Transcript PRESENTATION TITLE HERE

STEERING OLDER
DRIVERS TOWARD INDEPENDENCE THROUGH
DRIVER REHABILITATION SERVICES
November 7, 2012
Holly Alexander, OTR/L, CDRS
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.
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.
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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)
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
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.
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
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.
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
TEAM APPROACH
REHABILITATION PROFESSIONALS MUST WORK
TOGETHER AS A TEAM
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Physical Therapists
Occupational Therapists
Speech Therapists
Nurses
Social Workers
Physician Assistants
Physicians
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.
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
ROLE OF SOCIAL WORKER
AND NURSES
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Discuss areas of concern related to driver safety
Direct client to appropriate resources
Inform team of findings
Document, document, document
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
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.
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).
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.
RED FLAGS/WARNING SIGNS
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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
RED FLAGS/WARNING SINGS
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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
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.
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
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
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
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
ALTERNATIVE TRANSPORTATION
RESOURCES
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Public transportation
Senior shuttles
Taxis
Area Office on Aging
Religious Organizations
Local VFW Volunteer Drivers
ALTERNATIVE TRANSPORTATION
RESOURCES
• Volunteer Driver Programs
• Para transit Services
• Transportation Vouchers Programs through Area
Agencies on Aging
• County/Borough Transportation Services
ALTERNATIVE TRANSPORTATION
RESOURCES
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Dementia Friendly Transportation
ADA Para transit
Dial-a-Ride
Curb to Curb Service
Door to Door Service
Door through Door Service
LOCATING A DRIVER
REHABILITATION SPECIALIST
• American Occupational Therapy Association (AOTA)
Driving Database. www.aota.org/olderdriver/
• Association for Driver Rehabilitation Specialists (ADED).
www.driver-ed.org
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.
• 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.org
EDUCATIONAL MATERIALS
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American Society on Aging: www.asaging.com
Community Transportation Association of America:www.ctaa.org
Easter Seals Project Action: http://projectaction.easterseals.com
National Association of Area Agencies on Aging: www.n4a.org
EDUCATIONAL MATERIALS
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The Hartford Group: www.thehartford.com/alzheimers
National Highway Traffic Safety Administration: www.nhtsa.gov
Automobile Association of America: www.seniordrivers.org
American Association of Retired People: www.aarp.org
EDUCATIONAL MATERIALS
• Alzheimer’s Association: www.alz.org
• National Institute on Aging: www.nia.nih.gov/
• Adaptive Mobility Services, Inc (specializing in educational
workshops): www.adaptivemobility.com
• Mobility Assessment Program and Partners in Safety
(videos) by L. Hunt [email protected]
TIPS FOR SAFE DRIVING
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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.
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.
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.
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
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
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.
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.
THANK YOU!
[email protected]
[email protected]