Road traffic accidents involving elderly people: an integrative review

To identify the epidemiological and socio-demographic profile of elderly victims of traffic accidents reported in articles published in scientific literature from 2013 to 2018.

Method:

The Literatura Latino Americana em Ciências da Saúde (Latin American Literature in Health Sciences), Base de Dados de Enfermagem (Database in Nursing), Scientific Electronic Library Online, and Medical Literature Analysis and Retrieval System Online databases were used, with the guiding question being: What is the scientific production on traffic accidents involving elderly people? A total of 355 articles were found. After the application of the selection criteria, 16 were evaluated, and nine remained for final analysis.

Results:

The age range was 60 to 69 years and the majority of the sample were men, who were married and had low schooling. Being run over was the most frequent accident. The width of the traffic lanes and the time of the accident influenced the frequency and risk of accidents and the severity of the injuries.

Conclusion:

Younger elderly persons were the most affected, and being run over was the most frequent type of accident.

Keywords:
Accidents Traffic; Health of the Elderly; Wounds and Injuries; Elderly Population

Authorship

Betise Mery Alencar Sousa Macau Furtado

Universidade de Pernambuco (UPE), Faculdade de Enfermagem Nossa senhora das Graças (FENSG). Faculdade de Odontologia (FOP), Mestrado de Perícias Forenses. Recife, Pernambuco, Brasil.Universidade de PernambucoBrazilRecife, Pernambuco, BrazilUniversidade de Pernambuco (UPE), Faculdade de Enfermagem Nossa senhora das Graças (FENSG). Faculdade de Odontologia (FOP), Mestrado de Perícias Forenses. Recife, Pernambuco, Brasil.

https://orcid.org/0000-0001-6344-8257

Ana Carolina Bezerra de Lima

Universidade de Pernambuco (UPE), Residência de enfermagem em Unidade de tratamento intensiva (UTI), Hospital da Restauração. Recife, Pernambuco, Brasil.Universidade de PernambucoBrazilRecife, Pernambuco, BrazilUniversidade de Pernambuco (UPE), Residência de enfermagem em Unidade de tratamento intensiva (UTI), Hospital da Restauração. Recife, Pernambuco, Brasil.

https://orcid.org/0000-0003-3110-2117

Ranna Carinny Gonçalves Ferreira

Universidade de Pernambuco (UPE), Faculdade de Enfermagem (FENSG). Recife, Pernambuco, Brasil.Universidade de PernambucoBrazilRecife, Pernambuco, BrazilUniversidade de Pernambuco (UPE), Faculdade de Enfermagem (FENSG). Recife, Pernambuco, Brasil.

https://orcid.org/0000-0003-1888-8143

Correspondence
Betise Mery Alencar Sousa Macau Furtado betise.furtado@upe.br

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (1)
Tables (1)

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Figure 1
Selection process of articles included in the present review. Recife, Pernambuco, Brazil, 2018.

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Chart 1
Studies included in review, Recife, Pernambuco, 2018.

Figure 1 Selection process of articles included in the present review. Recife, Pernambuco, Brazil, 2018.

Chart 1 Studies included in review, Recife, Pernambuco, 2018.

