Car Fitting You and Your Client
for Best Practice
Meredith Sweeney, OTR/L, CDI, CDRS
and Tina Young, DRS, MSOT, OOTA
Older Adult MSG
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.
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Objectives
1. Define Senior Tsunami and the relationship with
older driving.
2. Understand your role in driving and the general
overall process.
3. Be able to identify the many available sources of
information, tools and references.
4. Overview of AOTA, AARP, AAA CarFit Program
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Senior Driver Tsunami Coming
 What is it?
 Why is it important?
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Aging and Driving
(NHTSA, n.d.)
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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
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
2000
2010
2020
1990
2000
2010
2020
 Most older drivers are safe! However….
Driver Rehabilitation Services – East Carolina University
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Fatalities
http://search.cga.state.ct.us/dtSearch_lpa.html
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Driver Rehabilitation Services – East Carolina University
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
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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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)
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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)
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Older Driver Diagnoses that Impact
Driving
 Dementia/Alzheimer’s Disease
 Vision Loss
 Diabetes
 Parkinson’s Disease
 CVA
 TBI
 Cardiovascular
Driver Rehabilitation Services – East Carolina University
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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
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Medications that Impact Driving

Anti-Depressants
• Wellbutrin
• Cymbalta
• Lexapro

High Blood Pressure
• Cardura
• Atenolol
• Lopressor

Anti-Histamines
• Benadryl
• Zyrtec
• Claritin
• Allegra

Pain Killers
• Darvocet
• Percocet
• Vicodin
• Lorcet

Benzodiazepenes
• Xanax
• Ativan
• Diazepam (Valium)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Senior Driver Tsunami Coming
 OT Involvement / Role
 General Process
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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.
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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Occupational Therapy

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
Driver Rehabilitation Services – East Carolina University
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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
Author: Dr. Anne Dickerson, East Carolina University
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Protocol to Evaluate Older Drivers
Handout from “Geriatrics, “ August
2005, Volume 60, Number 8, p.24
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Driver Rehabilitation Specialists
 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
Driver Rehabilitation Services – East Carolina University
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Role of the Driver Rehabilitation Specialist in
Assessing Older Driver Safety




Driver Rehabilitation Services – East Carolina University
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.
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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
Driver Rehabilitation Services – East Carolina University
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Overview of the
Assessment Process
 Client History
 Physical Assessment
 Functional Mobility
 Reaction Time
 Visual/Perceptual
Driver Rehabilitation Services – East Carolina University
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Treatment Components in the Clinic
 What to do
 IADL components
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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.
Driver Rehabilitation Services – East Carolina University
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What Older Drivers Can Do
To Improve Their Driving
 Maximize VISION
and the aspects
of driving that
affect vision.
Driver Rehabilitation Services – East Carolina University
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What Older Drivers Can Do
To Improve Their Driving
 Cease night driving.
 Compensate for
decreased reaction
time.
 Avoid in-car
distractions.
 Plan ahead.
Driver Rehabilitation Services – East Carolina University
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What Older Drivers Can Do
To Improve Their Driving
 Communicate
 Check Mirrors
 Implement safe lane
changing procedures
 Implement safe backing
procedures
Driver Rehabilitation Services – East Carolina University
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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
Driver Rehabilitation Services – East Carolina University
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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.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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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.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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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.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Driving in Adverse Weather
 Don’t use cruise control in bad weather
(AARP, n.d.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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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.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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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.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Driving Transitions Education
 Driving Transitions Education Program:
http://www.asaging.org/asav2/drivewell/driving_t
ransitions.cfm
 ASA; funded by NHTSA
 Modules and Scripts
 How to interact with family
members
 Practice Exercises – use with
other professionals
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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Professionals: Direct Service

http://www.nhtsa.dot.gov/portal/site/nhtsa/menuit
em.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
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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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
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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Physician’s Guide to Assessing
and Counseling Older Drivers
 Chapter 5: The Driver
Rehabilitation Specialist
 www.ama-
assn.org/go/olderdrivers
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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AAA Foundation for Traffic Safety
 Good resources
 4 highlights
 Get on their mailing list
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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Professionals: Direct Service
 AARP, ASA – same information
 Show how to find a driving rehab specialist
• AOTA Website:
• ADED Website:
http://www1.aota.org/driver_search/index.aspx
http://www.driver-ed.org/custom/directorycdrs/?pageid=320&showTitle=1
 Share about CarFit
• http://www.car-fit.org/
• Best setting for CarFits
 Share caregivers’ information
• Deal with same issues
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University
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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.)
Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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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.
Driver Rehabilitation Services – East Carolina University
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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
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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
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