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

Car Fitting You and Your Client for Best Practice

Meredith Sweeney, OTR/L, CDI, CDRS

and Tina Young, DRS, MSOT, OOTA Older Adult MSG

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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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What is it?

Why is it important?

Senior Driver Tsunami Coming

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Aging and Driving

(NHTSA, n.d.)

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Driving and Driving and DemographicsDemographics

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

11.812.8

6.3

10.1

13.9

17.9

0

4

8

12

16

20

1990 2000 2010 2020 1990 2000 2010 2020

MalesFemales

Driver Rehabilitation Services – East Carolina University

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FatalitiesFatalities

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


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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 Older Driver Diagnoses that Impact DrivingImpact Driving

Dementia/Alzheimer’s Disease

Vision Loss

Diabetes

Parkinson’s Disease

CVA

TBI

Cardiovascular


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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

Anti-Histamines– Benadryl– Zyrtec– Claritin– Allegra

Benzodiazepenes– Xanax– Ativan– Diazepam (Valium)

High Blood Pressure– Cardura– Atenolol– Lopressor

Pain Killers– Darvocet– Percocet– Vicodin– Lorcet


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OT Involvement / Role

General Process

Senior Driver Tsunami Coming

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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.


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OccupationalOccupational TherapyTherapy

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


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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 RehabilitationDriver Rehabilitation SpecialistsSpecialists

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


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Role of the Driver Rehabilitation Specialist Role of the Driver Rehabilitation Specialist in Assessing Older Driver Safetyin 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.


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Who Does Driving Who Does Driving Evaluations?Evaluations?

Varies depending on state, setting, staff, trainingBMV or licensing authority

Structured, “same for all”Pass/fail Medical review board

Driving Rehabilitation SpecialistsIndividualizedScreen or evaluate sub-skillsPerformance in Context – On Road


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Overview of theOverview of theAssessment Assessment ProcessProcess

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


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Treatment Components in the Clinic

What to do

IADL components

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What Older Drivers What Older Drivers Can Do Can Do To Improve Their To Improve Their DrivingDriving

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.


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What Older Drivers Can What Older Drivers Can Do Do To Improve Their To Improve Their DrivingDriving

Maximize VISION and the aspects of driving that affect vision.


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Cease night driving.

Compensate for decreased reaction time.

Avoid in-car distractions.

Plan ahead.


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Communicate Check Mirrors Implement safe lane

changing procedures Implement safe

backing procedures


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Look for driver opportunities.

Be proactive when in comes to your safety and public safety.

CarFit


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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.)


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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.)


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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.)


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Tips for Driving in Adverse Weather

Don’t use cruise control in bad weather

(AARP, n.d.)


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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.)


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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.)


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Driving Transitions Education Program: http://www.asaging.org/asav2/drivewell/driving_transitions.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

Driving Transitions Education

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http://www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.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 reportsAnne Dickerson, PhD, OTR/L, FAOTA – East Carolina University

Professionals: Direct Service

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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


NHTSA: Resources for Direct Service

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Chapter 5: The Driver Rehabilitation Specialist

www.ama-assn.org/go/olderdrivers


Physician’s Guide to Assessing and Counseling Older Drivers

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Good resources

4 highlights

Get on their mailing list


AAA Foundation for Traffic Safety

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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


Professionals: Direct Service

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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.)


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What is What is CarFit?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.


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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 OhioHealth561 West Central AvenueDelaware, OH 43015(740) 615-2660

Documents

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