Older Age Does Not Cause Car Accidents—Medication with Adverse Effects Do


When cognitively healthy older adults performed a road test when taking a medicine with adverse effects, 35% of participants received a marginal/fail rating.

Older Age Does Not Cause Car Accidents—Medication with Adverse Effects Do

David Carr, MD

Credit: Washington University

Key Takeaways

  • Older adults aged 65 and above who take sedative and hypnotic agents for sleep disorders or anxiety are at risk of car accidents due to impaired driving abilities.
  • Benzodiazepines, commonly prescribed for these conditions, can lead to sedation, impaired motor coordination, and drowsiness in older adults, affecting their ability to react to changes in the driving environment.
  • Medications containing noradrenaline, serotonin, histamine, acetylcholine, and GABA can also pose risks to older adults' driving abilities, causing symptoms like dizziness, drowsiness, attention deficits, cognitive difficulties, and psychomotor impairment.
  • SSRIs have milder side effects than older antidepressants but can still lead to sleep disturbances, agitation, dizziness, headache, and fatigue, all of which impair driving.

When adults aged ≥65 years old take sedative and hypnotic agents to treat sleep disorders or anxiety, they unknowingly put themselves at risk of car accidents, according to new research. What’s more, the commonly prescribed benzodiazepines may cause sedation, impaired motor coordination, and drowsiness in older adults.1

“This can impair drivers’ ability to focus and react quickly to changes in the environment, such as other vehicles, pedestrians, or traffic signals,” wrote investigators of a new study, led by David Carr, MD, of the department of medicine at Washington University.

It is not just the drug benzodiazepines either—any medicine that contains noradrenaline, serotonin, histamine, acetylcholine, and GABA.48 puts older adults at risk of car accidents.

These drugs may lead to ill effects—dizziness, drowsiness, attention deficit, cognitive difficulties, and psychomotor impairment.

Selective serotonin reuptake inhibitors (SSRIs) have milder ill effects than older antidepressants, but side effects include sleep disturbance, agitation, dizziness, headache, and fatigue—all symptoms that lead to driving impairment.

In Carr’s study, cognitively healthy older people (aged ≥65 years old) who were enrolled in the Knight Alzheimer’s Disease Research Center took the Washington University Road test. All participants had a valid driver’s license and Clinical Dementia Rating Score of 0 at baseline and subsequent visits.

Despite this score, 70 (35%) of the 198 adults received a marginal or fail rating on the road test.

Any antidepressants, serotonin, and norepinephrine reuptake inhibitors or non-steroidal anti-inflammatory drugs were associated risk of participants failing the road test, but participants who took lipid-lowering agents had a lower risk of failing.

Medicine that impairs driving also commonly causes sedation, motor coordination, hypoglycemia, blurred vision, hypotension, syncope, and ataxia. The antidepressants that cause these ill effects are benzodiazepines, sedatives and hypnotics, antihistamines, opioids, antipsychotics, and anticholinergics.

Previous systematic meta-analyses with older adult samples found that driving impairment was identified for specific medical conditions, such as dementia, Parkinson disease, and stroke. People who reported being Black also have a higher risk of driving impairment, mobility restriction, and driving cessation compared to people who reported being White.

Carr and colleagues wanted to determine whether certain classes of medication increase risk of driving impairment.

In the study, people who received a marginal/fail rating on the road test had a lower near visual acuity scores, with the mean score 63.8 at baseline (P = .001).

“This cohort study found that in a cognitively healthy, community-residing sample of adults 65 years and older who were taking SSRI or SNRIs, antidepressants, sedatives or hypnotics, or NSAIDs or acetaminophen were found to have a higher risk of driving impairment on a road test (marginal/fail rating) compared to nonuse,” investigators wrote. “These results suggest that the potentially driver-impairing medication classes may increase the risk or poor driving performance over time among older drivers.”

Nonsteroidal anti-inflammatory (NSAID) drugs typically do not impact driving if taken correctly, but they can result in adverse effects, such as dizziness, lightheadedness, drowsiness, vision impairment, and difficulty concentrating.

“Long-term use of NSAIDs by older patients is common and could result in drug-drug interactions that exacerbate existing medical conditions known to contribute to driving impairment, such as hypertension and heart failure,” investigators concluded.


Carr DB, Beyene K, Doherty J, et al. Medication and Road Test Performance Among Cognitively Healthy Older Adults. JAMA Netw Open. 2023;6(9):e2335651. doi:10.1001/jamanetworkopen.2023.35651

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