evaluation of the elderly driver - university of · evaluation of the elderly driver jennifer...
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Evaluation of the Elderly Driver
Jennifer Spegel, MAOT, OTR/LImmanuel Rehabilitation Center
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Facts Regarding Elderly Drivers
• There are 35 million Americans 65 and over (13% of the US population)
• Expected to double by 2030
• Drivers 55 and over comprise 28% of the population(Pellerito, 2006)
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Accidents and Elderly Drivers
• 7000 elderly drivers die in accidents each year. This number has increased by 39% in the last 10 years
• Car accidents are the leading cause of accidental deaths for people 65-74 years old
• Drivers 75 and older experienced accidents at a rate second only to new drivers
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Risk Factors with Elderly Drivers
• Chronic or new medical conditions secondary to injury, illness or the aging process often result in decreased cognition, movement, vision and hearing with decreases and individual’s ability to drive safely
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Cognition
• Dementia is the most common cognitive impairment– 11.6% in people 65 and over– 47.8% in people 85 and over
• Stroke is another contributing factor– 58% don’t resume driving secondary to
residual cognitive affects
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Physical Abilities
• Aging leads to decreased:– Strength– Coordination– Reaction time– Range of motion– Trunk mobility
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Sensory Condition
• Hearing Deficits• Sensation/numbness• Changes in vision
– Cataracts– Glaucoma– Macular degeneration– Diabetic changes– Neglect after a CVA
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Why Do a Driving Evaluation• A physician may request an evaluation after a
medical setback
• If a doctor has been asked to fill out paperwork from the DMV they usually will have an evaluation done prior to filling out that paperwork
• The DMV may require a medical evaluation prior to being eligible for license renewal/testing
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Reason for Referral (con’t)
• To help family feel better• To avoid lawsuits• Receive recommendations about driving
safely longer– Adaptive equipment– Only during daylight hours– Specific geographical locations– Drivers training
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Driver Evaluation Programs
• Association of Driver Rehabilitation Specialists (ADED)– Provide measurement of a standard of current
knowledge desirable for individuals practicing driver rehabilitation
– www.driver-ed.org• Membership directory• CDRS Directory
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Evaluation ProcessClinical Portion
• Intake– Past medical history– Driving history– Reason for referral– Driving goals– Medications
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Clinical Eval (cont)
• Visual testing– Far acuity– Phoria– Depth perception– Peripheral vision/total arch of vision– Color vision and near acuity only for CDL
• Road signs and related question
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Clinical Eval (cont)
• Trail making part A and B– Used to assess ability to multitask information
• Motor Free visual Perception Test (MVPT)– Spatial relationships– Visual discrimination– Figure-ground– Visual memory– Visual closure
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Clinical Eval (cont)• Mini-Mental State Examination• Montreal Cognitive Assessment (MoCA)
– Visuospatial– Memory– Attention– Language/abstraction/delayed recall
• Doron Driving Simulator– Reaction time– Cue recognition– Threat recognition– Crash avoidance
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On the Road Assessment
• Areas assessed:– General operation of the vehicle, control of
the vehicle in the lane while in motion, use of turn signals and turn bays, making turns and checking the blind spot, speed control while driving, the ability to initiate and make stops in an approriate amount of time and the ability to make safe lane changes
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On the Road (con’t)
– They are also tested in overall judgment when driving, knowledge of rules of the road and the ability to follow through with the rules of the road
– The route attempts to simulate their goals and challenge any potential deficits noted.
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Possible Recommendations
• Driving without restriction• Restricted driving recommended
– Distance -Demographic area– Speed -Adaptive equipment– Daylight only
• Driver training• Driving not recommended• Follow up evaluation
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Composition of Patient’s Evaluated
24%
20%15%
9%
15%
6% 5% 5% 1%0%0%
CognitionStrokeHead InjuryOther: MusculoskeletalOther: NeurologicalCongenitalSpinal Cord InjuryMental IllnessMisc
CC
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Cognition
Pass
Fail
Restricted Driving
Training
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Stroke
Pass
Fail
Restricted Driving
Training
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Other: Neurological
Pass
Fail
Restricted Driving
Training
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Other: Musculoskeletal
Pass
Fail
Restricted Driving
Training
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Warning Signs• Feeling nervous or fearful while driving• Dents and scrapes on the car (garage, fences,
mail box, etc.)• Friends or relatives don’t want to ride with them• Other drivers honking • Easily distracted• Doesn’t observe signs, signals or other traffic• Needs instruction from passengers• Slow or poor decision making
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Warning Signs (con’t)
• Easily frustrated or confused• Frequently gets lost, even in familiar areas• Inappropriate driving speeds (too fast or
slow)• Poor position or wide turns• Slowed reaction times• Reports of near misses• Drifting across lane marking
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Driving Resources
• National Highway Traffic Safety Administration (www.nhsta.dot.gov)– Offers info about traffic safety– Physician’s Guide to Assessing and Counseling Older
Drivers• Nebraska Department of Roads
(www.nebraskatransportation.org/intermodal/transit-dir/index.htm)– Inormation on the transit directory for the state of NE
broken down into 93 counties
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Resources (con’t)• www.seniordrivers.org
– AAA Foundation for Traffic Safety– Measuring driving skills– Keeping safe and driving longer– Planning for continued mobility when you can no
longer drive• Occupational Therapy and Driving
– www.aota.org/olderdriver/• Association for Driver Rehabilitation Specialists
– www.driver-ed.org
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References
• Carr, David B., The Older Adult Driver with Cognitive Impairment. JAMA. Vol 303(16): April 28, 2010.
• Gallo JJ, Rebok GW, Lesikar SE: Driving Habits of Adults Aged 60 Years and Older. Journal of American Geriatric Society 47:335-341, 1999.
• Pellerito, Joseph Michael, Jr., Driver Rehabilitation and Community Mobility. Mosby, Inc., St. Louis, MO. 2006
• www.aarp.org