Car Fitting You and Your Client for Best Practice

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Presentation transcript:

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. 2

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

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

Aging and Driving Older drivers have a higher number of crashes per mile driven and are more likely to experience injury or death As the population of older drivers increases, motor vehicle collisions involving older adult drivers is likely to increase 50% or more of crashes occur at intersections for drivers in their 70’s and 80’s (AARP, 2005; Gallo, Rebok, & Lesikar, 1999; Ball, Roenker, Wadley, Edwards, Roth, McGwin, Raleigh, Joyce, Cissel, & Dube, 2006) (NHTSA, n.d.) 5 5 5

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

Fatalities 7 7 http://search.cga.state.ct.us/dtSearch_lpa.html 7 Script: Older adults have increased fragility and are more likely to die from crashes that expose them to injury (1). Similar to the statistics that indicate high mortality with hip fractures, injury in a motor vehicle crash may begin the spiral downward for an older adult. (1)Insurance Institute for Highway Safety, Fatality Facts: Older People as of November 2002. Arlington (VA): IIHS 2003. Notes: You may want to add the following additional information: In the year 2000, persons aged 65 years and older made up 13% of the U.S. population (1) yet suffered 18% of all traffic fatalities (2). When adjusted for number of vehicle miles traveled, older adults have the highest rate of fatal crashes (3). Population projections of the total resident population by 5-year age groups, and sex with special age categories: middle series, 1999 to 2000. Washington DC: Population Projections Programs, Population Division, U.S. Census Bureau 2000. Traffic Safety Facts 2000: A compilation of motor vehicle crash data from the Fatality Analysis Reporting System. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 2001. (3) IIHS Fatality Facts, Elderly. Arlington (VA): IIHS 2001. . 7 Driver Rehabilitation Services – East Carolina University 7 7

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 We know there are 78 million baby boomers who began to turn 60 last year. All of you have seen the general statistics of what this means at the national level, both in terms of the number of healthy older adults and the number of older adults who will have chronic disabilities. The new study from NIH shows that 1 in 7 over the age of 71 will have some type of dementia. I applied that to North Carolina - just as one example of a state that has their older adult population growing. In 2000, 969,000 thousand over 65; 7 years later, those folks are all over 71 years of age. 8 Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University 8 8

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) Once dementia has been diagnosed by a doctor, warning signs indicating the disease is affecting driving include: 9 9 9

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) Once dementia has been diagnosed by a doctor, warning signs indicating the disease is affecting driving include: 10 10 10

Dementia/Alzheimer’s Disease Vision Loss Diabetes Parkinson’s Disease 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

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 12

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

Senior Driver Tsunami Coming OT Involvement / Role General Process 14

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 15 15

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 16 Driver Rehabilitation Services – East Carolina University

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 Today I would like to present a model that attempts to clarify and describe the desired hierarchy for conceptualizing how occupational therapists address Driving and community mobility. This flowchart describes how various services and providers are involved when considering assessment, referral and training. 17 Author: Dr. Anne Dickerson, East Carolina University 17

Protocol to Evaluate Older Drivers Handout from “Geriatrics, “ August 2005, Volume 60, Number 8, p.24 Today I would like to present a model that attempts to clarify and describe the desired hierarchy for conceptualizing how occupational therapists address Driving and community mobility. This flowchart describes how various services and providers are involved when considering assessment, referral and training. 18 18

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 19 Driver Rehabilitation Services – East Carolina University

Provide objective data regarding abilities required for driving 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. I have a job that really allows me to use a majority of the tools in my Occupational therapy tool box. I see individuals with impairments related to driving throughout the state of NC, and some into VA and SC. The questions of the aging persons safety in operating a motor vehicle is challenging and complex. As Anne talked about, the red line or the decision line between fit and unfit driving ability is often difficult to detect. We Don’t want to limit a person’s independence but we also don’t want to place their safety or the safety of other’s at risk. The OT generalist is trained to initiate discussions and be aware of concerns regarding driver independence. As the specialist, I am trained to objectively evaluate a persons skills and help the client arrive at the safest decision regarding driving. I hope to outline that process in the next few slides. 20 Driver Rehabilitation Services – East Carolina University 20 20

