DRIVING IN THE ELDERLY

REFERENCE LIST

Care Pathways, (2013). Home Care Transportation Services. Retrieved from: http://www.carepathways.com/TRANSx.cfm

Layton J. (2013) How does the aging process affect driving ability. Retrieved from

http://health.howstuffworks.com/wellness/aging/aging-process/age-and-driving.htm

New Zealand Association of Occupational Therapists (2006). Assessing fitness to drive. Retrieved from http://www.aa.co.nz/assets/about/events/aa-def/pdf/senior-driver-nzaot-assessing-fitness-to-drive.

New Zealand Association of Occupational Therapists (2006). Driving assessments. Retrieved from http://www.nzaot.com/about-occupational-therapy/driving-assessments.php. 

Saisan, J., White, M., Robinson, L. (2013). Age and Driving. Retrieved from http://www.helpguide.org/elder/senior_citizen_driving.htm

INTERVIEW WITH GRANDFATHER

Questions

1. Do you still drive?

Yes I do.

2. When did you start driving?

As soon as I could, back in my day I was driving motorbikes, tractors at the age of 13 and then I got my license as soon as I could. We lived on a farm so driving was just part of my everyday life from a very young age.

3. Why is driving important to you?

Driving has always been something really important to me, not only because it gets me where I want to go but I was diagnosed with Polio when I was 21 years old and since then I haven't ever been able to walk properly again. Driving enables me to get to the places I need to go. Since Polio my muscles and joints have deteriorated so I do a lot of swimming to keep me healthy and fit as possible. I swim every day and if I didn't have a car to get me to that pool I would not be happy!!!

4. How would you feel if you could no longer drive?

I don't know what I would do if I couldn't drive. I would feel very helpless. Driving is the one thing I can do that I don't need help with. I have had to ask for help my entire life and as I am getting older my body just cannot do the things it used to.

5. Would you consider different transportation services when you do have to stop driving?

Yes I would if I had to, but then it almost seems as though I would have to plan my days out according to bus schedules and taxi services.

6. Are you noticing any warning signs that your driving is being affected?

No I have done the driving test and passed. My reactions are still pretty good however I do have to wear my glasses when I drive as my vision has deteriorated. I also experience the occasional stiff shoulder and neck muscles when turning my head to reverse etc. 

7. When do you think you will stop driving?

I would stop driving if I was a danger to myself or to somebody else. 

8. Any last thoughts? 

It wouldn't be the same if I couldn't drive. It would feel as though my life would be over.

I cannot sit around in the house all day waiting for time. 

To me that would be sitting around waiting to die and I don't want to do that. 

Me and my Granddad John

EMOTIONAL AFFECTS OF LOSS OF LICENCE

The emotional affects of not being able to drive is definitely something to consider as there is definitely a great loss of independence that comes with turning over the keys. Families have a responsibility to do something if there loved one is no longer a safe driver. 

But when does it seem okay to step in and take somebody’s independence? 

Freedom and independence is of very high value for all of us and loosing the ability to drive can have a major emotional impact for the elderly. 

They may have to rely on there families and friends to get there everyday tasks done leaving them feeling helpless and frustrated. It is important to be supportive during this time because this is major lifestyle change, which will take a lot of time and getting used to. 

OCCUPATIONAL THERAPY DRIVING ASSESSMENTS

The New Zealand Association of Occupational therapists, 2006 gives a detailed explanation of the driving assessments administrated by occupational therapists.

Assessments are conducted by occupational therapists that specialize in driving assessments. These usually begin with an off-road assessment in the therapist's office. This part of the assessment may take up to two hours. After that, the occupational therapist will take the person for an on-road driving assessment.

The Off Road Assessment

The Occupational Therapist needs to know:

1. Is their driver’s license current?

2. Where the client normally drives?

3. Are there any residual physical problems, which may affect driving?

4. What type of car they drive?

-       Hemi paresis

-       Tone

-       Functional Movement

-       Co-ordination

-       Sensation

-       Visual field deficits: If present then a referral is made to an Optometrist for visual testing.

To assess Cognitive Function a computer-based program called the CanDAT (Canterbury Driving Assessment Tool) is typically used.

What does the CanDAT Assess?

• Vision (basic screening)

• Reaction Time

• Memory

• Speed of Information Processing

• Movement Speed

• Visual Spatial Ability

• Divided Attention

• Complex Attention

• Planning

The off road assessment will also look at the client’s knowledge of road rules and signs.

The On Road Assessment

The on road drive is undertaken in the individual’s own car or one of the assessment cars if required. The assessment is undertaken by a driving instructor and the occupational therapist. The driving instructors job is to give directions and risk manage that is intervening in the driving if required.

The drive begins in the individual’s own area and covers places where they would normally drive. Part of the assessment drive will be in less familiar areas and will involve different driving situations such as the local shopping area, suburban and back streets and the motorway or highway if appropriate.