Database	Títle of article	Author	Year of publication	Country of origin	Main results
PubMed	Associations of Near-Miss Traffic Incidents with Attention and Executive Function among Older Japanese Drivers	Makizako H, Shimada H, Hotta R, Doi T, Tsutsumimoto K, Nakakubo S, et al.¹⁴14 Makizako H, Shimada H, Hotta R, Doi T, Tsutsumimoto K, Nakakubo S, et al. Associations of near-miss traffic incidents with attention and executive function among older japanese drivers. Gerontology [Internet]. 2018 [acesso em 17 fev. 2019];64(5):495-502. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/29428957 https://www.ncbi.nlm.nih.gov/pubmed/2942...	2018	Japan	Visual and auditory acuity deficits increased the risk of collisions of vehicles between elderly drivers. Attention may be one of the measurable and modifiable contributors related to car accidents in the general population of older drivers.
PubMed	What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital?	Heinrich D, Holzmann C, Wagner A, Fischer A, Pfeifer H, Graw M, et al.¹⁵15 Heinrich D, Holzmann C, Wagner A, Fischer A, Pfeifer H, Graw M, et al. What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital? Int J Legal Med [Internet]. 2017 [acesso em 28 ago. 2019];131(4):1023-37. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28180986 https://www.ncbi.nlm.nih.gov/pubmed/2818...	2017	Germany	The majority of pedestrian deaths were caused by polytrauma. Most deaths at the scene of the crash were due to thoracic and pelvic injuries, while in hospital the most prevalent were abdominal injuries.
PubMed	Age-related differences in fatal intersection crashes in the United States	Lombardi DA, Horrey WJ, Courtney TK.¹⁶16 Lombardi DA, Horrey WJ, Courtney TK. Age-related differences in fatal intersection crashes in the United States. Accid Anal Prev [Internet]. 2017 [acesso em 28 jan. 2019];99(Pt A):20-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/27855312 https://www.ncbi.nlm.nih.gov/pubmed/2785...	2017	USA	Accidents involving the elderly mostly occurred during the day, from Tuesday to Friday, with a lower collision speed than in accidents involving younger people. Older drivers were more likely to make mistakes regarding the culpability of the accident.
PubMed	Features of fatal injuries in older cyclists in vehicle-bicycle accidents in Japan	Matsui Y, Oikawa S, Hitosugi M.¹⁷17 Matsui Y, Oikawa S, Hitosugi M. Features of fatal injuries in older cyclists in vehicle: bicycle accidents in Japan. Traffic Inj Prev [Internet]. 2017 [acesso em 17 jan. 2019];19(1):60-5. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28581829 https://www.ncbi.nlm.nih.gov/pubmed/2858...	2017	Japan	Head injuries were the most common causes of cyclist fatalities after collision with a vehicle among those aged over 75 years, with severe injuries even at low speeds.
ScienceDirect	Predictors of older drivers’ involvement in rapid deceleration events	Chevalier A, Coxon K, Chevalier AJ, Clarke E, Rogers K, Brown J, et al.¹⁸18 Chevalier A, Coxon K, Chevalier AJ, Clarke E, Rogers K, Brown J, et al. Predictors of older drivers’ involvement in rapid deceleration events. Accid Anal Prev [Internet]. 2017 [acesso em 17 jan. 2019];98:312-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/27810673 https://www.ncbi.nlm.nih.gov/pubmed/2781...	2017	Australia	64% of participants were involved in at least one rapid deceleration event over one year, with most of those involved being older drivers with declining sensitivity and reduced confidence.
PubMed	Elderly road collision injury outcomes associated with seat positions and seatbelt use in a rapidly aging society - A case study in South Korea	Noh Y, Yoon Y.¹⁹19 Noh Y, Yoon Y. Elderly road collision injury outcomes associated with seat positions and seatbelt use in a rapidly aging society: a case study in South Korea. PLoS ONE [Internet]. 2017 [acesso em 17 jan. 2019];12(8):1-13. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183043 https://journals.plos.org/plosone/articl...	2017	South Korea	When younger (65-74 years) and older (75 years or more) elderly persons were compared, it was observed that older individuals were more likely to suffer serious injury. Severe injuries due to the absence of seat belts were also more frequent in the elderly. The proper application of the use of safety restrictions plays an important role in reducing injuries among the elderly in these accidents.
