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Audience (for this presentation):
 State Area Agencies of Aging Conference
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Objectives:
 Describe the role of the driving rehabilitation specialist
 Explain the comprehensive driving evaluation
 Identify what the professionals who work with aging can do for their
clients concerning driving
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Time:
 60-90 minutes
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Success:
 Staff seems to understand the role of the occupational therapist with
driving.
 Was asked to represent our area on state Older Drivers Coalition.
Keeping Drivers on the Road:
The Occupational Therapist’s Role
Your name
Your organization
Date/name of conference/group
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Identify the role of occupational
therapy in driving evaluation and
rehabilitation
Differentiate the types of driving
specialists
Describe the driving assessment process
Explain rehabilitation potential in
driving
Describe the benefits of CarFit
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The number of older licensed drivers in the U.S. is
expected to increase
 from ~20 million today to ~40 million in 2020.
 Graph is for drivers 70 years and older
Males
Females
20
16
11.8
12
13.9
12.8
10.1
9.0
8
17.9
7.0
6.3
4
0
1990
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2000
2010
2020
1990
2000
2010
2020
Most older drivers are safe! However….
Crash Involvement
http://search.cga.state.ct.us/dtSearch_lpa.html
Driving is and will remain the primary mode of
transportation for older adults.
• Driving represents the ability to maintain
connections and contribute to the community.
• Studies of older drivers show there may be a
relationship between health, sense of autonomy,
and ability to drive.
• Loss of mobility can lead to depression, low life
satisfaction, health problems, isolation, and
loneliness.
•
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Men outlive their ability to drive by 6 years;
women outlive their ability to drive by 10
years. Source: Foley, et al (2002)
More than 600,000 people age 70+ stop
driving each year
Question: When? How do I know?
Older drivers begin to self-restrict
 Women often stop prematurely
Act to Maximize Ability
Act to Promote Driving Retirement
Physically or
Mentally
Perceived
Competent
Appropriate
Competent
Perceived
Incompetent
Inappropriate
restriction
Physically or
Mentally
Perceived
Competent
At Risk
Perceived
Incompetent
Appropriate
Restrictions
Incompetent
Individuals with dementia are at
increased risk for unsafe motor vehicle
operation
 Becoming lost in familiar areas
 Incorrect turning & lane deviation
 Impaired signaling
 Decreased comprehension of traffic
signs
 Unaware of not being a responsible
driver
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NIH - 1 in 7 over 71 years of age have some
type of dementia (Plassman et al. 2007)
NC: Do the math for your state.
 In 2000, 969,048 over 65
 138,435 with dementia
 147 DMV offices
 942 per office
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Dementia - Special issues with driving
 Can it be done by DMV evaluators?
 Or need specialists?
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North Carolina - 11 Driving Specialists
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12,585 dementia referrals for each
evaluator
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34.5 a day, 365 days a year.
Need to have a system in place to deal with these
issues
•Varies depending on state, setting, staff, training
•DMV 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
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Specialized training
ADED – Association for Driver Rehabilitation
Specialist
 80% of DRS are occupational therapists
 CDRS – Certification administered by ADED
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American Occupational Therapy Association
 Specialty Certificate in Driving and Community Mobility
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Your definition of occupational therapy.
Areas of occupation include: ADL, IADL, work,
leisure, education, social participation
Community mobility is under IADL
 Rural communities: Driving is the only community
mobility option.
 Occupational Therapy Practitioners:
 Understand the critical demands of
driving
 Have science-based knowledge to
understand progressive conditions and
life changes affecting driving
 Understand how community mobility
affects quality of life
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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
 Client History
 Physical Assessment
 Visual/Perceptual
 Cognitive
 Behind the Wheel
 Recommendations
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Diagnoses, onset,
functional limitations
Secondary diagnosis
Medications side effects
Years of driving experience
Restrictions
Estimated amount of driving
Type of vehicle
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Strength and reach
Sensory changes
 Ability to get
in and out of
a vehicle
•
Looking out the
center of the
windshield
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Supportive seat
•
May need to tilt
the steering wheel
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Acuity
Efficiency of visual system
Contrast sensitivity
Glare vision & glare recovery
Night vision
Eye Movement
Central Vision
 Peripheral Vision
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Depth Perception
Dynamic Perception
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Attention and
concentration
Following directions
Judgment and insight
Knowledge of the road
Memory, planning, and
organization
Self-control
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Entry Skills – Adjust mirror, seat, and seat belt
Operates controls
Right and left turns, backing up, and parking
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Structured
 Parking lot
 Quiet neighborhood
 City driving with increasing traffic and
turns
 Highway driving
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Client’s Home Area
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Decision making and
route planning
Lane changes
Spacing
Visual scanning
Highway/Interstate
driving as appropriate
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Integrate the results of
components of in clinic and
BTW
Include the client and family
Consider modifications
restrictions, or retiring from
driving
Followed up with written
documentation
Maximize physical, visual
and cognitive health
• Consider medications
• Maintain a realistic
perspective related to
experience, ability, and the
driving environment
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Maximize VISION and the aspects of driving
that affect vision.
Understand “dangers” such as crowded
intersections, unprotected left turns, driving
when stressed or fatigued
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Cease night driving
Compensate for decreased reaction time
Avoid in-car distractions
Plan ahead
Communicate
Check mirrors
Implement safe lane
changing procedures
• Implement safe backing
procedures
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Look for driver
opportunities
• Be proactive when in
comes to your safety
and public safety
• CarFit
•
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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
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Driving is a critical IADL
Need to keep safe drivers driving longer
Need to determine who is safe and who is
unsafe
Occupational therapists need to address
driving as an IADL
 Generalists & specialists
 CarFit: One option
Your information.