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Wednesday: Screening and Evaluations

AOTA's Older Driver Safety Awareness Week seeks to raise awareness and increase the availability of education about the aging driver's options. Each day of the week, AOTA spotlights a different aspect of older driver safety.

Following a family conversation an older driver may decide that it is time to get a check-up for his or her driving fitness. Checking up one's driving fitness is important because driving requires complex physical, visual, and cognitive abilities. These abilities can change in subtle ways, such as difficulties driving at night but having no problems driving in the daylight.

Driving fitness evaluations range from self-assessments, which can be useful educational tools to help identify potential challenges, to a comprehensive driving evaluation from an occupational therapy driving rehabilitation specialist.

"Driving evaluations by occupational therapists are necessary for individuals living with medical conditions that may affect the skills required for driving," says Anne Dickerson, PhD, OTR/L, FAOTA. "Driving school instructors are trained to address and focus on the rules of the road and the safe control of the vehicle, , but not the medical condition faced by the senior driver. Select an occupational therapy practitioner who is trained and/or certified as a driving rehabilitation specialist [CDRS, or SCDCM] if the driver is concerned with the effect of his or her medical condition on driving safety."

When preparing for a comprehensive driving evaluation, older adults need to present the truest picture of their current functional level. "I recommend making no changes to the older driver's routine, such as medication schedule, sleep pattern, meal intake, etc. prior to the appointment," says Meredith Sweeney, OTR/L, CDI, CDRS. A driving evaluation should measure drivers at their best, so a good nights sleep and healthy nutrition are the best way to prepare. "The older driver should be involved in the scheduling process, as the opportunity to ask specific questions to the occupational therapy driver rehabilitation staff typically decreases anxiety."

It is also important for older drivers and their family members to know what will happen at the evaluation, and because every facility is different, that question needs to be asked before making an appointment. "Generally, there will be a clinical component that may last approximately 1 hour and consists of tests of vision, physical abilities, memory, and 'quickness' of mental functioning," says Dickerson. "There is usually a break and then the person is asked to drive in the facility's vehicle, on roads in the neighborhood, for about an hour. It is important that the older driver is prepared to be driving a different vehicle for the driving test." The testing vehicle is equipped with an instructor brake, to ensure safety for driver and evaluator.

Families should plan to have an adult child or another family member attend the evaluation to help with the initial interview that reviews driving history and medical history, to have another set of ears when hearing the results, to have the information to assist with recommended adaptations, and to have family or friends prepared to help with planning for driving retirement if that is the recommendation.

"The therapist can assist the family in talking with the older adult if cessation is necessary and just the opposite—the therapist can help the family understand that the older adult can learn to make judgments that are safer or use adaptive equipment that might make it easier to get in and out of the car or improve visibility" to maintain driving, says Dickerson.

"The driving rehabilitation assessment is often viewed as a mechanism by which older drivers lose their licenses," says Carol Wheatley, OTR/L, CDRS. "In actuality, the focus is on determining the means, such as adaptive equipment or strategies, to enable the person to continue to drive safely."

If you are you looking for an evaluation tailored individually to you, looking at your strengths and your limitations, and generating a plan for your continued safe mobility, an occupational therapy driving evaluation will offer the following:

  1. Identify your strengths and any changes in vision, physical ability, and/or cognition that may pose a risk for driving safely.
  2. Recommend how you might strengthen skills, compensate for weaknesses, and develop a relationship with the driving specialist to work together to explore every option.
  3. Prioritize your goal to continue driving safely, but recommend a plan to stop driving now or in the near future if changes in your skills and abilities are too severe, placing you or others in your community in harm's way. .
  4. Remain focused on transportation and participation in your community. The occupational therapy professional will work with you to identify the alternative modes of transportation that would work for you, and provide the support you need to get you where you want to go when you want to get there.

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