STEERING OLDER DRIVERS TOWARD INDEPENDENCE THROUGH DRIVER REHABILITATION SERVICES

STEERING OLDER DRIVERS TOWARD INDEPENDENCE THROUGH DRIVER REHABILITATION SERVICES

November 7, 2012

Holly Alexander, OTR/L, CDRS

LEARNING OBJECTIVES

• Identify red flags related to driver safety.

• Identify proactive ideas for helping older drivers

stay on the road safely.• Identify resources to assist in safe and effective

community mobility.

OLDER DRIVER FACTS

• Motor vehicle injuries are the leading cause of injury related deaths among 65-74 year olds.

• Motor vehicle injuries are the second leading cause of injury related deaths (after falls) among75-84 year olds. *(National Highway Traffic Safety Administration National Center for Statistics and Analysis)

• The Centers for Disease Control estimated in 2005 that billion dollars are spent annually on medical costs related to older driver motor vehicle crashes.

•

OLDER DRIVER FACTS

• People over the age of 65 are the fastest growing population in the United States.

• By 2030, 63 million Americans with driver’s licenses will be 65 and over.

• Only approximately 600,000 older drivers (less than 1%) will cease driving on their own volition.

*(National Highway Traffic Safety Administration National Center for Statistics and Analysis)

NATIONAL ISSUE

• Driving safety is a public health issue• Code of ethics state we have an obligation to protect

our patients as well as the public• Public safety takes precedence over HIPPA rules per

OT Practice Act• ABC World News Reporthttp://www.youtube.com/watch?v=egGaliwsTBA&NR=1

http://www.youtube.com/watch?v=egGaliwsTBA&NR=1

COMMUNITY MOBILITY

• Community mobility is defined by the Occupational Therapy Practice Framework as: “moving self in the community and using public or private transportation, such as driving, or accessing buses, taxi cabs or other public transportation systems” (AOTA, 2008)• In 2010, Driving and Community Mobility was declared an “emerging practice area” by the AOTA.

COMMUNITY MOBILITY

• Community mobility is a critical area of occupation which promotes independence, spontaneity and identity• Community mobility issues cross the life span• Community mobility is an occupation that can affect a person’s satisfaction with life roles• Lack of community mobility can lead to increased isolation and depression

COMMUNITY MOBILITY

• Engaging in community mobility, either by motor or

manpowered methods is an important aspect of human

participation which enables engagement of occupations

outside the home.• Health Care Providers play a vital role in facilitating this

important area of performance.

INTERVENTIONS

INTERVENTIONS MAY ADDRESS

• Passenger safety• Community mobility• Evaluation, education and training in preparation of acquiring a first driver’s license• Evaluation and training of experienced drivers• Exploration of alternative transportation options to facilitate successful community participation

TEAM APPROACH REHABILITATION PROFESSIONALS MUST WORK

TOGETHER AS A TEAM

• Physical Therapists• Occupational Therapists• Speech Therapists• Nurses• Social Workers• Physician Assistants• Physicians

ROLE OF OCCUPATIONAL THERAPISTS • Occupational Therapy programs can reinforce driving

and community mobility as important occupations by

offering a range of services both within the program and

through referral to a driver rehabilitation specialist.• The goal is to provide the necessary interventions, to

promote participation and preserve safety.

ROLES OF PHYSICAL & SPEECH THERAPISTS

• Provide remediation of deficit performance areas

related to driver fitness• Discuss areas of concern related to driver safety• Direct client to appropriate resources• Inform team of findings• Document, document, document

ROLE OF SOCIAL WORKER AND NURSES• Discuss areas of concern related to driver safety• Direct client to appropriate resources• Inform team of findings• Document, document, document

ROLE OF PHYSICIANS /PHYSICIAN’S ASSISTANTS

• Duty to protect The Patient The Public

• Adhere to state reporting laws

• Utilize “The Physician’s Guide to Assessing and

Counseling Older Drivers”

• Refer to a driver rehabilitation specialist when necessary

• Counsel patient and caregivers

• Recommend driving retirement when appropriate

• Document, document, document

ROLE OF DRIVER REHABILITATIONSPECIALISTS (DRS)

• The DRS has a working knowledge of Driver Licensing

and Regulatory Practices. • Determines if the client meets the state requirements.• Provides evaluation of the performance components

for driving.• Provides on the road assessments when appropriate.

ROLE OF DRIVER REHABILITATIONSPECIALISTS (DRS)

• Determines if the client is capable of driving/recommend

retirement of driving when necessary/schedules

reevaluation for clients with progressive conditions.• Provides intervention to address deficit areas.• Recommends/prescribes and trains in use of adaptive

equipment for driving (explore funding options).

ROLE OF DRIVER REHABILITATIONSPECIALISTS

• Provides training in the use of adapted/

compensatory techniques. • Perform client-vehicle fittings regarding modifications.• Identify and implement driving retirement plans

including alternative means of transportation and

counseling.

RED FLAGS/WARNING SIGNS

• Moving into the wrong lane• Driving at inappropriate speeds• Stopping in traffic for no apparent reason*• Confusing the gas and brake pedal• “Getting lost” driving to familiar areas• Confusing the gas and brake*

*Stop driving immediately

RED FLAGS/WARNING SINGS

• Recent crashes• Recent incidents of being pulled over and/or ticketed• Damage to garage, house or mailbox• Riding the brake• Use of a “co-pilot”• Poor judgment making left hand turns• Unexplained dents or scrapes on vehicle

CASE STUDY 1

74 y.o. woman referred following being pulled over for

erratic driving. It was determined she was lost returning

home from church.• Some deficits noted on clinical evaluation with

divided attention.• During on the road evaluation patient became

increasingly confused in stimulating environments.• Unable to locate local grocery store.• Consistently drove under the speed limit.• Recommendation was driving retirement.

