Driving Safety and the Driving Safety and the Senior DriverSenior Driver

Karl Hoffman, OTR/L, CDRS, CDIKarl Hoffman, OTR/L, CDRS, CDI

Director of Driver Rehabilitation ServicesDirector of Driver Rehabilitation Services

ObjectivesObjectives

Aging and the impact on drivingAging and the impact on driving

Discuss the importance of driving Discuss the importance of driving independence for seniorsindependence for seniors

Components of a driving evaluationComponents of a driving evaluation

Driving retirementDriving retirement

Aging and the Impact on Aging and the Impact on DrivingDriving

1 in 8 drivers are over age 65 today; by 2030 it will be 1 in 5 1 in 8 drivers are over age 65 today; by 2030 it will be 1 in 5

70 million people over age 65 by 203070 million people over age 65 by 2030

Seniors have fewer crashes than drivers in other age groups, Seniors have fewer crashes than drivers in other age groups, but are more likely to be seriously injured or killed due to but are more likely to be seriously injured or killed due to decreased physiologic reservedecreased physiologic reserve

For drivers age 70-75, the number of fatalities is almost triple For drivers age 70-75, the number of fatalities is almost triple that of drivers age 30-59that of drivers age 30-59

For drivers over 80 (the fastest growing age group), the rate is For drivers over 80 (the fastest growing age group), the rate is over quadruple that of drivers age 30-59over quadruple that of drivers age 30-59

Common Causes of Unsafe Common Causes of Unsafe DrivingDriving

Vision impairmentVision impairment

Cognitive impairmentCognitive impairment

Side effects of medicationsSide effects of medications

Slower processing/reaction timesSlower processing/reaction times

Muscular difficultiesMuscular difficulties

Limited range of motionLimited range of motion

The Importance of Driving The Importance of Driving IndependenceIndependence

Most seniors depend on the automobile for the bulk of their Most seniors depend on the automobile for the bulk of their travel – 90% of their trips are in a car as either a driver or travel – 90% of their trips are in a car as either a driver or passengerpassenger

Driving a private vehicle provides seniors with independence, Driving a private vehicle provides seniors with independence, enabling them to get essential services, and make social enabling them to get essential services, and make social contact outside the homecontact outside the home

For many, it is a key factor for successful aging in placeFor many, it is a key factor for successful aging in place

The Importance of Driving The Importance of Driving IndependenceIndependence

When driving is curtailed, seniors may find themselves When driving is curtailed, seniors may find themselves isolated from activities that filled their lives, especially if they isolated from activities that filled their lives, especially if they live in an area with limited public transportationlive in an area with limited public transportation

Isolation can undermine one’s quality of life, and accelerate Isolation can undermine one’s quality of life, and accelerate health declinehealth decline

Emotionally, it can represent a loss of independence and even Emotionally, it can represent a loss of independence and even identity. identity.

Driver EvaluationsDriver Evaluations

An evaluation is recommended if any of the following warning signs are observed:

• Doesn’t observe signs, signals, or other traffic

• Poor road position, or lane departures

• Accidents or near misses

• Inappropriate driving speeds (too fast or too slow)

• Slow or poor decisions

• Easily confused or frustrated

• Frequently gets lost, even in familiar areas

• Needs help or instructions from passengers

Components of a Driving Components of a Driving EvaluationEvaluation

Selection of a qualified evaluator

Clinical “Pre-Driving” Assessment

Driving Assessment

Vehicle Modification

Additional Education and Training

Final Counseling

Components of a Driving Components of a Driving EvaluationEvaluation

Selection of a qualified evaluator

Occupational Therapists are uniquely qualified

Select a program licensed as a Commercial Driving School

The clinical evaluator should be dually qualified as a Driving Instructor to ensure continuity and thoroughness

Seek out a Certified Driver Rehabilitation Specialist (CDRS)

Components of a Driving Components of a Driving EvaluationEvaluation

Clinical “Pre-Driving” Assessment

Background: diagnosis, medical history, driving history, license status, vehicle type, “why are you here?”

Visual Assessment: acuity, visual fields, depth perception, color vision, saccades and pursuits

Visual Perception: figure ground, spatial relations, topographical orientation, unilateral neglect

Components of a Driving Components of a Driving EvaluationEvaluation

Clinical “Pre-Driving” Assessment Cont.

