Aging & Driving: Making Informed Decisions That Support Independence & Safety

“It is easy to say, ‘just give up the keys’. It is important for me to stay active, and if I don’t drive I am stuck in the house forever. I can’t live that way.” – Quote from older adult driver

“I am worried about my dad. He has had several ‘fender benders’ over the past year. There is always a good reason, but this never happened before. I am worried about his safety, and the safety of others. But it is so hard to bring this up. Driving is the key to his independence. He would go right down the tubes if he couldn’t get out of the house.” – Quote from family caregiver

“The good news is that people who keep track of changes in their eyesight, physical fitness and reflexes may be able to adjust their driving habits so they stay safe on the road.” – Quote from the US Department of Transportation/NHTSA

Older Driver Safety Awareness Week – December 2nd – 6th

On December 2nd we recognize Older Driver Safety Awareness Week. This is a great week to get more immersed in the needs of older adults and their family caregivers. This is also a great time share best practice tools and approaches that drive independence, safety and quality of life.

I have been very fortunate to spend many years working with older adults and have benefited from important conversations related to the issue of safe driving. Many of the older adults I spoke with lamented that most articles are written about the older adult, as if the older adults aren’t reading. It was also common for older adults to become very defensive when reading/hearing that they cannot drive safely. I wonder if we have done enough to truly understand the needs of older adults with respect to driving decisions. The quotes above captured the dilemma that we face with this important issue.

Older adults value work and volunteerism

A recent study published in Gerontology (Curl, A. 2013) entitled, “Giving Up the Keys: How Driving Cessation Affects Engagement in Later Life,”offers results from a study of the impact of driving cessation on 4,788 older adults. This study found that the greatest impact for older adults was the inability to maintain valued volunteer and work activities. Most people would assume that the greater impact would be with social activities, but this was not the case. This article demonstrates the benefits of assessing for the educational, emotional and mobility needs of older adults.

Proactive discussion and planning are critical

The study mentioned above offers that proactive discussion and planning between older adults and their family/professional caregivers often drives the most positive outcomes. However, discussion and planning are easier said than done. I think that there is often a disconnect between older adults, family caregivers and primary care providers. Older adults are often reluctant to share their concerns, for fear that they will have to “give up the keys.” Family caregivers often feel a great sense of guilt and anxiety when approaching their parent/grandparent about driving concerns. Primary care providers also find it difficult to assess and manage driving challenges given the complexity of the situation and brevity of office visits.

Occupational Therapy is the key to expert assessment, support and mobility

“The American Occupational Therapy Association (AOTA) believes that occupational therapy practitioners have the skills to evaluate a person’s overall ability to operate a vehicle safely and provide rehabilitation, if necessary. Many are specially trained in the full scope of driving rehabilitation.” AOTA

“Occupational therapy practitioners work with older adults as well as their families and caregivers, offering individualized assessment. They can identify individuals’ unique challenges and find strategies that will help them live life to its fullest by keeping them active, healthy, and safe in their communities.” AOTA

The good news is that there are occupational therapists who are specially trained to support older adults and their families with driving decisions. As mentioned in the two quotes above from AOTA, OTs have the skills to support older adults and their families with:

• Understanding how aging can effect driving
• Assessing driving skills and needs
• Identifying adaptive driving equipment and technologies
• Planning alternative transportation if needed

The best way to find an Occupational Therapist is to ask your primary care provider for a referral. You can also visit www.aota.org to find an area therapist.

In many cases, older adults and/or their families will need to pay out of pocket for the driving assessment. Medicare and most private insurance does not typically cover a driver’s assessment. The average cost for a full assessment will often range from $200 to $400. A one-hour driving rehabilitation session may cost between $80 and $100. There may be additional costs for adaptive equipment that is not covered by Medicare or private insurance.

Your “Driving Independence” Action Plan and Toolkit

If you are concerned about driving safety, review the Action Plan and Toolkit below and Take Action!

Learn how aging can affect driving 

• Many older adults are safe and excellent drivers
• Aging can cause changes in:
  • Vision
  • Hearing
  • Coordination
  • Reflexes
  • Physical strength
  • Attention and reaction time
  • Memory
  • Judgment
  • Emotions (anxiety)

• Tools:
  • http://www.aota.org/Conference-Events/Older-Driver-Safety-Awareness-Week/Monday-Full-Article.aspx
  • http://www.thehartford.com/mature-market-excellence/publications-on-aging

Learn how dementia can affect driving and how to manage

• Tool:
  • http://www.alz.org/search/results.asp?q=driving&as_dt=i#gsc.tab=0&gsc.q=driving&gsc.page=1

Learn about Driving Assessments

• Tool:
  • http://www.nhtsa.gov/people/injury/olddrive/Driving%20Safely%20Aging%20Web/index.html
  • http://www.thehartford.com/mature-market-excellence/driving-assessment
  • http://seniordriving.aaa.com/evaluate-your-driving-ability

Find a Driving Assessment Specialist/Occupational Therapist

• Tool:
  • http://myaota.aota.org/driver_search/index.aspx

Improve driving skills

• Tool:
  • http://www.aarpdriversafety.org/?CMP=KNC-360I-GOOGLE-DSP&HBX_PK=Safe_1&utm_source=GOOGLE&utm_medium=cpc&utm_term=Safe%2B1&utm_campaign=G_Branded%2BDriver%2BSafety&360cid=SI_56146246_3772371478_1

Learn about adaptive equipment for a car

• Tools:
  • http://www.aota.org/en/Conference-Events/Older-Driver-Safety-Awareness-Week/Thursday-full-article.aspx 
  • http://www.car-fit.org

Consider other forms of transportation

• Losing the ability to drive is a major life change that is very difficult to cope with. There are many older adults that have adjusted and found other forms of transportation such as:
  • Public transportation
  • Family or friends
  • Non-medical home care
  • Walking
  • Taxi
  • Grocery stores that deliver
  • Community shuttle buses
  • Trips with places of worship

Advocates for increased mobility programs for older adults

• http://www.apta.com/resources/reportsandpublications/Documents/enhancing_options.pdf
• http://www.aarp.org/livable-communities/act/walkable-livable-communities/info-12-2012/funding-the-public-transportation-needs-of-an-aging-population-2010.html

For Family Caregivers and Friends – Talking about Driving Concerns 

• http://www.thehartford.com/mature-market-excellence/family-conversations-with-older-drivers
• http://www.aarp.org/home-garden/transportation/we_need_to_talk

For Healthcare Providers – Get more immersed in best practice guidelines 

• http://www.aota.org/Practice/Productive-Aging/Evidence-based.aspx
• http://myaota.aota.org/shop_aota/prodview.aspx?TYPE=D&SKU=2210

I hope that this blog has been informative and helpful.

It would be great to hear other tools, resources, best practices and experiences that you have had. Please add any thoughts in the comment box below. Thank you.

For more information, please review our Aging & Driving Resources.