Driving Safely: Occupational Therapist’s Key Role in Aging Population

1. Template for Professionals who Work with Aging Individuals • 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.

2. Keeping Drivers on the Road: The Occupational Therapist’s Role Your name Your organization Date/name of conference/group

3. Objectives • 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

4. Driving & Demographics • 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….

5. Crash Involvement

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

7. Driving and Aging • 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.

8. Plan for Driving Retirement • 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 know? • Older drivers begin to self-restrict • Women often stop prematurely

9. Driving Spectrum Act to Maximize Ability Act to Promote Driving Retirement

10. Mobility Outcomes

11. Dementia Impacts Critical Driving Skills • Individuals with dementia are at increased risk for unsafe motor vehicle operation • Becoming lost in familiar areas • Incorrect turning & lane deviation • Impaired signaling • Decreased comprehension of traffic signs • Unaware of not being a responsible driver

12. Dementia’s Impact on the Baby Boomers • 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

13. Dementia Continued • Dementia - Special issues with driving • Can it be done by DMV evaluators? • Or need specialists? • North Carolina - 11 Driving Specialists • 12,585 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

14. Who does Driving Evaluations? • 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

15. Driver Rehabilitation Specialists • Specialized training • ADED – Association for Driver Rehabilitation Specialist • 80% of DRS are occupational therapists • CDRS – Certification administered by ADED • American Occupational Therapy Association • Specialty Certificate in Driving and Community Mobility

16. Occupational Therapy • 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.

17. Why Occupational Therapy? • 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

18. Role of the Driver Rehabilitation Specialist in Assessing Older Driver Safety • 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

19. Overview of theAssessment Process • Client History • Physical Assessment • Visual/Perceptual • Cognitive • Behind the Wheel • Recommendations

20. Client History • Diagnoses, onset, functional limitations • Secondary diagnosis • Medications side effects • Years of driving experience • Restrictions • Estimated amount of driving • Type of vehicle

21. Physical Assessment • Strength and reach • Sensory changes

22. Physical Assessment • Ability to get in and out of a vehicle

23. Seating & Positioning Behind the Wheel • Looking out the center of the windshield • Supportive seat • May need to tilt the steering wheel

24. Visual Changes with Aging • Acuity • Efficiency of visual system • Contrast sensitivity • Glare vision & glare recovery • Night vision

25. Visual and Perceptual Challenges • Eye Movement • Central Vision • Peripheral Vision

26. Vision In The Real World Depth Perception Dynamic Perception

27. Cognitive Assessment • Attention and concentration • Following directions • Judgment and insight • Knowledge of the road • Memory, planning, and organization • Self-control

28. Behind the Wheel Assessment • Entry Skills – Adjust mirror, seat, and seat belt • Operates controls • Right and left turns, backing up, and parking

29. Behind the Wheel Assessment • Structured • Parking lot • Quiet neighborhood • City driving with increasing traffic and turns • Highway driving • Client’s Home Area

30. Behind the Wheel Assessment • Decision making and route planning • Lane changes • Spacing • Visual scanning • Highway/Interstate driving as appropriate

31. Recommendations • 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

32. Helpful Tips for Safer Driving • Maximize physical, visual and cognitive health • Consider medications • Maintain a realistic perspective related to experience, ability, and the driving environment

33. Helpful Tips for Safer Driving • Maximize VISION and the aspects of driving that affect vision. • Understand “dangers” such as crowded intersections, unprotected left turns, driving when stressed or fatigued

34. Helpful Tips for Safer Driving • Cease night driving • Compensate for decreased reaction time • Avoid in-car distractions • Plan ahead

35. Helpful Tips for Safer Driving • Communicate • Check mirrors • Implement safe lane changing procedures • Implement safe backing procedures

36. Helpful Tips for Safer Driving • Look for driver opportunities • Be proactive when in comes to your safety and public safety • CarFit

37. What is 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

38. Take Home Message • Driving is a critical IADL • Need to keep safe drivers driving longer • Need to determine who is safe and who is unsafe • Occupational therapists need to address driving as an IADL • Generalists & specialists • CarFit: One option

39. Thank You! Your information.