INTRODUCTION

In 2017, nearly 7000 individuals aged 65 years or older died in motor vehicle collisions and nearly 15,000 were injured, resulting in numerous hospitalizations and increased health care costs in the United States (U.S.).1 Furthermore, older individuals made up 18% of all traffic fatalities in 2017.1 Moreover, driving errors tend to increase with age, when compared to middle-aged drivers.2 Few studies, however, have examined driving under the influence among U.S. samples since the early 2000s, especially among older adults.3 There are over 40 million licensed driving adults aged 65 years or older, a 34% increase in the past decade1; therefore, it is important to understand driving behaviors and risks of driving under the influence to inform harm reduction and injury prevention. The objectives of this cross-sectional study were to estimate the prevalence and explore predictors of driving under the influence of alcohol among a nationally representative sample of older adults in the U.S.

METHODS

We utilized data from respondents ≥65 years of age in the National Survey on Drug Use and Health’s survey years 2015–2019,4 an annual cross-sectional representative survey of non-institutionalized individuals conducted in the U.S. We estimated past-year prevalence of driving under in the influence of alcohol and past-year prevalence of other substances including marijuana, binge alcohol use, cocaine, methamphetamine, and misuse of opioids. Misuse was defined as using in any way not directed by a doctor, including use without a prescription, use in greater amounts, more often, or longer than instructed to take them, or use in any other way a doctor did not direct.4 We assessed demographic characteristics and whether or not an individual infrequently wore a seatbelt. We calculated adjusted odds ratios, controlling for age, race, gender, education, and poverty level. Data were weighted to adjust for non-response, probability selection, population distribution, and the complex sampling design. Multiple-imputed variables were used when available to limit the amount of missing data.

RESULTS

The analytic sample included 18,794 participants. An estimated 3.03% of individuals 65 years or older reported driving under the influence of alcohol in the past year (see Table 1). Males were more likely to drive under the influence than females (aOR: 2.80, 95% CI 2.21, 3.55). Participants identifying as racial/ethnic minorities were all less likely to drive under the influence than non-Hispanic White participants (p<.0001 for all categories). Older individuals reporting higher education were more likely to drive under the influence (aOR: 3.83, 95% CI 2.24, 6.54). Compared to individuals living in poverty, older individuals with income up to three times or greater the FPL were more likely to report driving under the influence (aOR: 2.88, 95% CI 1.37, 6.02). Drug use significantly predicted driving under the influence of alcohol (i.e., marijuana, opioids, and binge alcohol use; p <.0001). Individuals who infrequently or never wore a seatbelt while in the passenger seat were more likely to drive under the influence (aOR: 1.99, 95% CI 1.10, 3.59).

Table 1 Participant Characteristics and Likelihood of Driving Under the Influence of Alcohol in the Past Year Among Older Adults, n=18,794, 2015–2019, US
Full size table

DISCUSSION

Previous studies have estimated driving under the influence of alcohol among older adults; however, few studies have estimated these correlates among national sample of U.S. older adults. Providing the most recent information is important for injury prevention interventions. Our findings show an estimated 3% of older adults in the U.S. who reported driving while under the influence of alcohol. These findings have important health implications for older individuals, not only as the number of older drivers in the U.S. is increasing5, but also as aging places individuals at risk for co-morbid health conditions, and physical and cognitive declines.2,3

Our analyses showed that the use of marijuana and opioids predicts driving under the influence of alcohol. This finding is important because older adults are increasingly engaging in marijuana and opioid use and the use of illegal substances impairs driving and increases the risk for collisions and trauma.6 Limitation of the present study includes that information is self-reported and therefore susceptible to limited recall and social desirability bias. The health risks associated with substance use and driving under the influence are magnified in older populations; therefore, screening, prevention, and interventions in the older population should be implemented using culturally competent and patient-centered approaches to reduce harm and risks from these behaviors.