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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.

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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

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

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 facts1

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

National Issue

community mobility

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 mobility1

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 mobility2

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

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

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

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

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

Role of Social Workerand 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

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 rehabilitation specialists drs

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 rehabilitation specialists drs1

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 rehabilitation specialists

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

REDFLAGS/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

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

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

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

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 31

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

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

ALTERNATIVE TRANSPORTATION RESOURCES

Public transportation

Senior shuttles

Taxis

Area Office on Aging

Religious Organizations

Local VFW Volunteer Drivers

alternative transportation resources1

ALTERNATIVE TRANSPORTATION RESOURCES

Volunteer Driver Programs

Para transit Services

Transportation Vouchers Programs through Area

Agencies on Aging

County/Borough Transportation Services

alternative transportation resources2

ALTERNATIVE TRANSPORTATION 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

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

online resources

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

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

educational materials1

EDUCATIONAL MATERIALS

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

educational materials2

EDUCATIONAL MATERIALS

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 lahunt@centurytel.net

tips for safe driving

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.

tips for safe driving1

TIPS FOR SAFE DRIVING

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.

tips for safe driving2

TIPS FOR SAFE DRIVING

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.

tips for safe driving3

TIPS FOR SAFE DRIVING

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

tips for safe driving4

TIPS FOR SAFE DRIVING

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

tips for safe driving5

TIPS 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

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 holly alexander@foxrehab org marvin lawson@foxrehab org
THANK YOU!

holly.alexander@foxrehab.org

marvin.lawson@foxrehab.org