Car Fitting You and Your Client for Best Practice

1. Car Fitting You and Your Client for Best Practice Meredith Sweeney, OTR/L, CDI, CDRS and Tina Young, DRS, MSOT, OOTA Older Adult MSG

2. 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. 2

3. Objectives Define Senior Tsunami and the relationship with older driving. Understand your role in driving and the general overall process. Be able to identify the many available sources of information, tools and references. Overview of AOTA, AARP, AAA CarFit Program 3

4. Senior Driver Tsunami Coming • What is it? • Why is it important? 4

5. Aging and Driving 5 (NHTSA, n.d.)

6. Males 20 17.9 Females 16 13.9 12.8 11.8 12 10.1 9.0 7.0 8 6.3 4 0 1990 2000 2010 2020 1990 2000 2010 2020 Driving and Demographics • 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…. 6 Driver Rehabilitation Services – East Carolina University

7. Fatalities http://search.cga.state.ct.us/dtSearch_lpa.html 7 Driver Rehabilitation Services – East Carolina University

8. 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 8 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

9. 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) 9

10. 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) 10

11. Older Driver Diagnoses that Impact Driving • Dementia/Alzheimer’s Disease • Vision Loss • Diabetes • Parkinson’s Disease • CVA • TBI • Cardiovascular 11 Driver Rehabilitation Services – East Carolina University

12. 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 12 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

13. 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 13

14. Senior Driver Tsunami Coming • OT Involvement / Role • General Process 14

15. 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. 15 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

16. OccupationalTherapy • 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 16 Driver Rehabilitation Services – East Carolina University

17. 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 17 Author: Dr. Anne Dickerson, East Carolina University

18. Protocol to Evaluate Older Drivers Handout from “Geriatrics, “ August 2005, Volume 60, Number 8, p.24 18

19. Driver RehabilitationSpecialists • 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 19 Driver Rehabilitation Services – East Carolina University

20. 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. 20 Driver Rehabilitation Services – East Carolina University

21. Who Does Driving Evaluations? • Varies depending on state, setting, staff, training • BMV 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 21 Driver Rehabilitation Services – East Carolina University

22. Overview of theAssessment Process • 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 22 Driver Rehabilitation Services – East Carolina University

23. Treatment Components in the Clinic • What to do • IADL components 23

24. What Older Drivers Can Do To Improve Their Driving • 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. 24 Driver Rehabilitation Services – East Carolina University

25. What Older Drivers Can Do To Improve Their Driving • Maximize VISION and the aspects of driving that affect vision. 25 Driver Rehabilitation Services – East Carolina University

26. What Older Drivers Can Do To Improve Their Driving • Cease night driving. • Compensate for decreased reaction time. • Avoid in-car distractions. • Plan ahead. 26 Driver Rehabilitation Services – East Carolina University

27. What Older Drivers Can Do To Improve Their Driving • Communicate • Check Mirrors • Implement safe lane changing procedures • Implement safe backing procedures 27 Driver Rehabilitation Services – East Carolina University

28. What Older Drivers Can Do To Improve Their Driving • Look for driver opportunities. • Be proactive when in comes to your safety and public safety. • CarFit 28 Driver Rehabilitation Services – East Carolina University

29. 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.) 29 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

30. 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.) 30 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

31. 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.) 31 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

32. Tips for Driving in Adverse Weather • Don’t use cruise control in bad weather (AARP, n.d.) 32 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

33. 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.) 33 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

34. 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.) 34 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

35. Driving Transitions Education • 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 35 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

36. Professionals: Direct Service • 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 reports 36 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

37. NHTSA: Resources for Direct Service • 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 37 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

38. Physician’s Guide to Assessing and Counseling Older Drivers • Chapter 5: The Driver Rehabilitation Specialist • www.ama-assn.org/go/olderdrivers 38 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

39. AAA Foundation for Traffic Safety • Good resources • 4 highlights • Get on their mailing list 39 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

40. Professionals: Direct Service • 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 40 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

41. 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.) 41 Ashley Christopher, OTS, CHES and Amy Wentz, OTS

42. 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. 42 Driver Rehabilitation Services – East Carolina University

43. 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 43

44. Our Contact Information • Meredith Sweeney, OTR/L, CDI, CDRS • Tina Young, MSOT, OTR/L Grady Memorial Hospital OhioHealth 561 West Central Avenue Delaware, OH 43015 (740) 615-2660 44