CASE STUDY 2

80 y.o. man newly diagnosed with Alzheimer’s

• First clinical and on the road evaluation Short Blessed Test score 2 MVPT figure ground 12/13 Trailmaking B 122 seconds Pass with recommended annual retesting

•On retest 1 year later Short Blessed Test score 11 MVPT figure ground 8/13 Trailmaking B 346 seconds Recommend driving retirement

CASE STUDY 3

66 y.o. male s/p L CVA 2 months prior to driving evaluation• Slow reaction time (.8 sec)• Weak grasp right hand (15#)• 110 right shoulder flexion• Impulsive and easily frustrated Recommend PT/OT to address deficit areas then retest

CASE STUDY 3

After discharge from PT / OT retest completed•Reaction time WFL (.6 sec)•Right hand grip strength WFL (50#)•Right shoulder flexion 160•No evidence of impulsivity•Recommended to resume driving without restriction

CAR FIT

•Educational program for the older driver sponsored by

AOTA, AARP and AAA•12 point check list to determine how well a person “fits”

in their vehicle•Provides information and materials that could enhance

safety as drivers and/or increase mobility within the

community

ALTERNATIVE TRANSPORTATION

RESOURCES• Public transportation• Senior shuttles• Taxis• Area Office on Aging• Religious Organizations• Local VFW Volunteer Drivers


RESOURCES• Volunteer Driver Programs• Para transit Services• Transportation Vouchers Programs through Area

Agencies on Aging• County/Borough Transportation Services


RESOURCES• Dementia Friendly Transportation• ADA Para transit• Dial-a-Ride• Curb to Curb Service• Door to Door Service• Door through Door Service

LOCATING A DRIVER REHABILITATION SPECIALIST

• American Occupational Therapy Association (AOTA)

Driving Database. www.aota.org/olderdriver/ • Association for Driver Rehabilitation Specialists (ADED).

www.driver-ed.org

http://www.aota.org/olderdriver/

http://www.driver-ed.org/

ONLINE RESOURCES

• AOTA Online Course: Driving and Community Mobility

for Older Adults: Occupational Therapy Roles

by S.L. Pierce & L.A. Hunt

• AOTA Online Course: Promoting Safety and Independence

Through Older Driver

Wellness www.aota.org/nonmembers/area3/links/link08k.asp.

• AOTA Online Course: Occupational Therapy and the

Older Driver: Addressing the IADL of Community Mobility

and Driving

• NMEDA CAMS Video: Consumer Automotive Mobility

Solutions. www.nmeda.org

EDUCATIONAL MATERIALS

• American Society on Aging: www.asaging.com• Community Transportation Association of

America:www.ctaa.org• Easter Seals Project Action:

http://projectaction.easterseals.com • National Association of Area Agencies on Aging:

www.n4a.org


• The Hartford Group: www.thehartford.com/alzheimers

• National Highway Traffic Safety Administration: www.nhtsa.gov

• Automobile Association of America: www.seniordrivers.org

• American Association of Retired People: www.aarp.org


• Alzheimer’s Association: www.alz.org • National Institute on Aging: www.nia.nih.gov/• Adaptive Mobility Services, Inc (specializing in

educational

workshops): www.adaptivemobility.com • Mobility Assessment Program and Partners in Safety

(videos) by L. Hunt [email protected]

TIPS FOR SAFE DRIVING

• Plan trips ahead of time.• Always wear your seat belt.• Drive the speed limit.• Be alert.• Keep enough distance between you and the car

in front of you.• Be extra careful at intersections.• Always use turn signals.


• Check your blind spots when changing lanes and

backing up.

• Know about the side effects of any medications.

• Never drink and drive.

• Do not drive when you are angry or tired.

• Avoid driving distractions i.e. eating, cell phone use,

changing radio stations.

• If you do not see well in the dark, try not to drive at

night, dusk or dawn.


• If you have trouble making left turns at an intersection,

it is better to make three right turns instead of one left.• Try to avoid driving in bad weather.• Have plenty of gas in your car.• Have regular tune ups.• Keep your windshield and mirrors clean.• Replace worn out windshield wipers.


• Have an assessment by a Driving Rehabilitation Specialist

• Take a driver safety class AARP 55 Alive Driver Safety Program 1-888-227-7669 AAA Safe Driving for Mature Operators Program

call your local AAA National Safety Council Defensive Driving Course

1-800-621-7619


• Driver safety classes usually last several hours and do not

cost much. Some of these classes will enable an

individual to receive a discount on auto insurance. • It is important to remember… with driver safety classes,

there is no formal evaluation being completed as with a

consultation with a Driver Rehabilitation Specialist (DRS).• Evaluations completed by a Driver Rehab Specialist will

assess your loved one’s specific skills that are required

for safe driving


• Evaluations completed by a Driver Rehab Specialist will

assess your loved one’s specific skills that are required

for safe driving. • In addition to this evaluation, remediation and training to

improve driving abilities may be provided.• The same is not true with driver safety classes which

review general information in a group setting.

TAKE HOME MESSAGES

• Driver rehabilitation and community mobility

issues require a team approach.• Driving is an integral part to our independence

and well being.• Driving should be addressed with all patients.

THANK YOU!

[email protected]

[email protected]

STEERING OLDER DRIVERS TOWARD INDEPENDENCE THROUGH DRIVER REHABILITATION SERVICES

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