1.  Audience (for this presentation):  State Area Agencies of Aging Conference  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  Time:  60-90 minutes  Success:  Staff seems to understand the role of the occupational therapist with driving.  Was asked to represent our area on state Older Drivers Coalition.

2. Keeping Drivers on the Road: The Occupational Therapist’s Role Your name Your organization Date/name of conference/group

3.  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

4. Driving & Demographics  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  Most older drivers are safe! However….

5. Crash Involvement

6. Fatalities http://search.cga.state.ct.us/dtSearch_lpa.html

7. 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.

8.  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

9. Act to Promote Driving Retirement Act to Maximize Ability

10. Physically or Mentally Competent Perceived Competent Appropriate Perceived Incompetent Inappropriate restriction Physically or Mentally Incompetent Perceived Competent At Risk Perceived Incompetent Appropriate Restrictions

11.  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

12.  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

13.  Dementia - Special issues with driving  Can it be done by DMV evaluators?  Or need specialists?  North Carolina - 11 Driving Specialists  12,585 dementia referrals for each evaluator  34.5 a day, 365 days a year.  Need to have a system in place to deal with these issues

14. 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

15.  Specialized training  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

16.  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.

17.  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

18. 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

19.  Client History  Physical Assessment  Visual/Perceptual  Cognitive  Behind the Wheel  Recommendations

20. Diagnoses, onset, functional limitations Secondary diagnosis Medications side effects Years of driving experience Restrictions Estimated amount of driving Type of vehicle

21.  Strength and reach  Sensory changes

22.  Ability to get in and out of a vehicle

23. Looking out the center of the windshield Supportive seat May need to tilt the steering wheel

24.  Acuity  Efficiency of visual system  Contrast sensitivity  Glare vision & glare recovery  Night vision

25.  Eye Movement  Central Vision  Peripheral Vision

26. Depth Perception Dynamic Perception

27.  Attention and concentration  Following directions  Judgment and insight  Knowledge of the road  Memory, planning, and organization  Self-control

28.  Entry Skills – Adjust mirror, seat, and seat belt  Operates controls  Right and left turns, backing up, and parking

29.  Structured  Parking lot  Quiet neighborhood  City driving with increasing traffic and turns  Highway driving  Client’s Home Area

30.  Decision making and route planning  Lane changes  Spacing  Visual scanning  Highway/Interstate driving as appropriate

31.  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

32. Maximize physical, visual and cognitive health Consider medications Maintain a realistic perspective related to experience, ability, and the driving environment

33.  Maximize VISION and the aspects of driving that affect vision.  Understand “dangers” such as crowded intersections, unprotected left turns, driving when stressed or fatigued

34. Cease night driving Compensate for decreased reaction time Avoid in-car distractions Plan ahead

35. Communicate Check mirrors Implement safe lane changing procedures Implement safe backing procedures

36. Look for driver opportunities Be proactive when in comes to your safety and public safety CarFit

37.  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

38.  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

39. Your information.