Driving Safety and the Senior Driver

1. Driving Safety and the Senior Driver Karl Hoffman, OTR/L, CDRS, CDI Director of Driver Rehabilitation Services

2. Objectives • Aging and the impact on driving • Discuss the importance of driving independence for seniors • Components of a driving evaluation • Driving retirement

3. Aging and the Impact on Driving • 1 in 8 drivers are over age 65 today; by 2030 it will be 1 in 5 • 70 million people over age 65 by 2030 • Seniors have fewer crashes than drivers in other age groups, but are more likely to be seriously injured or killed due to decreased physiologic reserve • For drivers age 70-75, the number of fatalities is almost triple that of drivers age 30-59 • For drivers over 80 (the fastest growing age group), the rate is over quadruple that of drivers age 30-59

4. Common Causes of Unsafe Driving • Vision impairment • Cognitive impairment • Side effects of medications • Slower processing/reaction times • Muscular difficulties • Limited range of motion

5. The Importance of Driving Independence • 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 passenger • Driving a private vehicle provides seniors with independence, enabling them to get essential services, and make social contact outside the home • For many, it is a key factor for successful aging in place

6. The Importance of Driving Independence • When driving is curtailed, seniors may find themselves isolated from activities that filled their lives, especially if they live in an area with limited public transportation • Isolation can undermine one’s quality of life, and accelerate health decline • Emotionally, it can represent a loss of independence and even identity.

7. Driver 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

8. Components of a Driving Evaluation • Selection of a qualified evaluator • Clinical “Pre-Driving” Assessment • Driving Assessment • Vehicle Modification • Additional Education and Training • Final Counseling

9. Components of a Driving Evaluation 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)

10. Components of a Driving Evaluation 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

11. Components of a Driving Evaluation 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”

12. Components of a Driving Evaluation 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

13. Components of a Driving Evaluation Vehicle Modification: • Instructing the client on proper positioning • Modified vehicle controls: • Wide view mirrors • Adapted controls for primary functions • Adapted controls for secondary functions

14. Components of a Driving Evaluation 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

15. Components of a Driving Evaluation 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

16. Driving 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.

17. Driving 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.

18. Driving 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.

19. Driving 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.

20. Driving 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

21. Driving 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?”

22. Driving 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?”

23. Driving 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.”

24. Driving 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

25. Contact Us Located in the Williamsburg Physicians Center The Center for Excellence in Aging and Geriatric Health 3901 Treyburn Drive, Suite 100 Williamsburg, VA 23185 757-220-4751 www.excellenceinaging.org