Tragedy in Denver
On July, 13, 2016, on a city street in southeast Denver, 81-year-old Patricia Livingston drove her Audi A4 into two boys out for an afternoon ride on their bicycles, killing 14-year-old Cole Sukle and severely injuring his 13-year-old friend, Jack Mahoney. Cole and Jack (and a third cyclist that was not struck) were standing in the bike lane/sidewalk when they were hit.
After striking the boys, Ms. Livingston continued driving for several blocks, reportedly weaving in and out of the oncoming lane, before crashing in a nearby park. Ms. Livingston’s blood alcohol content (BAC) was found to be .135%, well above Colorado’s legal limit of .08%. Livingston, a 32-year trustee at the University of Denver, suffered injuries in the second crash and died ten days later.
One dead 14-year-old boy, one injured 13-year-old boy, and one deceased elderly driver. Sadly, these types of tragedies involving older (and younger!) drivers occur every day across America.
The Purpose of This Article
The purpose of this article is to discuss the role alcohol, prescription medications, the prescribing cascade and polypharmacy play in older driver safety. Our hopes are that by bringing additional awareness to these particular issues, at least one tragedy can be avoided somewhere down the road.
Not included in this article are insights on the role mental health issues, cognitive decline, medical conditions, alcoholism, sleep disorders or the use of illicit drugs play in older driver safety. Although obviously relevant and important in any highway safety discussion, these latter topics might serve us better by being addressed in a future article. It should also be noted that in no way is this article meant to be an indictment against the late Ms. Livingston.
Alcohol and the Older Driver
As we all know, alcohol is a depressant that slows down the functions of the central nervous system. This means that normal brain function is delayed, and a person is unable to perform as one would expect.
As we age, our ability to efficiently break down alcohol decreases, causing alcohol to stay in our bodies longer. The National Institutes of Health (NIH) confirms that aging can lower the body’s tolerance for alcohol; this results in higher blood alcohol levels per drink and swifter, longer-lasting intoxication. Even if the individual has been a long time drinker, older adults generally experience the effects of alcohol more quickly than when they were younger, placing them at higher risks for falls, car crashes, and other unintentional injuries.
The natural aging process tends to slow our reaction time and our ability to judge distances and speeds. Combine this natural slowing process with the depressant effects of alcohol, and we have created a volatile recipe for disaster.
Prescription Medications and the Older Driver
When we hear “DUI” or driving under the influence, the first thing that often comes to mind is drinking and driving. What some readers may not realize is the fact that DUI/OVI laws not only refer to alcohol impairment, but also impairment caused by prescription medications and drugs of abuse.
In today’s society, the association between medication use and the risk of motor vehicle collisions is particularly important considering that drivers are living longer and maintaining their mobility later in life, often times despite any medical conditions.
It is well-established that medication usage increases with age. In the United States, adults over 65 years of age consume more than 30% of all annual written prescriptions. The AAA Foundation for Traffic Safety reports that a whopping 95% of seniors use medications that might impair their driving. To make that worse, a University of Alabama-Birmingham study of 630 older adults (M=70.4), revealed that only 28% of seniors acknowledged even some awareness of the potential impact their medications had on their driving performance.
Prescriptions and even some over-the-counter medications come with warnings about possible side-effects, such as drowsiness or other risks related to driving, yet many people ignore them or simply do not understand them.
Polypharmacy, Prescribing Cascade and the Older Driver
In its simplest terms, polypharmacy can be described as the use of four or more medications by one individual. Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes. A recent article in American Nurse Today reports that 44% of men and 57% of women older than age 65 take five or more medications per week, and about 12% of both men and women take 10 or more medications per week.
As we know, side effects for an individual drug can change when combined with other medications, especially new prescriptions.
A 2014 study conducted by the Oregon State University found that three out of four older Americans have multiple chronic health conditions, and more than 20 percent of them are being treated with drugs that work at odds with each other. In other words, the medication being used to treat one condition can actually make the other condition worse.
Prescribing cascade refers to the process whereby the side effects of medications are misdiagnosed as symptoms of another problem resulting in further prescriptions and further side effects and unanticipated drug interactions. This may lead to further misdiagnoses and further symptoms.
The American Society of Consultant Pharmacists offers a solution to the prescribing cascade, suggesting that any new symptom in an older adult be considered a drug side effect until proven otherwise. That may be good advice for all of us to remember the next time we go to the doctor to report a new issue.
The Synergistic effect of combining alcohol and medications
Mixing alcohol and medications may have unexpected effects on your driving. Many prescription medications and over-the-counter medications can become very dangerous or even deadly when mixed with alcohol.
When alcohol is consumed, many of the skills that safe driving requires, like judgment, concentration, coordination, visual acuity, and reaction time become impaired. And guess what; when prescription medications are consumed, many of the skills that safe driving requires, like judgment, concentration, coordination, visual acuity, and reaction time also become impaired. It’s pretty much a safe bet that when prescription medications are mixed with alcohol and driving, a catastrophic highway event is imminent.
Toward Safer Travels
So what can you do to reduce the likelihood of becoming involved in an alcohol and/or prescription-related traffic crash? Here are a few suggestions:
Communicating with your doctor and/or pharmacist is the key!
The AAA Foundation for Traffic Safety reports that despite high prescription and over-the-counter medication use, almost half of senior drivers using medications have never talked with their health care providers about how the medications might adversely affect their safe driving abilities.
When your doctor prescribes a new drug, discuss all prescription medications, over-the-counter drugs, dietary supplements, vitamins, botanicals, minerals and herbals you take, as well as the foods you eat. Remember to ask about the possible side effects and if this new medication will work safely with your other medications (including non-prescription medicines). Ask your doctor “What is the most important thing I should know about this new medication?”.
Read and follow the instructions and warnings printed on the medication label
According to Consumer Reports, instructions on the bottle’s label may not seem to be hard to follow, but more than 500,000 Americans misinterpret them every year. It is very important to read, understand and follow the instructions on both the container’s warning label and the package insert! The package insert provides the most up-to-date information on your medication and is usually in a very easy-to-read format.
Take full advantage of the “Roadwise Rx” program
The AAA Foundation for Traffic Safety has developed a nifty tool titled Roadwise Rx. This is a confidential tool that helps you explore how your medications may affect your safe driving abilities.
Roadwise Rx (www.roadwiserx.com) provides you with a way to record all of your medications in one central location but more importantly, it also provides customized feedback on how your prescription and over-the-counter drugs, herbal supplements and foods (as well as their interactions with each other), can affect safe driving. Although never meant to be used in lieu of recommendations from your doctor or pharmacists, it is a great way to gain additional information on the possible interactions of medications you are taking. Try it today, it’s free!
As respecters of life, each of us has both a legal duty and a personal duty to never allow ourselves to operate a motor vehicle in a state that has rendered us impaired, and there can be no exceptions to this rule. We cannot simply “chance it”, hoping that nothing bad will happen as a result of our poor decision to drive impaired. If we adhere to this rule, thousands of highway tragedies could be averted every year in America.
As E. C. McKenzie once explained, “It is easy to dodge our responsibilities, but we cannot dodge the consequences of dodging our responsibilities”.