Join us as Griswold Home Care’s Christopher Kelly, M.Ed., Director of Learning & Development, focuses on making informed decisions that support independence, quality of life and safety with aging and driving. There are many older adults who are excellent drivers. However, aging can cause changes in functioning that impact driving skills. As a result, the issue of aging and driving has been both an emotional and controversial topic for many years.
The workshop features five parts:
Part 1: Understand the nature and scope of the Aging and Driving issue.
Part 2: Learn about the aspects of aging that can impact an older adult’s ability to drive safely.
Part 3: Understand best practice approaches for assessing and improving safe driving skills in older adults.
Part 4: Hear real stories and practical tips from expert panelists who have lived and worked through aging and driving issues.
Part 5: Access a Driving Independence Toolkit that offers innovative tools and resources for older adults and their family/professional caregivers.
Family caregivers, professional caregivers, healthcare providers, and those generally interested in learning more about aging and driving are encouraged to view this webinar.
Derek: Happy December. Hope everybody’s having a great month. Welcome to today’s
Solution Series webinar, titled “Driving and Aging: Making Informed Decisions that Drive Independence and Safety.”
This webinar is hosted by Griswold Homecare, an at-home care services company which refers caregivers who provide non-medical personal care, homemaking, and companionship services to the elderly and adult disabled.
This webinar, we have several hundred people registered, and we have several people still joining the webinar. Thank you for spending a few moments of your time with us today on this great topic.
Our team here in Philadelphia was just chatting before the webinar that this topic is not only very relevant for the season, but also has the opportunity to be polar, and really can be a lightning rod for both healthcare professionals, seniors, and the adult children.
Just in promoting the event and driving registration, we received dozens of social media inquiries and comments on both sides. Both comments that were, “Hey, I’d love to hear more about this topic” and “Hey, I don’t want to hear anyone tell me to take the keys away.”
That’s exactly why we’re here today to talk about this really important topic. Just a few notes. All lines are muted. We will allow opportunities throughout the webinar to do something called brain writing, which we will discuss in just a few moments. We will hold a formal Q&A session at the end of the webinar.
Also, all the tools that will be demoed during the call today will be sent to any of the webinar registrants within 48 hours of the webinar’s close. The call is recorded, and the entire transcript will be made available within two to three days also after the webinar.
With that, let’s get started. Early in December, we do celebrate Older Driver Safety Awareness Week, which is the premise of the webinar today. The AOTA actually is the advocacy group for occupational therapists, and has provided the quote here. They also are the organization that founded the Older Driver Safety Awareness Week.
We thought it was really important just to prime the conversation by reading one of the quotes from the AOTA. “AOTA’s Older Driver Safety Awareness Week aims to promote understanding of the importance of mobility and transportation to ensure older adults remain active in the community. Shopping, working, or volunteering with the confidence that transportation will not be the barrier to strand them at home.”
I think for us at Griswold Homecare and for the presenters, which we’re about to introduce, we think this quote really hits on a unique angle of this topic. When this topic of driving and the aging has taken place a lot in the past, a lot of the topics can really just surround when to take the keys away. Or when to tell your parents that they can’t drive anymore.
That’s certainly not the core focus of this webinar. With this quote, we think it’s core to understanding how to keep anyone really engaged in the community, and certainly driving is a piece of that.
With that, our goals for today. Three very simple goals. We want to understand the nature and scope of driving issues in the older adult population. Learn how occupational therapists can help older adults and family caregivers with driving skills and decisions.
Most important, really the premise of the Solutions Series webinar, is to bring tools that can help you—whether you’re a healthcare professional, an aging adult yourself, or anyone on the call really to provide tools at your fingertips that can help you with this topic.
I want to introduce our panelists for today. Our first panelist is Marv Lawson. Marv is joining us remotely today. We have the Griswold Homecare team in a conference center in Philadelphia, and we thank Marv for his time to spend with us today.
Before we introduce Marv and let him say a few words, I want to list the background that Marv has, which really aligns with today’s topic. Marv is the Director of Occupational Therapy and Clinical services at Fox Rehab in Cherry Hill, New Jersey.