LILACS	Trends in mortality from road traffic accidents in the elderly in Brazil	Scolari GAS, Derhun FM, Rossoni DF, MathiasTAF, Fernando CAM, Carreira L.²⁰20 Scolari GAS, Derhun FM, Rossoni DF, Mathias TAF, Fernando CAM, Carreira L. Trend in mortality of elderly by land transport accidents In Brazil. Cogitare Enferm [Internet]. 2017 [acesso em 17 jan. 2019];22(3):1-9. Disponível em: https://revistas.ufpr.br/cogitare/article/view/50170/pdf_en https://revistas.ufpr.br/cogitare/articl...	2017	Brazil	27% of registered causes of death were due to road traffic accidents. There were greater growing trends in: the northeast region, accidents involving elderly pedestrians, cyclists, motorcyclists and occupants of automobiles. The elderly are more susceptible to being knocked down.
SciELO	Trauma from traffic accidents among the elderly: risk factors and consequences	Santos AMR, Rodrigues RAP, Diniz MA.²¹21 Santos AMR, Rodrigues RAP, Diniz MA. Trauma by traffic accident in elderly people risk factors and consequences. Texto & Contexto Enferm [Internet]. 2017 [acesso em 17 jan. 2019];26(2):2-10. Disponível em: http://www.scielo.br/pdf/tce/v26n2/pt_0104-0707-tce-26-02-e4220015.pdf http://www.scielo.br/pdf/tce/v26n2/pt_01...	2017	Brazil	The elderly were between 60 and 79 years of age, male, married, with elementary school education, pedestrians, followed by motorcyclists, and not drunk.
ScienceDirect	Pedestrian injury risk and the effect of age	Niebuhr T, Junge M, Rosén E.²²22 Niebuhr T, Junge M, Rosén E. Pedestrian injury risk and the effect of age. Accid Anal Prev [Internet]. 2016 [acesso em 17 jan. 2019];86:121-8. Disponível em: https://www.sciencedirect.com/science/article/pii/S0001457515301081?via%3Dihub https://www.sciencedirect.com/science/ar...	2016	Germany	Age and physical conditions are the main risk factors for traffic injuries, and age groups from the youngest and oldest extremities present a higher risk of fatalities. The risk for the elderly is double that of adults, with more serious consequences for elderly persons over 65 years.
PubMed	The characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008 2012	Rudisill TM, Zhu M, Abate M, Davidov D, Delagarza V, Long DL, et al.²³23 Rudisill TM, Zhu M, Abate M, Davidov D, Delagarza V, Long DL, et al. The characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008-2012. Traffic Inj Prev [Internet]. 2016 [acesso em 17 jan. 2019];17(8):788-95. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039044/ https://www.ncbi.nlm.nih.gov/pmc/article...	2016	USA	20% of the tested drivers were considered drug-positive. The highest prevalence was in the elderly of 65-69 years. The most commonly reported drugs were antidepressants and narcotics, as well as benzodiazepines. Those who tested positive for drugs were 43% more likely to not be wearing a seat belt at the time of the collision.
PubMed	Age-Related Differences in Vehicle Control and Eye Movement Patterns at Intersections: Older and Middle-Aged Drivers	Yamani Y,Horrey WJ, Liang Y, Fisher DL.²⁴24 Yamani Y, Horrey WJ, Liang Y, Fisher DL. Age-related differences in vehicle control and eye movement patterns at intersections: older and middle-aged drivers. PLoS ONE [Internet]. 2016 [acesso em 17 jan. 2019];11(10):1-17. Disponível em: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0164124&type=printable https://journals.plos.org/plosone/articl...	2016	USA	Older drivers had difficulty performing simultaneous tasks. Older drivers (over 70 years) have a high risk of a fatal vehicle accidents at intersections, as elderly drivers generally do not look twice for potential hazards at intersections.
Scielo	Trauma among the elderly: access to the health system through mobile pre-hospital treatment.	Silva HC, Pessoa RL, Menezes RMP.²⁵25 Silva HC, Pessoa RL, Menezes RMP. Trauma in elderly people: access to the health system through pre-hospital care. Rev Latinoam Enferm [Internet]. 2016 [acesso em 17 jan. 2019];24:1-8. Disponível em: http://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-24-02690.pdf http://www.scielo.br/pdf/rlae/v24/0104-1...	2016	Brazil	Among the victims of trauma, women were most prevalent, and were victims of falls, with pre-hospital treatment (basic life support), who were then transported to a tertiary referral unit.
Scielo	Instruction program with emphasis on self-care practices for elderly motorists	Almeida MHM, Caromano FA, Ribeiro SS, Batista MPP.²⁶26 Almeida MHM, Caromano FA, Ribeiro SS, Batista MPP. An orientation program for elderly drivers with an emphasis on self-care practices. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 17 jan. 2019];19(2):303-11. Disponível em: http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00303.pdf http://www.scielo.br/pdf/rbgg/v19n2/en_1...	2016	Brazil	54% of respondents reported difficulty driving, 42.9% reported emotional difficulties, and another 42.9% said they had physical, sensory and/or cognitive difficulties. There was also a deficit related to education, as well as inspection and punishment of traffic violations.
