Older Driver Safety Awareness Week: Responding to needs of older drivers

Aging is an inevitable and natural process of change experienced by all. The ability to drive safely can be affected by changes in our physical, sensory, emotional, and cognitive health. These changes occur individually and at different rates and times. Just as one plans for finances and housing that may change in retirement, it's important to plan for changes in transportation needs by exploring solutions and making informed choices for desired engagement and participation in the community.

1. CarFit - CarFit is an education program developed in collaboration with AAA, AARP and AOTA. CarFit supports drivers and exposes practitioners to challenges faced by community-dwelling drivers. The focus for general practice practitioners is on support and the exploration of solutions individuals may face, such seat too low to see over the dash or difficulty with ingress and egress. CarFit can build your confidence of what to look for and what to say.
   
   • Visit CarFit website
   • Video - CarFit overview
   • Video - OT at CarFit
     
     
2. Planning
   • Assessment of readiness (Plan for the Road Ahead)
   • Road Safe Seniors (ChORUS)
   • Transportation Safety (CDC)
     
     
3. Resources for The Conversation (The Hartford)
   • Family Conversations with Older Drivers
   • Free Home & Car Safety Guides
   • Conversation Starters

• Drivers & family support
  • Driving rehab in occupational therapy - Learn about driving rehabilitation in occupational therapy. (video)
    
    
• Occupational therapy practitioners
  • Keeping Senior Drivers Independent - Explore how occupational therapy can assist the medical profession in helping older drivers maintain mobility and driving independence. (video)
  • Occupational Therapy’s Role in Driving is Important - Discuss the importance of occupational therapy’s role in driving. (video)

AOTA's Older Driver Safety Awareness Week is intentionally held each year in December because this is the time of year when families often come together for the holidays. One of the first steps in addressing older driver safety with a loved one is to create a safe space to discuss any concerns or changes and explore solutions that support continued safe and independent driving.

The occupational therapy profession is part of the medical team, and we have our clients’ back. Medical events, chronic conditions, or sensory changes can impair one’s safety behind the wheel. As frontline health professionals, we can address community mobility and the medically related changes that impact driving. An interprofessional approach helps older drivers preserve a thriving lifestyle and provides hope for continued driving independence.

1. View driving “risk” as a process and driving as a goal.
   • AOTA resources
     • Choose safe driving – PDF
     • Driving & community mobility partner organizations & stakeholders
     • OT-DRIVE: Integrating the IADL of driving & community mobility into routine practice
       
       
2. When to call OT, options for when “life happens”

Most aging drivers will experience gradual changes that they manage well. But for some, medically related changes impose the need to consider their transportation and mobility needs, including transition from the role of driver to getting to where they want and need to go as a passenger.

• Drivers & family support
  • Overcome Senior Driver Concerns with Occupational Therapy - Occupational therapy practitioners can help older drivers stay safe behind the wheel and increase community mobility. (video)
  • Listening & addressing driver concerns - Occupational therapists and occupational therapy assistants address drivers' concerns. (video)
  • Partnering with medical community - The benefits of engaging occupational therapy on driving needs. (video)
  • Get advice from the pros
    
    
• Occupational therapy practitioners
  • Occupational therapy role & OT Drive - Occupational therapy looks at the occupations that help people live the best way they can. (video)
  • The Occupation of Driving - Occupational therapy practitioners can use the AOTA OT-Drive model for guidance when the occupational profile identifies driving related goals as valued occupations. Addressing driving goals begins in generalist OT practice. (video)
  • AOTA's Occupational Profile Template

Many clients have a fear of losing their licenses just by asking for support in driving. As occupational therapy practitioners, we can replace fear of the unknown through empowerment by promoting awareness, providing facts, and offering options.

An older driver may decide that it is time to get a check-up on their driving fitness. These services, described as "driving fitness evaluations," may seem confusing. They range from self-assessments (useful educational tools to help identify potential challenges) to “driving risk assessment” by occupational therapy practitioners who screen for changes in vision, physical ability, and cognition, to a comprehensive driving evaluation performed by an occupational therapy driving rehabilitation specialist. Older drivers and their family members need to understand the driving service they are getting. An occupational therapy practitioner is here to support clients and their families to act on the results meaningfully.

• Drivers & family support
  • Driving test and evaluation of the occupation of driving - This video explains how driving tests and evaluations are used for the occupation of driving. (video)
  • Fitness to Drive Screening Measure - Developed by occupational therapy as a screening measure, caregivers and/or family members who have driven with the driver in the last 3 months can rate a driver's difficulties with 21 driving skills, through this online screening. (video)
    
    
• Occupational therapy practitioners
  • Navigating the Driving Journey - Support older drivers in their driving journey. (video)
  • Driving Rehabilitation in Occupational Therapy - Learn more on driving rehabilitation in occupational therapy. (video)
  • OT programs address driving (driving rehabilitation)

When clients realize their needs have increased, occupational therapy should provide options about mobility and transportation solutions. The instrumental activity of daily living (IADL) is fundamentally about safe mobility, recognizing that questions of “driving” are front of mind for many clients. Considering mobility as a passenger for those who identify as a driver requires a thoughtful process of transition.

