Association of Hearing Impairment and Subsequent Driving Mobility in Older Adults

Jerri D. Edwards, PhD; Jennifer J. Lister, PhD; Frank R. Lin, PhD; Ross Andel, PhD; Lisa Brown, PhD; Joanne M. Wood, BSc, PhD

Disclosures

Gerontologist. 2017;57(4):767-775. 

In This Article

Abstract and Introduction

Abstract

Purpose of the Study: Hearing impairment (HI) is associated with driving safety (e.g., increased crashes and poor on-road driving performance). However, little is known about HI and driving mobility. This study examined the longitudinal association of audiometric hearing with older adults' driving mobility over 3 years.

Design and Methods: Secondary data analyses were conducted of 500 individuals (63–90 years of age) from the Staying Keen in Later Life (SKILL) study. Hearing (pure tone average of 0.5, 1, and 2kHz) was assessed in the better hearing ear and categorized into normal hearing ≤25 dB hearing level (HL); mild HI 26–40 dB HL; or moderate and greater HI ≥41 dB HL. The Useful Field of View Test (UFOV) was used to estimate the risk for adverse driving events. Multivariate analysis of covariance compared driving mobility between HI levels across time, adjusting for age, sex, race, hypertension, and stroke. Adjusting for these same covariates, Cox regression analyses examined incidence of driving cessation by HI across 3 years.

Results: Individuals with moderate or greater HI performed poorly on the UFOV, indicating increased risk for adverse driving events (p < .001). No significant differences were found among older adults with varying levels of HI for driving mobility (p values > .05), including driving cessation rates (p = .38), across time.

Implications: Although prior research indicates older adults with HI may be at higher risk for crashes, they may not modify driving over time. Further exploration of this issue is required to optimize efforts to improve driving safety and mobility among older adults.

Introduction

Although vision is considered to be the main sensory input for driving, hearing is also likely to be important, particularly with regard to providing information about approaching vehicles, hazards, or potential vehicle problems. However, a limited amount of research has explored the relationship between hearing and driving. This is problematic given that the prevalence of hearing impairment (HI) increases substantially in older age, affecting up to 30 million older adults in the United States (Chien & Lin, 2012; Cruickshanks et al., 1998). Understanding the relationship between hearing and driving is important in that maintaining safe driving mobility is vital for the health and well-being of older adults (Edwards, Lunsman, Perkins, Rebok, & Roth, 2009; Freeman, Gange, Munoz, & West, 2006; Marottoli et al., 2000). The purpose of these secondary data analyses was to investigate the longitudinal association of hearing and subsequent driving mobility among older adults.

Driving can be quantified by assessing driving safety as well as mobility. Driving safety measures may include on-road driving performance, citations, and crashes. Driving mobility is quantified by examining driving habits such as miles driven, driving space, exposure to challenging situations, difficulty with or avoidance of challenging situations, and driving cessation. Older adults' needs for maintaining both driving safety and mobility must be balanced (Oxley & Whelan, 2008). Although older drivers are more likely to incur higher rates of at-fault crashes than are younger drivers, ceasing driving has numerous negative health ramifications (e.g., Freeman et al., 2006; Marottoli et al., 2000; Papa et al., 2014).

Hearing and Driving Safety

Prior research has established a link between HI and driving safety. A limitation of the existing literature linking hearing and driving safety is that most studies have explored this relationship using self-reported hearing measures. Self-reports of hearing loss underestimate actual HI (Chang, Ho, & Chou, 2009; Nondahl et al., 1998; Sindhusake et al., 2001) and thus confound our ability to determine the relationships between hearing and driving. One study found that after adjusting for covariates (i.e., age, sex, medications, and chronic health conditions), self-reported hearing loss among older adults was associated with higher crash involvement (Ivers, Mitchell, & Cumming, 1999). Hearing aid use was not related to crashes (Ivers et al., 1999). In another study hearing aid use, but not HI, was associated with higher injurious crash rates after adjusting for race, education, and miles driven (McCloskey, Koepsell, Wolf, & Buchner, 1994). Conversely, other studies have failed to find any associations between self-reported hearing and driving safety after adjusting for covariates such as age, race, sex, miles driven at baseline, and/or cognitive status (Gallo, Rebok, & Lesikar, 1999; Green, McGwin, & Owsley, 2013; Sims, McGwin, Allman, Ball, & Owsley, 2000). To our knowledge, only two studies have examined objectively measured hearing and driving safety. Among a sample of Canadian young and older adults (16–65 years of age), Picard and colleagues (2008) showed a significant relationship between objectively measured hearing and both crashes and citations other than speeding. In the only study examining objective hearing assessments and on-road driving performance, Hickson, Wood, Chaparro, Lacherez, and Marszalek (2010) found that older Australian adults with moderate-to-severe HI demonstrated worse driving performance in the presence of distractors than those with good hearing.

Hearing and Driving Mobility

Driving mobility can be quantified by miles driven, driving space, exposure to challenging situations, difficulty with or avoidance of challenging situations, or driving cessation. Maintaining driving mobility is an important issue for older adults in that driving cessation is associated with numerous negative outcomes such as decreased access to health care, declining health, increased depression, and greater risk of nursing home admissions (Edwards, Lunsman, et al., 2009; Freeman et al., 2006; Marottoli et al., 2000). Studies investigating the association of HI and driving mobility are few, primarily include subjective assessments of hearing, and are typically cross-sectional. Gallo and colleagues (1999) found in cross-sectional analyses that self-reported hearing was not associated with reduced driving mobility among older adults after adjusting for age, sex, and miles driven. Conversely, worse self-reported hearing was independently related to restricted driving mobility including higher rates of driving cessation in cross-sectional analyses (Forrest, Bunker, Songer, Coben, & Cauley, 1997; Gilhotra, Mitchell, Ivers, & Cumming, 2001). In an Australian study, poorer hearing thresholds were not longitudinally associated with subsequent driving cessation over 5 years after adjusting for age, sex, and education (Anstey, Windsor, Luszcz, & Andrews, 2006). To our knowledge, no previous studies have longitudinally examined objective assessments of hearing with subsequent aspects of driving mobility other than driving cessation (e.g., driving habits such as miles driven, driving space, exposure to challenging situations, or avoidance of challenging situations). No studies have examined the longitudinal associations of objectively assessed hearing and driving safety or mobility among older adults in the United States.

Hypotheses

Secondary data analyses were conducted with the Staying Keen in Later Life (SKILL) study, a prospective cohort study of sensory, cognitive, and everyday function (including driving) among older adults in the southeast region of the United States. The aim was to examine the longitudinal relationship of objective measures of hearing to subsequent self-report indices of driving mobility across a 3-year period. Driving mobility was quantified as driving space (i.e., the distance driven from one's home); driving challenges (exposure to challenging driving situations such as driving at night); difficulty in such challenging situations (Edwards, Myers, et al., 2009; Owsley, Stalvey, Wells, & Sloane, 1999); and driving cessation. We hypothesized that, after controlling for appropriate risk factors, hearing loss would be associated with subsequent restrictions in driving mobility among older adults.

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