DRIVING

1
DRIVING

• When is it time to stop?
• Alison Finney and Wendy Schuld
• CRAGS

2
Driving

• Important for everyone
• Independence
• Social integration identity
• Mental and physical health1
• Licence cancellation2
• whole world collapsed around me
• without drivingits the end of my life

3
Ageing

• Associated with changes in pre-requisite skills
  for driving
• Physical function
• Vision
• Cognition
• Not related to chronological age
• Can remain driving longer than they can use other
  means of transport

4
Crash Rates

• Do older drivers have a higher crash rate than
  other drivers?
• Frailty means MVA often causes injury
• Drive short distances (? crash rate)
• If adjust for this older drivers are as safe or
  safer than other age groups3

5
Common Crash Situations

• Turning right at intersections
• With other vehicles
• Below average speed
• During daylight hours
• Low BAC
• Where they fail to give way
• l looked but I didnt see them

6
Challenge

• Identify at risk drivers before they crash
• Canadian research4
• Self regulation
• Many older drivers do self-regulate
• Others over-estimate skills
• Even in the face of objective evidence5,6

7
Indications for Referral

• Recent accident record
• Minor damage to vehicle
• Reports from relatives
• Not wanting to drive with relative
• But relatives can be compromised
• Significant memory or processing deficits
• Reduced insight
• Cognitive deficits
• Driving competence

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What can you do?

• Consider driving as a critical ADL
• Use RTA booklet A guide for older drivers
• Self-administered questionnaire
• Health
• Road law
• Attitudes and emotions
• Driving record
• First tier assessment
• Tool for discussion with family

9
We all need to plan

• Plan our retirement
• Plan more suitable accommodation
• But most of us do not plan to stop driving
• Aged Medical Reviews- 80, soon 75

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Is Driving Important?

• Driving is so important in current society it is
  considered an Activity of Daily Living
• Driving equals Independence
• Privilege not a right.

11
Legislation

• Drivers responsibility to report
• Rely on advice from health professionals

12
Legislation And Guidelines

• National uniform law requires a patient to advise
  their own Driver Licensing Authority of any
  permanent or long term illness or injury that may
  impair his or her ability to drive safely.
• Penalties for failure to report
• From ASSESSING FITNESS TO DRIVE
• Austroads 2003

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Legislation cont.

• Liability at common law if continue to drive
• Long term financial and legal consequences
• If Driver Licensing Authority request a medical
  then patient also has duty of care to truthfully
  declare their health status

14

• Medical standards for licensing and clinical
  management guidelines
• Assessing Fitness to Drive for commercial and
  private vehicle drivers, published by Austroads
  (2003).
• RTA Medical/License Review Unit (Grafton)
  available for consultation (ph 6640 2883)

15
Psychiatric Disorders

• RTA guidelines state NOT MET IF
• Chronic Disorder-perceptual, cognitive or motor
  impairment
• Chronic Disorder-behavioural problems
  (aggression)
• Psychoactive drugs-impair driving long term
• Conditional licence granted if condition well
  controlled, letter from doctor and periodic
  review

16
Challenges

• The Occupational Therapy Driving Assessment is
  concerned with the skill performance of the
  driver using a variety of conditions to challenge
  their physical control and perception, response
  to environmental cues and unexpected hazards and
  their planning and judgement

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Competency

• The Driving Assessment is dictated by competency
  standards set for all driver trained Occupational
  Therapists. The Off and On Road tasks are
  determined, but each assessment is also tailored
  to the individual needs of the client.

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OT Driving Assessment

• Assessment takes up to 3 hours
• Off Road (2 hours)
• On-Road (1hour)
• No pass/fail score
• Remediation and education
• Understanding of medical diagnosis
• Liaison with LMO family
• Alternative transport options considered
• Cost involved

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Purpose of the Off Road Assessment?

• To identify
• possible deficits requiring further assessment
  On-Road
• which modifications are required
• appropriate route for the On-Road Assessment

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Off Road Assessment

• Interview
• driving history experience, licence status,
  current driving requirements vehicle
• medical history, current treatments, medications
• Physical Assessment
• range of motion, strength, tone, pain
• sensation (tactile localisation, proprioception,
  kinaesthesia)
• co-ordination
• balance
• mobility transfers

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Off Road Assessment cont..

