car fitting you and your client for best practice meredith sweeney, otr/l, cdi, cdrs and tina young,...
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Car Fitting You and Your Client for Best Practice
Meredith Sweeney, OTR/L, CDI, CDRS
and Tina Young, DRS, MSOT, OOTA Older Adult MSG
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AOTA Older Driver Initiative Mission
The mission of the American Occupational Therapy
Association’s (AOTA) Older Driver Initiative is to:
Build the capacity of occupational therapy programs to address the needs of at risk senior drivers, with the goal of ensuring IADL independence, including driving, for as long as safely possible and to
Develop a toolkit of resources for occupational therapy program development.
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Objectives
1. Define Senior Tsunami and the relationship with older driving.
2. Understand your role in driving and the general overall process.
3. Be able to identify the many available sources of information, tools and references.
4. Overview of AOTA, AARP, AAA CarFit Program
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Driving and Driving and DemographicsDemographics
The number of older licensed drivers in the US 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
MalesFemales
Driver Rehabilitation Services – East Carolina University
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FatalitiesFatalities
http://search.cga.state.ct.us/dtSearch_lpa.html
Driver Rehabilitation Services – East Carolina University
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78 Million Baby Boomers
What does that mean? NIH - 1 in 7 over 71 years of age have some type
of dementia (Plassman et al. 2007)
Ohio– In 2008, 1,573,570 over 65– 224,796 with dementia– 205 BMV offices in Ohio– 1,096 per office
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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Dementia and Driving: Warning Signs
Needing more help with directions or learning a new driving route
Having trouble remembering the destination of the trip or where the car is parked
Getting lost in unfamiliar places Having trouble making turns Feeling confused when exiting a highway or by
traffic signs
(Drive Well, 2005)
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Dementia and Driving: Warning Signs
Receiving citations for moving violations
Stopping at green lights or braking inappropriately
Drifting out of road lane
Causing damage to one’s car and not being able to explain what happened
Having difficulty controlling emotions while driving
(Drive Well, 2005)
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Older Driver Diagnoses that Older Driver Diagnoses that Impact DrivingImpact Driving
Dementia/Alzheimer’s Disease
Vision Loss
Diabetes
Parkinson’s Disease
CVA
TBI
Cardiovascular
Driver Rehabilitation Services – East Carolina University
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Normal Aging Progression that Impacts Driving
Sensory – vision, hearing and perception
Cognitive – memory, attention, judgment and executive functioning skills
Physical – reaction times, strength and flexibility
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Medications that Impact Driving
Anti-Depressants– Wellbutrin– Cymbalta– Lexapro
Anti-Histamines– Benadryl– Zyrtec– Claritin– Allegra
Benzodiazepenes– Xanax– Ativan– Diazepam (Valium)
High Blood Pressure– Cardura– Atenolol– Lopressor
Pain Killers– Darvocet– Percocet– Vicodin– Lorcet
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Impact on OT
Special issues with Driving– Can it be done by BMV Evaluators?
Issue 1: Need more driving specialists
Issue 2: Need tools that are effective, efficient, & utilized by others than driving specialists.
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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OccupationalOccupational TherapyTherapy
Community mobility is under IADL– Moving around in the community and
using public or private transportation, such as driving, walking, bicycling, or accessing and riding in buses, taxis.
– Rural communities: Driving is the only community mobility option.
Comprehensive OT treatment will address the client’s home and community mobility status
Driver Rehabilitation Services – East Carolina University
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Algorithm for Driving and Community Mobility:Assessment, Referral, & Training
Using the Occupational Therapy Practice Framework: Domain and Process, 2nd edition, American Occupational Therapy Association, 2008
Author: Dr. Anne Dickerson, East Carolina University
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Protocol to Evaluate Older Drivers
Handout from “Geriatrics, “ August 2005, Volume 60, Number 8, p.24
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Driver RehabilitationDriver Rehabilitation SpecialistsSpecialists
Professionals with specialized training in driving evaluation, training and rehabilitation.
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
Driver Rehabilitation Services – East Carolina University
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Role of the Driver Rehabilitation Specialist Role of the Driver Rehabilitation Specialist in Assessing Older Driver Safetyin 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.
Driver Rehabilitation Services – East Carolina University
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Who Does Driving Who Does Driving Evaluations?Evaluations?
Varies depending on state, setting, staff, trainingBMV or licensing authority
Structured, “same for all”Pass/fail Medical review board
Driving Rehabilitation SpecialistsIndividualizedScreen or evaluate sub-skillsPerformance in Context – On Road
Driver Rehabilitation Services – East Carolina University
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Overview of theOverview of theAssessment Assessment ProcessProcess
Client History Physical Assessment Functional Mobility Reaction Time Visual/Perceptual
Visual Acuity
Depth Perception
Color Discrimination
Contrast Sensitivity
Field of View
Cognitive Road Signs Behind the Wheel Recommendations
Driver Rehabilitation Services – East Carolina University
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What Older Drivers What Older Drivers Can Do Can Do To Improve Their To Improve Their DrivingDriving
Maximize Physical, Visual and Cognitive Health.