Occupational therapy intervention is a collaboration between the client and the occupational therapy practitioner. For many older drivers, the transition from driver to passenger is best described as a process, allowing active drivers to select transportation options to reduce risk for some trips by choosing the passenger seat, such as evening concerts or a medical appointment in a congested setting. Occupational therapy intervention aims to recognize the factors and build awareness of possible ways a client can continue to drive safely for as long as possible.

Awareness & interventions

Awareness: Can OT have a vision of solutions? What interventions could I imagine?

• Physical changes
  • Loss of right lower leg and foot/amputation (compensate by physically adapting the vehicle to navigate and control vehicle using hands)
• Sensory changes
  • Loss of feeling in feet or hands/neuropathy ((compensate by physically adapting the vehicle to navigate and control vehicle using limbs that can feel and control)
• Vision changes
  • Some forms of vision loss can be addressed through the specialized skills and equipment offered for Low Vision Driving (trained in the used of specialized vision aids some states will license drivers meeting criteria)
• Memory and Cognitive changes
  • Early stages of memory loss can be addressed through awareness building and use of compensatory strategies, such as careful route planning (familiar routes) and reduced distractions (no radio or extraneous conversations)
• Distinct terms and services (Transportation Research Board's (TRB) Transportation Research Circular, 2016)

• Drivers & family support
  • The National Highway Transportation Safety Administration (NHTSA) offers many online resources to help older drivers learn how to best approach driving when faced with certain medical conditions. Browse their selection of YouTube videos, starting with an Introduction to Medically At-Risk Driving and How to Adapt Your Vehicle to explore all of your options for the safest choices.
  • YouTube Videos About Driving with Medical Conditions from the National Highway Traffic Safety Administration (NHTSA)
    • Alzheimer's Disease
    • Diabetes
    • Parkinson's Disease
    • Severe Arthritis
    • Sleep Apnea
    • Stroke
    • Vision Disorders
      
      
• Occupational therapy practitioners
  • Occupational Therapy Driving Interventions - Occupational therapy supports older drivers on available options and interventions. (video)
  • We’re Team YOU in the Driving Journey - Occupational therapy works with a team of health professionals to provide the best care for our clients. (video)

For many, the transition away from safe and competent vehicle operation is a process, with incremental changes to be recognized and addressed. For others, the changes may be catastrophic and abrupt, such as following a severe stroke or advanced dementia that eliminates driving as a safe and responsible option. When older drivers need to adjust to changing mobility needs, families and friends can help support them in this transition. As an ideal, awareness of resources for independent community mobility should be explored and understood long before driving cessation occurs. An occupational therapy practitioner with the breadth of understanding and awareness of resources is the sought-after professional to assist in the driving journey.

Driving Cessation Program - Offers information and support for individuals who will likely face the need to stop driving, and their families.

• For individuals facing a debilitating condition that interferes with memory and judgment, such as dementia, the individual themselves cannot be expected to retain or "remember” that they no longer are licensed to drive.
• Family support systems can be guided and empowered by an occupational therapy driving cessation program to understand the losses and how they translate to driving risk.
• Acknowledging that the safe decision is to not drive, the occupational therapy practitioner, older driver, and family/support will work together to develop strategies that eliminate access to a vehicle and ideally develop alternative means for the non-driver to access the community.
• The sooner the planning for this transition, the more robust the network may be to support mobility.

• Drivers & family support
  • Transportation planning
  • Your ride is here
  • ChORUS transportation planning tool
  • CDC My Mobility Plan
    
    
• Occupational therapy practitioners
  • Finding the Best Choices for Older Drivers - Occupational therapy can assist older drivers in making the best and safest driving choices. (video)

• Association for Driver Rehabilitation Specialists (ADED)
• Clearinghouse for Older Road User Safety (CHORUS)
• National Highway Traffic Safety Administration (NHTSA) – Older Drivers
• The National Mobility Equipment Dealers Association (NMEDA)

• Safe Driving for a Lifetime
• Your Road Ahead: A Guide to Comprehensive Driving Evaluations
• We Need to Talk: Family Conversations with Older Drivers
• At the Crossroads: Family Conversations about Alzheimer's Disease, Dementia & Driving

A micro credential is issued upon completion of a set of required thematically connected courses and three essentials courses that are specifically chosen for the micro credential that you are earning. The micro credential provides acknowledgement of your growing knowledge base and can either be completed as a step to the professional certificate or completed for its own merits without advancement to a certificate—it is considered a stand-alone designation.

Explore microcredential options:

• Driving and Community Mobility Foundation Badge
• Micro Credentials and Professional Certificates
• The Driving and Community Mobility Micro Credential

This Course Bundle

• The Ethical and Professional Obligation to Address Driving When Delivering Occupational Therapy Services
• The Impact of Visual Dysfunction on IADLs Including Driving and Community Mobility
• Community Mobility: Interventions for Functional Cognition
• The IADL of Driving & Community Mobility: Understanding the Client, Occupation and Environment
• Occupational Therapy Intervention: Driving & Community Mobility Priorities for Older Adults
• Screening and Evaluation of Driving Risk

Additional Required Courses (these must be completed before earning this microcredential and are NOT included in this course bundle):

Essentials Courses:

• Promotion, Prevention, and Intervention in Mental Health
• Introduction to Functional Cognition
• Population Health: Discovering New Opportunities