The On Road Assessment is NOT a driving test of the type required to sit or retain a Driver’s License. The assessment focus is on a range of behaviours, which can be associated with cognitive function.

These include:

-       The ability to apply priority rules.

-       The ability to make decision in a reasonable time acting appropriately.

-       Observe and recognise signs (includes knowing you are at a give way or stop sign).

-       Reacting in time to hazards, i.e. late breaking for other vehicles, intersections, bends in the road, pedestrians, including inappropriate stopping for empty pedestrian crossings and intersections.

-       Selecting correct lanes

-       The ability to self navigate from point to point selecting an appropriate route.

The assessment also looks for pre-existing habits such as:

-       Failure to blind spot check when moving off and with lane changes.

-       Stopping too close to the car in front.

-       Following too close- two-second rule.

-       Minor speed limit infringements.

-       Failure to consistently indicate.

-       If a manual car

-       Clutch coasting

-       Neutral coasting

-       Occasional incorrect gear selection

-       Riding the clutch

When both parts of the driving assessment are finished the occupational therapist will write a report outlining their observations and providing a professional recommendation. Occupational therapists have no power to grant or revoke a Driver’s License. The occupational therapist recommendations may be that they can continue to drive however with limitations, such as time of the day, distance and automatic vehicle only.

This report will be sent back to the GP who asked for the assessment to be done. The GP will read the report then decide whether or not they consider the person medically fit to drive the classes or endorsements necessary for a renew of license. If the GP signs the medical certificate confirming that the person is fit to drive, then they can continue with applying for driver licensing application.

References

New Zealand Association of Occupational Therapists (2006). Assessing fitness to drive. Retrieved from http://www.aa.co.nz/assets/about/events/aa-def/pdf/senior-driver-nzaot-assessing-fitness-to-drive.

New Zealand Association of Occupational Therapists (2006). Driving assessments. Retrieved from http://www.nzaot.com/about-occupational-therapy/driving-assessments.php. 

HOW TO TALK TO A LOVED ONE ABOUT DRIVING CONCERNS

Having concerns about your loved ones driving safety is completely normal and often can be a very sensitive issue to talk about. A driver’s license can signify more than the ability to drive a car, it can be a symbol of freedom, independence and self-sufficiency. Therefore it isn’t something you want to take away from them if there driving is of a sufficient standard. However when you are concerned for their safety and the safety of others it is time to talk to the older friend or family member about their driving and your concerns for them. As this isn’t an easy position to be put in, Saisen et al, 2013 describes some important things to remember when talking to the elderly person.

First of all be respectful as for many seniors driving is an integral part of independence. You need to give specific examples like “You just can’t drive safely anymore.” And outline concerns that you have noticed, such as “You have a harder time turning your head than you used to,” or “You braked suddenly at stop signs three times the last time we drove.”

Sometimes finding more than one family member or close friend to help you through this talk may help.  A loved one may also listen to a more impartial party, such as a doctor or driving specialist. It is important that if you are having the talk then you need to help them find alternatives to driving and possibly offering rides when possible may also ensure how much you care about them.

Its time to turn over the keys!!!

References

Saisan, J., White, M., Robinson, L. (2013). Age and Driving. Retrieved from 
http://www.helpguide.org/elder/senior_citizen_driving.htm

TRANSPORTATION ALTERNATIVES

Transportation is crucial for elderly people as they have to be able to attend doctor’s appointments and carry out there grocery shopping each week. The availability of adequate transportation enables elderly people to live independently in their communities. Many elderly people rely on family and friends for transportation however for others who do not have family around it is necessary to find community resources that provide transportation. 

Care Pathways 2013, indicates some of the following transportation ideas for seniors who are no longer able to drive and are looking for transportation alternatives. 

Public transportation: This will vary depending on where they live. If they live in an area that is well connected with public transportation, it can be a very handy way to get around. It is important for elderly people to check their local public transportation options and ask about reduced prices for older adults.

Ride sharing: Family members, friends, and neighbors may be a resource for ride sharing. 

Community shuttles/senior transit: The local community may have shuttle service available, especially for medical appointments.  They can offer door to door service and can take wheelchairs however will require advanced notice. Fees are usually required with door-to-door services but will often have senior discounted rates. 

Taxis or private drivers: Taxis may be a good option for quick trips without a lot of prior scheduling. There are often reduced prices for seniors. 

Walking/cycling: Walking or cycling if you can is a great way to not only get around but also to get some exercise. Regular physical activity lowers your risk for a variety of conditions, including Alzheimer’s and dementia, heart disease, diabetes, colon cancer, high blood pressure, and obesity.

Motorized wheelchairs: Can be a good way to get around if you live in an area with easily accessible stores and well-paved streets.