PubMed	Impact of road traffic accidents on the elderly	Etehad H, Yousefzadeh-ChabokSh, Davoudi-Kiakalaye A, Dehnadi AM, Hemati H, Mohtasham-Amiri Z.²⁷27 Etehad H, Yousefzadeh-Chabok SH, Davoudi-Kiakalaye A, Dehnadi AM, Hemati H, Mohtasham-Amiri Z. Impact of road traffic accidents on the elderly. Arch Gerontol Geriatr [Internet]. 2015 [acesso em 17 jan. 2019];61(3):489-93. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26321733 https://www.ncbi.nlm.nih.gov/pubmed/2632...	2015	Iran	The study divided the elderly into <75 and >75 years of age and, when comparing the two, found that the majority of the injured were male, married, pedestrians, affected by TBI and extremity fractures, while the elderly persons <75 years remained hospitalized for longer, and mortality was higher among the >75 years group
PubMed	Incidence and related factors of traffic accidents among the older population in a rapidly aging society	Hong K, Lee KM, Jang S.²⁸28 Hong K, Lee KM, Jang S. Incidence and related factors of traffic accidents among the older population in a rapidly aging society. Arch Gerontol Geriatr [Internet]. 2015 [acesso em 17 jan. 2019];60(3):471-7. Disponível em: https://www.sciencedirect.com/science/article/pii/S0167494315000230 https://www.sciencedirect.com/science/ar...	2015	South Korea	The incidence of traffic accidents among elderly Koreans was estimated at 11.74/1,000 inhabitants for men and 7.65/1,000 inhabitants for women. The most common risk factors were: depressive symptoms for both genders, employability for males and comorbidities such as arthritis for females.
SciELO	Elderly persons treated in urgent care services in Brazil: a study of falls and accidents in traffic.	Freitas MG, Bonolo PF, Moraes EN, Machado CJ.²⁹29 Freitas MG, Bonolo PF, Moraes EN, Machado CJ. Elderly patients attended in emergency health services in Brazil: a study for victims of falls and traffic accidents. Ciênc Saúde Colet [Internet]. 2015 [acesso em 17 jan. 2019];20(3):701-12. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232015000300701 http://www.scielo.br/scielo.php?script=s...	2015	Brazil	Main victims of falls: women with low levels of schooling, without a current job. Main victims of traffic accidents: younger men. Complications were found at similar levels in both sexes.
PubMed	The effects of age, gender, and crash types on drivers’ injury-related health care costs	Shen S, Neyens DM.³⁰30 Shen S, Neyens DM. The effects of age, gender, and crash types on drivers’ injury-related health care costs. Accid Anal Prev [Internet]. 2015 [acesso em 17 jan. 2019];77:82-90. Disponível em: https://www.sciencedirect.com/science/article/pii/S0001457515000251?via%3Dihub https://www.sciencedirect.com/science/ar...	2015	USA	The estimate of average health costs in in US dollars in 2007 was $2310 for men >65 years and $2055 for women >65 years. In terms of age and gender, drivers in older groups have higher health care costs than drivers in younger age groups. The former have a reduced capacity to recover from lesions, leading to longer hospitalization time
PubMed	Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study	Zito GA, Cazzoli D, Scheffler L, JägerM, Müri RM, Mosimann UP, et al.³¹31 Zito GA, Cazzoli D, Scheffler L, Jäger M, Müri RM, Mosimann UP, et al. Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study. BMC Geriatrics [Internet]. 2015 [acesso em 17 jan. 2019];15:1-10. Disponível em: https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-015-0175-0 https://bmcgeriatr.biomedcentral.com/tra...	2015	Switzerland	Elderly persons performed significantly worse on the visual acuity test. Older participants significantly overestimated their walking speed, but they needed more time to complete the crossing. Older pedestrians have more difficulty analyzing the movement of an approaching car when it is still far away, increasing risky decisions and decreasing performance at the intersection.
ScienceDirect	Crossing a two-way street: comparison of young and old pedestrians	Dommes A, Cavallo V, Dubuisson JB, Tournier I, Vienne F.³²32 Dommes A, Cavallo V, Dubuisson JB, Tournier I, Vienne F. Crossing a two-way street: comparison of young and old pedestrians. J Safety Res [Internet]. 2014 [acesso em 17 jan. 2019];50:27-34. Disponível em: https://www.sciencedirect.com/science/article/pii/S0022437514000395 https://www.sciencedirect.com/science/ar...	2014	USA	Reduced functional skills increase the risk of collision. The elderly presented flaws when required to increase the speed and the length of their steps in comparison with younger people. The elderly also had difficulty processing information from the visual scene, as well as not looking directly at traffic, in addition to making more risky decisions compared to young participants.
