1. STEERING OLDER DRIVERS TOWARD INDEPENDENCE THROUGH DRIVER REHABILITATION SERVICES November 7, 2012 Holly Alexander, OTR/L, CDRS

2. LEARNING OBJECTIVES Identify red flags related to driver safety. Identify proactive ideas for helping older drivers stay on the road safely. Identify resources to assist in safe and effective community mobility.

3. OLDER DRIVER FACTS Motor vehicle injuries are the leading cause of injury related deaths among 65-74 year olds. Motor vehicle injuries are the second leading cause of injury related deaths (after falls) among75-84 year olds. *(National Highway Traffic Safety Administration National Center for Statistics and Analysis) The Centers for Disease Control estimated in 2005 that billion dollars are spent annually on medical costs related to older driver motor vehicle crashes.

4. OLDER DRIVER FACTS People over the age of 65 are the fastest growing population in the United States. By 2030, 63 million Americans with driver’s licenses will be 65 and over. Only approximately 600,000 older drivers (less than 1%) will cease driving on their own volition. *(National Highway Traffic Safety Administration National Center for Statistics and Analysis)

5. NATIONAL ISSUE Driving safety is a public health issue Code of ethics state we have an obligation to protect our patients as well as the public Public safety takes precedence over HIPPA rules per OT Practice Act ABC World News Report http://www.youtube.com/watch?v=egGaliwsTBA&NR=1

6. COMMUNITY MOBILITY Community mobility is defined by the Occupational Therapy Practice Framework as: “moving self in the community and using public or private transportation, such as driving, or accessing buses, taxi cabs or other public transportation systems” (AOTA, 2008) In 2010, Driving and Community Mobility was declared an “emerging practice area” by the AOTA.

7. COMMUNITY MOBILITY Community mobility is a critical area of occupation which promotes independence, spontaneity and identity Community mobility issues cross the life span Community mobility is an occupation that can affect a person’s satisfaction with life roles Lack of community mobility can lead to increased isolation and depression

8. COMMUNITY MOBILITY Engaging in community mobility, either by motor or manpowered methods is an important aspect of human participation which enables engagement of occupations outside the home. Health Care Providers play a vital role in facilitating this important area of performance.

9. INTERVENTIONS INTERVENTIONS MAY ADDRESS Passenger safety Community mobility Evaluation, education and training in preparation of acquiring a first driver’s license Evaluation and training of experienced drivers Exploration of alternative transportation options to facilitate successful community participation

10. TEAM APPROACH REHABILITATION PROFESSIONALS MUST WORK TOGETHER AS A TEAM Physical Therapists Occupational Therapists Speech Therapists Nurses Social Workers Physician Assistants Physicians

11. ROLE OF OCCUPATIONAL THERAPISTS Occupational Therapy programs can reinforce driving and community mobility as important occupations by offering a range of services both within the program and through referral to a driver rehabilitation specialist. The goal is to provide the necessary interventions, to promote participation and preserve safety.

12. ROLES OF PHYSICAL & SPEECH THERAPISTS Provide remediation of deficit performance areas related to driver fitness Discuss areas of concern related to driver safety Direct client to appropriate resources Inform team of findings Document, document, document

13. ROLE OF SOCIAL WORKER AND NURSES Discuss areas of concern related to driver safety Direct client to appropriate resources Inform team of findings Document, document, document

14. ROLE OF PHYSICIANS / PHYSICIAN’S ASSISTANTS Duty to protect  The Patient  The Public Adhere to state reporting laws Utilize “The Physician’s Guide to Assessing and Counseling Older Drivers” Refer to a driver rehabilitation specialist when necessary Counsel patient and caregivers Recommend driving retirement when appropriate Document, document, document

15. ROLE OF DRIVER REHABILITATION SPECIALISTS (DRS) The DRS has a working knowledge of Driver Licensing and Regulatory Practices. Determines if the client meets the state requirements. Provides evaluation of the performance components for driving. Provides on the road assessments when appropriate.

16. ROLE OF DRIVER REHABILITATION SPECIALISTS (DRS) Determines if the client is capable of driving/recommend retirement of driving when necessary/schedules reevaluation for clients with progressive conditions. Provides intervention to address deficit areas. Recommends/prescribes and trains in use of adaptive equipment for driving (explore funding options).

17. ROLE OF DRIVER REHABILITATION SPECIALISTS Provides training in the use of adapted/ compensatory techniques. Perform client-vehicle fittings regarding modifications. Identify and implement driving retirement plans including alternative means of transportation and counseling.

18. RED FLAGS/WARNING SIGNS Moving into the wrong lane Driving at inappropriate speeds Stopping in traffic for no apparent reason* Confusing the gas and brake pedal “Getting lost” driving to familiar areas Confusing the gas and brake* *Stop driving immediately

19. RED FLAGS/WARNING SINGS Recent crashes Recent incidents of being pulled over and/or ticketed Damage to garage, house or mailbox Riding the brake Use of a “co-pilot” Poor judgment making left hand turns Unexplained dents or scrapes on vehicle

20. CASE STUDY 1 74 y.o. woman referred following being pulled over for erratic driving. It was determined she was lost returning home from church. Some deficits noted on clinical evaluation with divided attention. During on the road evaluation patient became increasingly confused in stimulating environments. Unable to locate local grocery store. Consistently drove under the speed limit. Recommendation was driving retirement.

