Behind the Wheel: Occupational Therapy and Older Drivers

Elderly couple standing alongside open car door

By Ashley Opp

Why would someone who has had a good driving record for more than 50 years need to have their driving skills evaluated?

The process of aging affects everyone, even the most prudent and capable drivers. Yet often the fear of losing independence overrides the fear of causing an accident. Occupational therapy practitioners who specialize in driving rehabilitation understand the emotions linked to driving and independence. With sensitivity to such issues, they can evaluate your driving skills and make recommendations to increase safety.

Often physicians or family members suggest that an older driver have their driving skills evaluated. Some older drivers simply want to make sure they are safe, and seek the help of an occupational therapy practitioner. In other cases, the state can insist that an older driver be evaluated if someone has reported him or her—at which point the test becomes mandatory.

Occupational therapy practitioners are uniquely qualified to evaluate driving skills, make recommendations for adaptive equipment or vehicle modifications, and assist with the emotional aspects of driving retirement. “We have the medical background to understand the aging process, diagnoses and their implications, and [the effects of] medications. We also have the ability to look at the whole picture and consider all issues in regards to the occupation of driving for each person,” says Susan Pierce, occupational therapist and owner of Adaptive Mobility Services, Inc. in Florida.

Older drivers typically enter an occupational therapy driving evaluation clinic with a fair amount of anxiety. Although this is understandable, older drivers should understand that occupational therapy practitioners excel at helping people do the things they want to do—such as driving. “We’re not these big monsters,” insists Pierce. “We want someone to drive as long and as safely as they can.”

The average evaluation costs about $250-$500 depending upon the individual program. At this time, Medicare does not cover a driving evaluation in most states. Driving evaluations differ slightly from clinic to clinic, but the process is mainly the same and typically takes about 2 hours.

First, the practitioner looks at physical abilities, reaction time, vision, and cognitive abilities, such as memory, judgment, and problem solving. Then the practitioner and client do a behind-the-wheel evaluation to assess the same skills in traffic. “Occupational therapy practitioners can isolate what happens while driving and find out what changes could be made to help them drive more safely,” says Theresa Robbins, an occupational therapist at Suburban Hospital in Bethesda, Maryland.

Some occupational therapy practitioners interview family members to gain additional insight into the client’s habits; practitioners are skilled at facilitating dialogue and reading between the lines to get the information they need from the driver and family members in order to make the best decision.

Finally, the practitioner talks about the results and makes recommendations. In some cases, technological modifications to the vehicle suffice, such as raising the seat or installing a left-foot accelerator. “Sometimes it’s as easy as showing a client how to use the adjustments already available in their car,” says Pierce. Depending on individual state laws, restrictions may also be an option, such as staying off the interstate and not driving at night. But, as Pierce points out, most older drivers have already imposed such restrictions on themselves.

Occasionally, occupational therapy practitioners must recommend that someone retire from driving. “We are very careful about how we inform drivers that they need to retire,” says Robbins. “We go through their strengths and weaknesses and describe what makes them safe and unsafe.”

Occupational therapy practitioners also help older adults find alternatives when they must stop driving. “We don’t leave clients high and dry,” says Pierce. Practitioners can show clients what resources are available in the community, such as public transportation and grocery delivery services. In cases of cognitive impairments like Alzheimer’s disease the practitioner focus on strategies and resources that address the unique challenges of providing the safest and most appropriate alternatives for continued mobility. “Occupational therapy is a ‘helping’ profession,” says Pierce, and practitioners want to help clients cope and stay active.

Family members tend to have immense interest in the driving evaluation results. According to Robbins, when family members doubt someone’s ability to drive they may prefer to have an unbiased opinion from a medical professional. In addition, the older driver usually is more accepting of recommendations if they come from an outside person. “Nobody wants to be the ‘bad child’ and suggest that their parent should no longer drive,” says Pierce. “They usually don’t talk about it until something happens.”

This lack of communication is where family members typically make their biggest mistake. According to Robbins, in the worst case scenario, being afraid and not taking the step to talk to the driver can result in someone having an accident.

Pierce concurs that simply ignoring the issue is extremely damaging. “Even baby boomers need to think ahead to driving retirement and start talking about the subject. It’s stressful, but you don’t want to wait until something bad happens.” She recommends a valuable family communication brochure published by The Hartford, titled “We Need to Talk: Family Conversations with Older Drivers.

It is important that families begin the conversation about driving retirement and make plans with the entire family. “We need to plan ahead,” says Pierce, “just like we plan for retirement from work.”

Ashley Opp is AOTA’s production editor.

Find an Occupational Therapy Practitioner

Physicians, case managers, and other medical professionals can refer you to occupational therapy practitioners who specialize in driving rehabilitation. You also can visit AOTA’s online database of driving programs and specialists to find a practitioner in your area.

For More Information

AOTA’s Older Driver Web site

Community Mobility

National Institute on Aging: Older Drivers