He received his certification in occupational therapy from Temple University. Marv has worked in acute and post-care, both in-patient and out-patient services, and also specifically has worked in homecare under Medicare Part A, and has made geriatric housecalls under Medicare Part B.
Really, really interesting that Marv also is currently the driving rehab specialist at Fox Rehab. Marv, we really appreciate you joining and spending some time with us today.
Marvin: I’m happy to be here to discuss this topic with you and all of your audience.
Derek: Fantastic. Our next presenter is Chris Kelly [SP], director of learning and
development at Griswold Homecare. We like to say that Chris is our architect of the Solutions Series webinar, and has done a lot of research and researched the tools that will be demoed here today.
Chris comes to us, he has a master’s in education. He leads all training and development at Griswold Homecare, and also contributes as a regular blog writer for the Caring Times blog. Previously to Griswold Homecare, Chris was VP of health education at Health Ed, a health and literacy agency in New Jersey.
Chris also has a number of engagements with the Alzheimer’s Association as director of education, and was the activities director and center manager at assisted living facilities. Chris, welcome to the webinar.
Chris: Great, thank you, Derek. Good afternoon, everyone. Really, really excited to
be part of this important webinar and topic.
During my time working with the Alzheimer’s Association, I was involved in many gut-wrenching discussions and decisions related to this topic of aging and driving. We really want to provide a path for those of you who are living and working through the issue.
I just want to echo that we feel very fortunate to have an expert like Marv to join us for the webinar today.
Marvin: My pleasure.
Chris: We’d like to recognize our audience, and really value the fact that we don’t
segment. We have a very mixed and great audience. We want to thank our healthcare providers on the webinar, franchisees, office staff, therapists, people that are working in the driving and aging issue every day for your dedication.
We want to thank the professional caregivers for your amazing care and skill. Family caregivers for your support and determination, particularly again with this challenging issue. Probably most importantly older adults who are living with this issue everyday for your perserverence and for your courage.
As Derek mentioned, we have a great activity that we call brain writing. You’ll notice on your screen there is an orange button with a white arrow. If you click on the arrow, you’ll see on the bottom of your dropdown, you’ll see a chat bar. Rather than wait to the end to comment and question, we really want you to help us to learn from you.
Throughout the webinar, we will be asking you questions. If you have any stories, tools, experiences that you’d like to share, we read them at the end of the webinar. That way we can all learn from each other.
Just very quickly I want to share, we have a very unique process and methodology for designing our webinars. We start with a literature review of anywhere between 20 and 30 peer reviewed journal articles.
We review social media, Facebook, Twitter, a lot of different online portals where people are talking about these topics every day.
We reach out to advocacy organizations like AARP. In this case, because this is such a specialty area, reached out to Fox Rehab to secure Marv for this presentation. Then finally again we learn from you, through the Solutions webinar and your comments on our toolkit.
Let’s begin by reviewing really the scope of this really challenging issue, through the voices of older adults, family caregivers, advocates and researchers. As Derek mentioned, this can be a polarizing topic, so we want to capture everyone’s perspectives.
We have a quote from AOTA. “We all experience physical and mental changes as we age. Slower reaction time, night blindness, pain and stiffness can affect driving skills.” But in emphasis here, “but do not need to prohibit driving.”
On the other side we have the Center for Disease Control saying, “Driving helps older adults stay mobile and independent, but the risk of being killed in a motor vehicle crash increases as you age.”
From the standpoint of dementia and driving, we have the Alzheimer’s Association and Academy of Neurology saying that they agree that a diagnosis of dementia is not a significant indicator of driving risk, and that in fact over 75% of patients with mild dementia are able to pass road tests and drive safely.
We have family caregivers who say, “I’m worried about my dad. He’s had several fender benders over the past year, there’s always a good reason, but this never happened before. I’m worried about his safety and the safety of others, but it is so hard to bring this up.”
Then finally from the perspective of the older adult driver, “It’s so easy to say ‘just give up the keys.’ It’s 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.”
