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 ones 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

• Doesnt 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

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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 therapists 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?
  Isnt 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