Physical Assessment: ROM, strength, endurance, coordination, sensation, proprioception, balance, mobility

Cognitive Assessment: arousal, orientation, affect and demeanor, attention, memory, problem solving, judgment

Traffic Sign Recognition

Driving Knowledge – “road rules”

Components of a Driving Components of a Driving EvaluationEvaluation

On-Road Assessment

Vehicle handling skills: brake and accelerator control, steering, lane positioning, merging

Driving behaviors: vehicle preparation, observance of road signs, use of directional signals, reactions to other vehicles, recognition of hazards, visual attention to the driving environment

Observe performance in a variety of traffic environments

Components of a Driving Components of a Driving EvaluationEvaluation

Vehicle Modification:

Instructing the client on proper positioning

Modified vehicle controls: Wide view mirrors Adapted controls for primary functions Adapted controls for secondary functions

Components of a Driving Components of a Driving EvaluationEvaluation

Additional Education and Training:

Instruction in the use of adapted vehicle controls

Practice safe driving behaviors

Strategies to compensate for deficits

Possible referral for rehabilitative services

Components of a Driving Components of a Driving EvaluationEvaluation

Final Counseling:

Reinforcement of safe driving habits

Discussion of driving restrictions

Consider periodic re-assessment

Compliance with DMV reporting

Discussion and counseling for driving retirement

Driving RetirementDriving Retirement

The client cannot physically manage control of the vehicle, even with adaptive equipment.

The client simply cannot drive safely, and lacks the cognitive capacity to make improvements.

Contradictory to the Occupational Therapy goal of increasing clients’ independence, but a necessary step to prevent injuries and fatalities.

Driving RetirementDriving Retirement

Strive to make the client understand why driving retirement is necessary.

Involve family: To provide support and assistance in the transition to non-driver

status. To assist with transportation alternatives. To prevent the inadvertent or deliberate sabotage of therapist’s

recommendations.

Driving RetirementDriving Retirement

Communication with all members of the healthcare team is crucial.

Copies of reports or recommendations should be sent to referring physician, case managers, and persons holding power of attorney.

The client may seek out opinions from other members of the team, and it is important to avoid offering conflicting opinions.

Driving RetirementDriving Retirement

Strategies for helping a driver accept failure:Ask the driver for their opinion of their performance. The goal is to have the client to come to the conclusion that they should stop driving.

Driving RetirementDriving Retirement

Strategies for helping a driver accept failure:Ask the driver for their opinion of their performance. The goal is to have the client to come to the conclusion that they should stop driving

Driving RetirementDriving Retirement

Questions for the Client:“Do you think your desire to drive has blinded you to some of your problem areas?”

“What are the three most important things in your life ( family, spouse, grandchildren, hobbies)? Driving is probably not one of them. Is it worth putting these things at risk?”

“We will likely outlive our ability to drive safely. How do we decide the exact day to stop? Isn’t it better to stop too soon than too late?”

Driving RetirementDriving Retirement

Questions for the Client:“You do not want to depend on others. But others depend on you. If you were hurt or killed, your (family, friends, business etc.) would miss you very much.”

“Your children are worried about your driving. You raised them to have good judgment, and they obviously care about you very much. Based on this evaluation, do you think that maybe they have reasons to be concerned?”

Driving RetirementDriving Retirement

Questions for the Client:“Others who have stopped driving have found it a relief to not worry about getting in an accident or hurting someone else. They also have extra money without the car, gas, and insurance expenses.”

Driving RetirementDriving Retirement

Provide transportation alternatives:Name, numbers, and availability schedule of friends and family willing to give rides

Phone number of local cab company

Public transit – ride with the individual the first time to make them feel comfortable

Seek out volunteer drivers through community centers and churches

Contact UsContact Us

Located in the Williamsburg Physicians CenterLocated in the Williamsburg Physicians Center

The Center for Excellence in Aging and Geriatric The Center for Excellence in Aging and Geriatric HealthHealth

3901 Treyburn Drive, Suite 1003901 Treyburn Drive, Suite 100

Williamsburg, VA 23185Williamsburg, VA 23185

757-220-4751757-220-4751

www.excellenceinaging.orgwww.excellenceinaging.org