21. CASE STUDY 2 80 y.o. man newly diagnosed with Alzheimer’s First clinical and on the road evaluation  Short Blessed Test score 2  MVPT figure ground 12/13  Trailmaking B 122 seconds  Pass with recommended annual retesting On retest 1 year later  Short Blessed Test score 11  MVPT figure ground 8/13  Trailmaking B 346 seconds  Recommend driving retirement

22. CASE STUDY 3 66 y.o. male s/p L CVA 2 months prior to driving evaluation Slow reaction time (.8 sec) Weak grasp right hand (15#) 110 right shoulder flexion Impulsive and easily frustrated  Recommend PT/OT to address deficit areas then retest

23. CASE STUDY 3 After discharge from PT / OT retest completed Reaction time WFL (.6 sec) Right hand grip strength WFL (50#) Right shoulder flexion 160 No evidence of impulsivity Recommended to resume driving without restriction

24. CAR FIT Educational program for the older driver sponsored by AOTA, AARP and AAA 12 point check list to determine how well a person “fits” in their vehicle Provides information and materials that could enhance safety as drivers and/or increase mobility within the community

25. ALTERNATIVE TRANSPORTATION RESOURCES Public transportation Senior shuttles Taxis Area Office on Aging Religious Organizations Local VFW Volunteer Drivers

26. ALTERNATIVE TRANSPORTATION RESOURCES Volunteer Driver Programs Para transit Services Transportation Vouchers Programs through Area Agencies on Aging County/Borough Transportation Services

27. ALTERNATIVE TRANSPORTATION RESOURCES Dementia Friendly Transportation ADA Para transit Dial-a-Ride Curb to Curb Service Door to Door Service Door through Door Service

28. LOCATING A DRIVER REHABILITATION SPECIALIST American Occupational Therapy Association (AOTA) Driving Database. www.aota.org/olderdriver/www.aota.org/olderdriver/ Association for Driver Rehabilitation Specialists (ADED). www.driver-ed.org

29. ONLINE RESOURCES AOTA Online Course: Driving and Community Mobility for Older Adults: Occupational Therapy Roles by S.L. Pierce & L.A. Hunt AOTA Online Course: Promoting Safety and Independence Through Older Driver Wellness www.aota.org/nonmembers/area3/links/link08k.asp.www.aota.org/nonmembers/area3/links/link08k.asp AOTA Online Course: Occupational Therapy and the Older Driver: Addressing the IADL of Community Mobility and Driving NMEDA CAMS Video: Consumer Automotive Mobility Solutions. www.nmeda.orgwww.nmeda.org

30. EDUCATIONAL MATERIALS American Society on Aging: www.asaging.comwww.asaging.com Community Transportation Association of America:www.ctaa.orgwww.ctaa.org Easter Seals Project Action: http://projectaction.easterseals.comhttp://projectaction.easterseals.com National Association of Area Agencies on Aging: www.n4a.orgwww.n4a.org

31. EDUCATIONAL MATERIALS The Hartford Group: www.thehartford.com/alzheimerswww.thehartford.com/alzheimers National Highway Traffic Safety Administration: www.nhtsa.govwww.nhtsa.gov Automobile Association of America: www.seniordrivers.orgwww.seniordrivers.org American Association of Retired People: www.aarp.orgwww.aarp.org

32. EDUCATIONAL MATERIALS Alzheimer’s Association: www.alz.orgwww.alz.org National Institute on Aging: www.nia.nih.gov/www.nia.nih.gov/ Adaptive Mobility Services, Inc (specializing in educational workshops): www.adaptivemobility.comwww.adaptivemobility.com Mobility Assessment Program and Partners in Safety (videos) by L. Hunt lahunt@centurytel.netlahunt@centurytel.net

33. TIPS FOR SAFE DRIVING Plan trips ahead of time. Always wear your seat belt. Drive the speed limit. Be alert. Keep enough distance between you and the car in front of you. Be extra careful at intersections. Always use turn signals.

34. TIPS FOR SAFE DRIVING Check your blind spots when changing lanes and backing up. Know about the side effects of any medications. Never drink and drive. Do not drive when you are angry or tired. Avoid driving distractions i.e. eating, cell phone use, changing radio stations. If you do not see well in the dark, try not to drive at night, dusk or dawn.

35. TIPS FOR SAFE DRIVING If you have trouble making left turns at an intersection, it is better to make three right turns instead of one left. Try to avoid driving in bad weather. Have plenty of gas in your car. Have regular tune ups. Keep your windshield and mirrors clean. Replace worn out windshield wipers.

36. TIPS FOR SAFE DRIVING Have an assessment by a Driving Rehabilitation Specialist Take a driver safety class  AARP 55 Alive Driver Safety Program 1-888-227-7669  AAA Safe Driving for Mature Operators Program call your local AAA  National Safety Council Defensive Driving Course 1-800-621-7619

37. TIPS FOR SAFE DRIVING Driver safety classes usually last several hours and do not cost much. Some of these classes will enable an individual to receive a discount on auto insurance. It is important to remember… with driver safety classes, there is no formal evaluation being completed as with a consultation with a Driver Rehabilitation Specialist (DRS). Evaluations completed by a Driver Rehab Specialist will assess your loved one’s specific skills that are required for safe driving

38. TIPS FOR SAFE DRIVING Evaluations completed by a Driver Rehab Specialist will assess your loved one’s specific skills that are required for safe driving. In addition to this evaluation, remediation and training to improve driving abilities may be provided. The same is not true with driver safety classes which review general information in a group setting.

39. TAKE HOME MESSAGES Driver rehabilitation and community mobility issues require a team approach. Driving is an integral part to our independence and well being. Driving should be addressed with all patients.

40. THANK YOU! holly.alexander@foxrehab.org marvin.lawson@foxrehab.org