Template for Professionals who Work with Aging Individuals
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Transcript of Template for Professionals who Work with Aging Individuals
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.
Keeping Drivers on the Road:
The Occupational Therapist’s Role
Your name
Your organization
Date/name of conference/group
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
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….
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1990 2000 2010 2020 1990 2000 2010 2020
Males
Females
Crash Involvement Crash Involvement
http://search.cga.state.ct.us/dtSearch_lpa.html
• 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.
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 Question: When? How do I know?know?
Older drivers begin to self-restrict Women often stop prematurely
Act to Promote Driving RetirementAct to Maximize Ability
Physically or Mentally
Competent
Perceived Competent
Appropriate
Perceived Incompetent
Inappropriaterestriction
Physically or Mentally
Incompetent
Perceived Competent
At Risk
Perceived Incompetent
Appropriate Restrictions
Individuals with dementia are at increased risk for unsafe motor vehicle operation
Becoming lost in familiar areas Incorrect turning & lane deviation Impaired signalingDecreased comprehension of traffic
signsUnaware of not being a responsible
driver
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
Dementia - Special issues with driving Can it be done by DMV evaluators? Or need specialists?
North Carolina - 11 Driving Specialists12,585 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
•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
Specialized trainingADED – Association for Driver
Rehabilitation Specialist 80% of DRS are occupational therapists CDRS – Certification administered by
ADEDAmerican Occupational Therapy
Association Specialty Certificate in Driving and Community Mobility
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.
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
• 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
Client History Physical Assessment Visual/Perceptual Cognitive Behind the Wheel Recommendations
• Diagnoses, onset, functional limitations
• Secondary diagnosis• Medications side effects• Years of driving experience• Restrictions• Estimated amount of driving
• Type of vehicle
Strength and reach
Sensory changes
Ability to get in and out of a vehicle
• Looking out the center of the windshield
• Supportive seat
• May need to tilt the steering wheel
AcuityEfficiency of visual systemContrast sensitivityGlare vision & glare recoveryNight vision
Eye Movement
Central VisionPeripheral
Vision
Depth Perception Dynamic Perception
Attention and concentration
Following directions Judgment and
insight Knowledge of the
road Memory, planning,
and organization Self-control
Entry Skills – Adjust mirror, seat, and seat belt
Operates controlsRight and left turns, backing up, and
parking
Structured Parking lot Quiet neighborhood City driving with increasing
traffic and turns Highway driving
Client’s Home Area
Decision making and route planning
Lane changesSpacingVisual scanningHighway/Interstate
driving as appropriate
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
• Maximize physical, visual and cognitive health
• Consider medications• Maintain a realistic
perspective related to experience, ability, and the driving environment
Maximize VISION and the aspects of driving that affect vision.
Understand “dangers” such as crowded intersections, unprotected left turns, driving when stressed or fatigued
• Cease night driving• Compensate for decreased reaction time• Avoid in-car distractions• Plan ahead
• Communicate • Check mirrors• Implement safe
lane changing procedures
• Implement safe backing procedures
• Look for driver opportunities
• Be proactive when in comes to your safety and public safety
• 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
Driving is a critical IADLNeed to keep safe drivers driving
longerNeed to determine who is safe and
who is unsafeOccupational therapists need to
address driving as an IADL Generalists & specialists CarFit: One option
Your information.