision Defects . .6 Section 10: Renal Diseases . .93 2.4 Contrast Sensitivity . .7 10.1 Chronic Renal Failure . .93 2.5 Diabetic Retinopathy . .7 10.2 End Stage Renal Disease . .93 2.6 Glaucoma . .8 2.7 Loss of Vision in One Eye (Monocular Vision) . .9 Section 11: Musculoskeletal Disabilities . .96 2.8 Macular Degeneration . .9 2.9 Nystagmus . .10 Section 12: Psychiatric Diseases . .102 2.10 Night Myopia . .10 2.11 Post-Eye Surgery . .11 Section 13: Drugs . .109 2.12 Visual Field Defects . .11 13.1 Antidepressants . .109 13.2 Antihistamines . .111 Section 3: Hearing . .19 13.3 Benzodiazepines . .112 Section 4: Cardiovascular Diseases . .22 Section 14: The Aging Driver . .115 4.1 Coronary Artery/Heart Disease . .22 14.1 Sensory Decline . .115 4.2 Disturbances of Cardiac Rhythm . 25 14.2 Motor Decline . .116 4.2a. Ventricular Arrhythmias . .25 14.3 Cognitive Decline . .116 4.2b. Atrial Fibrillation/Flutter . .26 14.4 Dementia . .117 4.2c. Heart Block . .27 4.2d. Pacemakers . .27 Section 15: The Effects of Anesthesia and Surgery . .126 4.2e. Implantable Cardioverter/ 15.1 General Anesthesia . .126 Defibrillator Devices (ICDs) . .27 15.2 Outpatient Surgery . .126 4.3 Congestive Heart Failure . .30 15.3 Major Surgery . .128 4.4 Abnormal Blood Pressure . .31 4.4a. Hypertension . .31 4.4b. Hypotension . .32 Appendix A: Preliminary Guidelines for Physicians: Assessing Medical Section 5: Cerebrovascular Diseases . .39 5.1 Transient Ischemic Attacks . .39 Fitness to Drive (June 2000) . .130 5.2 Cerebrovascular Accidents . .39 Section 1: Introduction . .131 Section 6: Peripheral Vascular Diseases . .56 Section 2: Vision . .132 Section 7: Diseases of the Nervous System . .58 7.1 Syncope . .58 Section 3: Hearing . .134 7.2 Seizures . .58 7.3 Sleep Disorders . .62 Section 4: Cardiovascular Diseases . .135 7.3a. Narcolepsy . .62 7.3b. Sleep Apnea . .64 Section 5: Cerebrovascular Diseases . .138 Section 6: Peripheral Vascular Diseases . .139 iii Medical Conditions and Driving: Section 7: Diseases of the Nervous System . Table 11 Summary of Studies Assessing Fitness-to- 140 Drive in Individuals Post-CVA . .42 Section 8: Respiratory Diseases . 142 Section 9: Metabolic Diseases . .143 Table 12 Summary of Studies Assessing the Psycho- metric Properties of Fitness-to-Drive Section 10: Renal Diseases . .144 Evaluations in Patients Suffering from Cerebrovascular Accidents . .47 Section 11: Musculoskeletal Disabilities . .145 Table 13 Guidelines for Cerebrovascular Diseases . .52 Section 12: Psychiatric Diseases . .147 Table 14 Guidelines for Peripheral Vascular Diseases . 56 Section 13: Drugs . .148 Table 15 Classification System of Epileptic Seizures Section 14: The Aging Driver . .150 as Advanced by the Commission on Section 15: The Effects of Anesthesia and Surgery . .151 Classification and Terminology of the International League Against Epilepsy . .59 Section 16: Conditions under Investigation . .151 Table 16 Summary of Studies Examining the Risk of Section 17: Miscellaneous Conditions . .151 Crash for Individuals With Epilepsy . .60 List of Tables Page Table 17 Summary of Studies Examining the Relationship Between Crashes and Table 1 Guidelines for Visual Conditions/Diseases .12 Narcolepsy, and Simulator Performance and Narcolepsy . .63 Table 2 Estimate of the Prevalence
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