• Vision Screen
• Visual Acuity (6/12 binocular)
• Visual Fields
• Depth Perception
• Eye Movements
• History of eye treatments

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Cognitive Assessment

• Visual/Verbal Memory
• Concentration
• Attention ability to change selective attention
• Information processing
• Visual attention

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Cognitive Assessment cont..

• Visual Slide Recognition Test- /140
• ability to recognise recall critical features
  objects presented for 3 seconds.
• all slides at roundabout, with changing number of
  objects and varying light contrasts

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Visual Slide Recognition Test - Example
25
Road Law Slide Test

• Multi-purpose test of 12 slides scored /48
• covers clients knowledge of road law, also
  cognitive ability to interpret questions asked
  and provide relevant information

26
Road Knowledge Test

• Written Road Law Test
• Example
• What is the speed limit outside a street lit area
  where there is no sign to indicate?
• A) 80km
• B) 100km
• C) 120km

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Road Knowledge Test

• Intersection Diagram Test

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On Road Assessment

• Completed by OT DI in modified vehicle
• DI ensures safety of vehicle occupants
• OT observes effect of driving habits deficits
  related to drivers medical condition to estimate
  potential for driving

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On Road Discussion

• Client apprehension
• Physical disability
• Driving experience-nil, minimal, extensive
• Client attitude
• Level of maturity
• Insight

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Observation

• Scanning
• Internal mirror use
• External mirror use
• Blind spot checks

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Speed Control

• Speed control
• Speed adjustment
• Speed consistency

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Planning Judgement

• Follow instructions-verbal/visual
• Manoeuvres-planned/unplanned
• Intersections-controlled/uncontrolled
• Ability to relate to other traffic

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Vehicle Positioning

• Marked/Unmarked
• Turns/Curves
• Parked vehicles
• Moving vehicles
• Buffer zone

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Reaction Time Physical Control

• Brake application
• Acceleration
• Steering wheel
• Modifications

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Outcome

• Fail licence cancelled
• Fail lessons required
• Pass licence reinstated

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Fail licence cancelled

• Client does not meet RTA standards for safe
  driving and no evidence demonstrated of new
  learning, therefore cancellation is required.
• Significant/frequent problems in 3 of the 5 areas
  must be observed (E.g. Observation, Speed
  Control, Planning Judgement, Vehicle
  Positioning, Reaction Time/Physical Control
• Intervention by the DI to ensure safe passage of
  the vehicle i.e. the DI applies the dual brake or
  takes control of the wheel

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Fail lessons required (behaviour related)

• Client does not meet RTA standards, but
  demonstrates ability to learn
• Remediation program designed by OT DI
• Program implemented by DI
• Re-Assessment by OT (if required)

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Fail lessons required (modification required)

• Client is unable to operate standard vehicle
  controls due to their condition.
• Remediation program designed by OT DI
• Program implemented by DI
• Re-Assessment by OT (if required)
• RTA Disability Test

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Eze-Spin
40
Tri-Spin
41
Left Foot Accelerator
42
Additional Mirrors
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Pass licence reinstated

• Client is safe and meets RTA standards for safe
  driving

44
Restricted Licences

• There is no evidence to state that a restricted
  licence is safe effective
• Gives false sense of security
• Co-Pilot option not proven safe
• Does reducing time distance SAFETY

45
Occupational Therapy Driver Assessment and
Rehabilitation

• Advantages
• Skill base (physical, psychological, visual
  perceptual and cognitive assessment activity
  analysis and modification of tasks)
• Knowledge of alternative transport options
• Assessment includes an on-road driver assessment

46
Transport Issues

• Many families dispersed
• Many elderly experience difficulty with public
  transport
• There is a need for further attention to
  transport options e.g.taxi subsidies

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Community Safety vs Individual Right

• Driving is not a once learned static skill that
  remains unchanged throughout our driving life, it
  is an ongoing process of learning and
  re-adjustment
• Indemnity under national uniform driver
  licensing law, already in place in all states,
  any person, professional or otherwise, who
  reports a driver to a driver licensing authority,
  in good faith, is protected from civil criminal
  liability

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Conclusion

• Driving is a complex task that is important for
  maintaining independence within the community
• Accurate assessment is important to ensure
  drivers who are safe are able to continue to
  drive
• Clients need specific information regarding their
  ability to drive
• The best predictor of driving ability is an
  on-road driving assessment, in combination with
  visual-perceptual cognitive assessments.