Audience (for this presentation): State Area Agencies of Aging Conference

Objectives: Describe the role of the driving rehabilitation specialist Explain the comprehensive driving evaluation Identify what the professionals who work with aging can

do for their clients concerning driving Time:

60-90 minutes Success:

Staff seems to understand the role of the occupational therapist with driving.

Was asked to represent our area on state Older Drivers Coalition.

Keeping Drivers on the Road:

The Occupational Therapist’s Role

Your name

Your organization

Date/name of conference/group

Identify the role of occupational therapy in driving evaluation and rehabilitation

Differentiate the types of driving specialists

Describe the driving assessment process

Explain rehabilitation potential in driving

Describe the benefits of CarFit

The number of older licensed drivers in the U.S. is expected to increase from ~20 million today to ~40 million in 2020. Graph is for drivers 70 years and older

Most older drivers are safe! However….

7.0

9.0

11.812.8

6.3

10.1

13.9

17.9

0

4

8

12

16

20

1990 2000 2010 2020 1990 2000 2010 2020

Males

Females

Crash Involvement Crash Involvement

http://search.cga.state.ct.us/dtSearch_lpa.html

• Driving is and will remain the primary mode of transportation for older adults.

• Driving represents the ability to maintain connections and contribute to the community.

• Studies of older drivers show there may be a relationship between health, sense of autonomy, and ability to drive.

• Loss of mobility can lead to depression, low life satisfaction, health problems, isolation, and loneliness.

Men outlive their ability to drive by 6 years; women outlive their ability to drive by 10 years. Source: Foley, et al (2002)

More than 600,000 people age 70+ stop driving each year

Question: When? How do I Question: When? How do I know?know?

Older drivers begin to self-restrict Women often stop prematurely

Act to Promote Driving RetirementAct to Maximize Ability

Physically or Mentally

Competent

Perceived Competent

Appropriate

Perceived Incompetent

Inappropriaterestriction

Physically or Mentally

Incompetent

Perceived Competent

At Risk

Perceived Incompetent

Appropriate Restrictions

Individuals with dementia are at increased risk for unsafe motor vehicle operation

Becoming lost in familiar areas Incorrect turning & lane deviation Impaired signalingDecreased comprehension of traffic

signsUnaware of not being a responsible

driver

NIH - 1 in 7 over 71 years of age have some type of dementia (Plassman et al. 2007)

NC: Do the math for your state. In 2000, 969,048 over 65 138,435 with dementia 147 DMV offices 942 per office

Dementia - Special issues with driving Can it be done by DMV evaluators? Or need specialists?

North Carolina - 11 Driving Specialists12,585 dementia referrals for

each evaluator 34.5 a day, 365 days a year. Need to have a system in place to

deal with these issues

•Varies depending on state, setting, staff, training•DMV or licensing authority•Structured, “same for all”•Pass/fail •Medical review board

•Driving Rehabilitation Specialists•Individualized•Screen or evaluate sub-skills•Performance in Context–On Road

Specialized trainingADED – Association for Driver

Rehabilitation Specialist 80% of DRS are occupational therapists CDRS – Certification administered by

ADEDAmerican Occupational Therapy

Association Specialty Certificate in Driving and Community Mobility

Your definition of occupational therapy.Areas of occupation include: ADL,

IADL, work, leisure, education, social participation

Community mobility is under IADL Rural communities: Driving is the only

community mobility option.

Occupational Therapy Practitioners: Understand the critical demands of driving

Have science-based knowledge to understand progressive conditions and life changes affecting driving

Understand how community mobility affects quality of life

• Provide objective data regarding abilities required for driving

• Assure that abilities are within State regulations

• Relate abilities to skill performance of the actual driving task

• Help client and family think about driving safety for the present and future

Client History Physical Assessment Visual/Perceptual Cognitive Behind the Wheel Recommendations

• Diagnoses, onset, functional limitations

• Secondary diagnosis• Medications side effects• Years of driving experience• Restrictions• Estimated amount of driving

• Type of vehicle

Strength and reach

Sensory changes

Ability to get in and out of a vehicle

• Looking out the center of the windshield

• Supportive seat

• May need to tilt the steering wheel

AcuityEfficiency of visual systemContrast sensitivityGlare vision & glare recoveryNight vision

Eye Movement

Central VisionPeripheral

Vision

Depth Perception Dynamic Perception

Attention and concentration

Following directions Judgment and

insight Knowledge of the

road Memory, planning,

and organization Self-control

Entry Skills – Adjust mirror, seat, and seat belt

Operates controlsRight and left turns, backing up, and

parking

Structured Parking lot Quiet neighborhood City driving with increasing

traffic and turns Highway driving

Client’s Home Area

Decision making and route planning

Lane changesSpacingVisual scanningHighway/Interstate

driving as appropriate

Integrate the results of components of in clinic and BTW

Include the client and family

Consider modifications restrictions, or retiring from driving

Followed up with written documentation

• Maximize physical, visual and cognitive health

• Consider medications• Maintain a realistic

perspective related to experience, ability, and the driving environment

Maximize VISION and the aspects of driving that affect vision.

Understand “dangers” such as crowded intersections, unprotected left turns, driving when stressed or fatigued

• Cease night driving• Compensate for decreased reaction time• Avoid in-car distractions• Plan ahead

• Communicate • Check mirrors• Implement safe

lane changing procedures

• Implement safe backing procedures

• Look for driver opportunities

• Be proactive when in comes to your safety and public safety

• CarFit

Educational program to check if an older adult fits their car

Provides community-specific resources to enhance driver safety

Developed by AARP American Automobile Association American Occupational Therapy

Association

Driving is a critical IADLNeed to keep safe drivers driving

longerNeed to determine who is safe and

who is unsafeOccupational therapists need to

address driving as an IADL Generalists & specialists CarFit: One option

Your information.