1. Car Fitting You and Your Client for Best Practice
Meredith Sweeney, OTR/L, CDI, CDRS
and Tina Young, DRS, MSOT, OOTA Older Adult MSG

2. 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

3. 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

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

5. 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

6. 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

7. 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 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 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 7
Driver Rehabilitation Services – East Carolina University 7 7

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Senior Driver Tsunami Coming
OT Involvement / Role
General Process 14

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Treatment Components in the Clinic
What to do
IADL components 23

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Driving Transitions Education
Driving Transitions Education Program: 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

36. Professionals: Direct Service
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

37. 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

38. Physician’s Guide to Assessing and Counseling Older Drivers
Chapter 5: The Driver Rehabilitation Specialist
assn.org/go/olderdrivers 38
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

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

40. Professionals: Direct Service
AARP, ASA – same information
Show how to find a driving rehab specialist
AOTA Website:
ADED Website: cdrs/?pageid=320&showTitle=1
Share about CarFit
Best setting for CarFits
Share caregivers’ information
Deal with same issues 40
Anne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

41. 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

42. 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

43. 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

44. Our Contact Information
Meredith Sweeney, OTR/L, CDI, CDRS
Tina Young, MSOT, OTR/L
Grady Memorial Hospital OhioHealth
561 West Central Avenue
Delaware, OH
(740) 44