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 21 21

Overview of the Assessment 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 An OVERVIEW: I see client’s in their local/home environment. The first 1—2 hours of my time interfacing with the individual is spent completing a clinical assessment of component skills as they relate to driving. This clinical assessment is followed by an actual driving performance evaluation in which the client is seen operating the motor vehicle. Based on the results of the clinical and BTW portions of the evaluation, recommendations are provided to the client regarding driver safety and independence. 22 Driver Rehabilitation Services – East Carolina University 22 22

Treatment Components in the Clinic What to do IADL components 23

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. As you have hopefully seen, maintaining or improving driver safety is really a matter of maximizing health and agility in all of the skill areas…physical, visual and cognitive. It is a matter of understanding that driving environments are changing both due to engineer and design issues, congestion, and simply the dynamic nature of encountering a different scenario almost every time even though the same route is executed. 24 Driver Rehabilitation Services – East Carolina University 24 24

What Older Drivers Can Do To Improve Their Driving Maximize VISION and the aspects of driving that affect vision. Utilize Headlights and keep them clean Don’t wear sunglasses or heavily tinted regular glasses for twilight or night driving. Avoid Frames with wide side pieces that can block side vision. Keep eye glasses clean. 25 Driver Rehabilitation Services – East Carolina University 25 25

What Older Drivers Can Do To Improve Their Driving Cease night driving. Compensate for decreased reaction time. Avoid in-car distractions. Plan ahead. If you have trouble walking on the street of in the yard at night, cease night driving. Maintain “buffer” zones to compensate for decreased reaction time. Turn off your radio and avoid in-car distractions. Plan your route in advance of an outing. 26 Driver Rehabilitation Services – East Carolina University 26 26

What Older Drivers Can Do To Improve Their Driving Communicate Check Mirrors Implement safe lane changing procedures Implement safe backing procedures Communicate by signaling and positioning your car in the proper lane. Check Mirrors Frequently – 360 degree awareness. When changing lanes, check traffic by glancing over your shoulder as well as activating your turn signal. Always look backward BEFORE putting the vehicle in reverse. 27 Driver Rehabilitation Services – East Carolina University 27 27

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 Take a driver improvement course such as the AARP Driver Safety Program. Undergo a professional evaluation of your driving skills. Be proactive when in comes to your safety and public safety. 28 Driver Rehabilitation Services – East Carolina University 28 28

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 29

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.) -Practice flexibility exercises each day in order to avoid neck and shoulder stiffness which may prevent you from looking left or right in your blind spots -The best way to compensate for blind spot is to turn and glance over each shoulder (AARP, n.d.) Ashley Christopher, OTS, CHES and Amy Wentz, OTS 30 30 30

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.) Turn your head and look out the rear window, in order to increase visibility and safety Make sure the space behind your vehicle is clear, especially when in a residential area (AARP, n.d.) Ashley Christopher, OTS, CHES and Amy Wentz, OTS 31 31 31

Tips for Driving in Adverse Weather Don’t use cruise control in bad weather (AARP, n.d.) Don’t use cruise control in bad weather because you will have better control of your car when you are controlling the speed (AARP, n.d.) Ashley Christopher, OTS, CHES and Amy Wentz, OTS 32 32 32

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

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.) Beneficial to try out all these options before you actually need to depend on them for all your transportation needs 34 Ashley Christopher, OTS, CHES and Amy Wentz, OTS 34 34

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

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

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 37

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

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

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

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.) -Making sure you and your vehicle “fit” together can be as important as a mechanical check-up (AARP, n.d.) -Proper adjustments of head restraints, and safety belts and air bags keep you securely in place during a crash. -CarFit: a program that determines the “fit” between you and your car. Trained technicians check your car with you in it and make recommendations for a better fit. (American Society on Aging, 2006) Ashley Christopher, OTS, CHES and Amy Wentz, OTS 41 41 41

What is CarFit? American Automobile Association 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

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

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