References: 

Care Pathways, (2013). Home Care Transportation Services. Retrieved from: http://www.carepathways.com/TRANSx.cfm

BENEFITS OF NOT DRIVING

At first life without a car will seem like a major adjustment to deal with. It is normal for you client to feel frustrated and angry when they have been driving their whole life and they may feel ashamed or worry that they are losing their independence. As an occupational therapist you need to remind them that it takes a lot of courage to stop driving and put the safety of yourself and others first. Saisen et al, 2013 lists many benefits to living without a car. The ones I thought mentioning are listed below and they may help people deal with the shock of not being able to drive anymore.

·   Save money on the cost of car ownership, including car insurance, maintenance, registration, and gasoline. These savings can pay for alternative transportation if necessary.

·   Improve your health. Giving up the car keys often means walking or cycling more, which can have a hugely beneficial effect on your health. Regular exercise can help elderly people to boost their energy, sleep better, and improve confidence. It can also help you manage the symptoms of illness and pain, maintain your independence, and even reverse some of the signs of aging. And not only is exercise good for your body it’s good for your mind, mood, and memory.

·   Expand your social circle. While many elderly people have difficulty to accept a ride offer from others they need to find a way of accepting rides that makes them comfortable. For example, offering a friend money for gas, or offering to cook a meal in return for your friend driving.

References

Saisan, J., White, M., Robinson, L. (2013). Age and Driving. Retrieved from 
http://www.helpguide.org/elder/senior_citizen_driving.htm

WARNING SIGNS OF UNSAFE DRIVING

Issues with Health

Conflicting medications

Many medications can interfere with safe driving by slowing reaction time, causing drowsiness and confusion and can also affect the senses and reflexes of the individual. (Layton, 2013)

Eyesight problems

Eyesight conditions may interfere with your ability to focus your peripheral vision and may cause extra sensitivity to light, trouble seeing in the dark, or blurred vision.  (Layton, 2013)

Saisan et al, 2013, recognizes that it is important for the Elderly to ask themselves the following questions:  

Can you easily see traffic lights and street signs?

Can you react appropriately to drivers coming from behind or the side?

Hearing problems

When hearing decreases you miss out on important cues to drive safely.

Can you hear emergency sirens?

If someone is accelerating next to you?

Honking of a horn?

Problems with reflexes and range of motion

Can you react quickly enough if you need to brake suddenly or quickly look back?

Have you confused the gas and brake pedals?

Do you find yourself getting more flustered while driving, or quick to anger?

Is it comfortable to look back over your shoulder, or does it take extra effort?

Problems with memory

Do you find yourself missing exits that used to be second nature, or find yourself getting lost frequently?

Health problems can make driving very dangerous for elderly people and for everyone else on the road. Recognizing the danger signs is the first step in solving the problem of unsafe drivers on the road. 

References

Layton J. (2013) How does the aging process affect driving ability. Retrieved from
http://health.howstuffworks.com/wellness/aging/aging-process/age-and-driving.htm

Saisan, J., White, M., Robinson, L. (2013). Age and Driving. Retrieved from http://www.helpguide.org/elder/senior_citizen_driving.htm

UNDERSTANDING HOW AGING EFFECTS DRIVING

As people age it is normal for their driving abilities to change and by reducing the risk factors and incorporating safe driving practices the elderly can continue to drive safely long into their senior years. But as occupational therapists we do have to pay attention to any warning signs where age is interfering with driving safety and then make appropriate adjustments to compensate for these loses.

Older adults are more likely to receive traffic citations and get into accidents than younger drivers.

The causes of this are that as we age, factors such as decreased vision, impaired hearing, or slowed motor reflexes may become a problem. You may have a chronic condition that gradually worsens with time, or you may have to adjust to a sudden change, such as a stroke.

Saisan et al, describes how aging results in a reduction of strength, coordination, and flexibility, which can have a major impact on your ability to safely control a car.

For example:

·      Pain or stiffness in the neck can make it harder to look over the shoulder to change lanes or look left and right at intersections to check for other traffic or pedestrians.

·      Leg pain can make it difficult to move the foot from the gas to the brake pedal.

·      Diminished arm strength can make it hard to turn the steering wheel quickly and effectively.

·      A slower reaction time impacts the ability to spot vehicles emerging from side streets and driveways, or to realize that the vehicle ahead has slowed or stopped.

·      Lose of ability to effectively divide attention between multiple activities such as keeping track of the many road signs, signals, and markings, as well as all the other traffic and pedestrians, can also become more difficult.

As people age it is critical for them to realize that their driving ability can change. It is very important as occupational therapists to help them recognize these changes and the safety implications for themselves and others.

References

Saisan, J., White, M., Robinson, L. (2013). Age and Driving. Retrieved from http://www.helpguide.org/elder/senior_citizen_driving.htm