Become a student of their medications
Maintain a realistic perspective related to experience, ability and the driving environment.
Understand “dangers” such as crowded intersections, unprotected left turns, driving when stressed or fatigued.
Driver Rehabilitation Services – East Carolina University
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What Older Drivers Can What Older Drivers Can Do Do To Improve Their To Improve Their DrivingDriving
Maximize VISION and the aspects of driving that affect vision.
Driver Rehabilitation Services – East Carolina University
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What Older Drivers What Older Drivers Can Do Can Do To Improve Their To Improve Their DrivingDriving
Cease night driving.
Compensate for decreased reaction time.
Avoid in-car distractions.
Plan ahead.
Driver Rehabilitation Services – East Carolina University
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What Older Drivers What Older Drivers Can Do Can Do To Improve Their To Improve Their DrivingDriving
Communicate Check Mirrors Implement safe lane
changing procedures Implement safe
backing procedures
Driver Rehabilitation Services – East Carolina University
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What Older Drivers What Older Drivers Can Do Can Do To Improve Their To Improve Their DrivingDriving
Look for driver opportunities.
Be proactive when in comes to your safety and public safety.
CarFit
Driver Rehabilitation Services – East Carolina University
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Tips for Safe Driving
Before Driving– Be rested and alert– Be calm, not upset or angry– Do not take medications which will interfere
with your driving prior to driving
Scan the road a mile ahead, and keep the big picture in mind
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips to Compensate for Blind Spots
Be aware of other driver’s blind spots and do not ride in them
Practice flexibility exercises each day
Glance over each shoulder
You will always have blind spots, no matter what type of vehicle you drive
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Safe Backing
Do not depend completely on your mirrors
Turn your head and look out the rear window
Make sure the space behind your vehicle is clear
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Driving in Adverse Weather
Don’t use cruise control in bad weather
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Avoiding a Head-on Crash
If a crash cannot be avoided, try to sideswipe instead of hitting head on
It is better to hit something else rather than another vehicle moving
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Other Forms of Transportation
Family, friends and neighbors
Public Transit (taxi, bus, railways, limo)
Non-profit or faith-based transportation
Private businesses
Try out all these options before you actually need to depend on them
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Driving Transitions Education Program: http://www.asaging.org/asav2/drivewell/driving_transitions.cfm
ASA; funded by NHTSA
Modules and Scripts
How to interact with family members
Practice Exercises – use with other professionals Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
Driving Transitions Education
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http://www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.31176b9b03647a189ca8e410dba046a0/
Older Driver Programs
Information for Older Drivers– Brochures as resources
Research and Reports
Resources for People Around Older Drivers
Links to Other Organizations
Research reportsAnne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
Professionals: Direct Service
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All of these are links to information on the site:– Occupant Protection issues among older drivers and
passengers– How to understand and influence older drivers– Family and friends concerned about an older driver– Driving safely while aging gracefully– Safe driving for older adults– Assessing and counseling older adults– Cues for law enforcement– Turning the corner and still driving– Physician’s guide to assessing and counseling older drivers– Adapting motor vehicles for older drivers
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
NHTSA: Resources for Direct Service
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Chapter 5: The Driver Rehabilitation Specialist
www.ama-assn.org/go/olderdrivers
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
Physician’s Guide to Assessing and Counseling Older Drivers
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Good resources
4 highlights
Get on their mailing list
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
AAA Foundation for Traffic Safety
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AARP, ASA – same information
Show how to find a driving rehab specialist– AOTA Website:
http://www1.aota.org/driver_search/index.aspx
– ADED Website: http://www.driver-ed.org/custom/directory-cdrs/?pageid=320&showTitle=1
Share about CarFit– http://www.car-fit.org/– Best setting for CarFits
Share caregivers’ information– Deal with same issues
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
Professionals: Direct Service
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The “Fit” Between You and Your Vehicle
Just as important as a mechanical check-up Proper adjustments of head restraints, and safety
belts and air bags CarFit *See Handouts*
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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What is What is CarFit?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.
Driver Rehabilitation Services – East Carolina University
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Resources
“Developing and Delivering Educational Presentations” – Anne Dickerson, PhD, OTR/L, FAOTA, East Carolina University
“Keeping Drivers on the Road: The Occupational Therapist’s Role” – Anne Dickerson, PhD, OTR/L, FAOTA and Cyndee Crompton, MS, OTR/L
“Managing Senior Mobility Across the Western Continents” – Jim Langford, Australia; Michelle Porter, Canada; Lisa Molnar, USA; Anne Dickerson, PhD, OTR/L, FAOTA, East Carolina University
“60 Going on 16: Knowledge to Keep Older Drivers on the Road” - Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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