PubMed	Comorbidities and Crash Involvement among Younger and Older Drivers	Papa M, Boccardi V, Prestano R, Angellotti E, Desiderio M, Marano L, et al.³³33 Papa M, Boccardi V, Prestano R, Angellotti E, Desiderio M, Marano L, et al. Comorbidities and crash involvement among younger and older drivers. PloS ONE [Internet]. 2014 [acesso em 18 jan. 2019];9(4):1-6. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094564 https://journals.plos.org/plosone/articl...	2014	Italy	The burden of comorbidity is a self-limiting factor among elderly drivers, since the increase in comorbidities is associated with a reduction in involvement in collisions. Thus, the burden of comorbidities is a predictor of involvement in traffic accidents, regardless of gender.
PubMed	Association Between Vision Impairment and Driving Exposure in Older Adults Aged 70 Years and Over: A Population-Based Examination	Sandlin D, McGwin Jr G, Owsley C.³⁴34 Sandlin D, McGwin Jr G, Owsley C. Association between vision impairment and driving exposure in older adults aged 70 years and over: a population-based examination. Acta Ophthalmol [Internet]. 2014 [acesso em 17 jan. 2019];92(3):207-12. Disponível em: https://onlinelibrary.wiley.com/doi/full/10.1111/aos.12050 https://onlinelibrary.wiley.com/doi/full...	2014	USA	Reduced visual processing speed was the strongest risk factor for the involvement of older drivers in vehicle collisions. Self-regulation was a highly adaptive strategy for reducing exposure to this risk.
PubMed	Mature Driver Laws and State Predictors of Motor Vehicle Crash Fatality Rates Among the Elderly: A Cross-sectional Ecological Study	Bell TM, Qiao N, Zarzaur BL.³⁵35 Bell TM, Qiao N, Zarzaur BL. Mature driver laws and state predictors of motor vehicle crash fatality rates among the elderly: a cross-sectional ecological study. Traffic Inj Prev [Internet]. 2015 [acesso em 17 jan. 2019];16(7):669-76. Disponível em: https://www.tandfonline.com/doi/full/10.1080/15389588.2014.999858 https://www.tandfonline.com/doi/full/10....	2014	USA	Overweight and a higher percentage of elderly persons >65 years with university degrees were associated with an increase in the rate of collisions between vehicles. Greater access to health services, such as primary care, access to medication and emergency surgeries, were associated with lower rates of fatality.
PubMed	Gender differences among older drivers in a comprehensive driving evaluation	Classen S, Wang Y, Crizzle AM, Winter SM, Lanford DN.³⁶36 Classen S, Wang Y, Crizzle AM, Winter SM, Lanford DN. Gender differences among older drivers in a comprehensive driving evaluation. Accid Anal Prev [Internet]. 2013 [acesso em 17 jan. 2019];61:146-52. Disponível em: https://linkinghub.elsevier.com/retrieve/pii/S0001457512003661 https://linkinghub.elsevier.com/retrieve...	2013	USA	Older female drivers presented more self-reported avoidance behaviors in relation to interstate/highway driving, driving in the rain, and driving at night. Contrast analysis by gender and age revealed that more emphasis should be given to the 75-year-old male and female group for failing the road test.
PubMed	Effect of Driver’s Age and Side of Impact on Crash Severity along Urban Freeways: A Mixed Logit Approach	Haleem K, Gan A.³⁷37 Haleem K, Gan A. Effect of driver’s age and side of impact on crash severity along urban freeways: a mixed logit approach. J Safety Res [Internet]. 2013 [acesso em 17 jan. 2019];46:67-76. Disponível em: https://www.sciencedirect.com/science/article/pii/S0022437513000285?via%3Dihub https://www.sciencedirect.com/science/ar...	2013	USA	Driver's age was an important predictor, and impacts from injuries, especially side impacts, were greater among elderly drivers.
SciELO	Comparative study of trauma among the elderly and non-elderly in a University Hospital in Curitiba	Broska Júnior CA, Folchini AB, Ruediger RR.³⁸38 Broska Júnior CA, Folchini AB, Ruediger RR. Comparative study of trauma in the elderly and non-elderly patients in a University Hospital in Curitiba. Rev Col Bras Cir [Internet]. 2013 [acesso em 17 jan. 2019];40(4):281-6. Disponível em: http://www.scielo.br/pdf/rcbc/v40n4/en_v40n4a05.pdf http://www.scielo.br/pdf/rcbc/v40n4/en_v...	2013	Brazil	The majority of trauma care in the elderly population was for women. Traffic accidents were the 2nd most frequent cause, with being knocked down predominating, while the elderly are most susceptible to femoral fractures and TBI.

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Road traffic accidents involving elderly people: an integrative review

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[1] Correspondence
Betise Mery Alencar Sousa Macau Furtado betise.furtado@upe.br