You can see from these many different voices, many different perspectives, that this is a really loaded topic. One of the things that I want to do now is really toss it over to Marv, who’s living this every day. He’s an occupational therapist.
Marv, just based on these quotes and your experience what is your perspective on the overall issue of aging and driving.
Marvin: I think as we were discussing yesterday I believe, what I have seen, and I have
been doing these evaluations and working with older drivers since 1996. What I see is that chronological age is not the determining factor as to whether someone remains to have the ability to continue to drive safely.
It’s not really the chronological age. Rather, it’s the individual person. Sometimes—I was telling this story—I had a driver who I did an evaluation on who was 96 years old, and passed the clinical driving assessment and the on the road assessment beautifully.
By the way, he had a Corvette. Just getting in and out of a Corvette can be a real challenge. It’s not necessarily the determining factor. On the other hand I’ve had much younger drivers, as early as people in their 60s, who really just have lost the ability for one reason or another, disease or injury, have lost the ability to drive safely.
Then we have to take that information and figure out the best way for them to move forward.
Chris: That’s a tremendous takeaway I think for everyone. We talk about aging, but it’s
really about each person’s individual functioning. Thanks for that insight, Marv.
For our first brain writing activity, we’d love for you to go into your chat bar, all of you in the audience, and hear your perspective. You’ve heard the quotes from advocacy and government and family caregivers, older adults.
You’ve heard Marv’s very insightful comment. We’d love to hear those as well, and again, we’ll read these at the close of the webinar.
Let’s shift now and discuss some of the changes that can happen as we age. I just want to emphasize the fact that some of these things can affect driving. It doesn’t mean they will, but these are some things that can affect driving.
Based on our research, some of the most common aging related changes that can affect driving can include vision, specifically depth perception, clarity of vision, particularly at night. Hearing, coordination, particularly when you think about all the multi-tasking when someone does when they drive.
Reflexes, physical strength that it takes to work the pedals. Again, steering, braking. Attention span, given the many distractions that happen when someone drives. Reaction time, memory, judgment, emotions. We highlight anxiety here because anxiety driving can actually affect your composure, particularly when you have to make very quick decisions.
Then also not talked about too much, the fact that older adults are in many cases are taking medications that have side effects, and some of those side effects can also affect driving.
From the standpoint of dementia and driving, which is again a really challenging situation. Some of the changes can include obviously memory in terms of remembering your surroundings, and remembering how to drive, remembering the skills and the steps. Your ability to concentrate while you’re driving.
Coordination and reflexes. The ability to recognize the purpose of objects, and also when you think about traffic signs, traffic lights, the ability to process that information and understand what it means.
The other really important point is that people with dementia often loose insight as part of the condition into their inability to drive or their challenges driving. Even though we heard earlier that 75% in one study were able to drive, there is definitely a point with dementia where a person may not be able to drive, and you may as a caregiver have a very difficult time having that discussion.
Marv, just to ask you a question, when you think about the aging and driving issue, the discussions that happen with dementia and someone without dementia, from an occupational therapist’s perspective, how is that different for you?
Marvin: It’s very different. Also that statistic about the 75% of those with mild dementia
still do okay, that’s probably true. But the question is, we use the global deterioration scale, meaning dementia runs the spectrum from stage one through stage seven.
Depending on where the person is on that spectrum can determine whether or not they are, at that particular moment, still safe to continue driving. Mild dementia, absolutely. What we would do in that case is we would do our testing procedures, our clinical assessment, and then follow that up with the on the road or behind the wheel assessment.
If the person passes, sometimes what we’ll ask them to do is to agree to be retested in six months or a year down the road. The reason for that is that we know that dementias are progressive, they are progressive diseases.
By the way, it’s not just Alzheimer’s. There’s many other dementias as well. They’re progressive diseases, meaning these don’t get better. They generally get worse. We need to be sure that the person is safe on the road not only today, but in six months or a year down the road, and that may require them being retested.
Chris: Great point again. The fact that this isn’t a decision made in a silo, this is
something that really happens over time.
Our first tool that we’d like to share comes from the Alzheimer’s Association, a great, great portal. If you want to learn more about this, there is an actual dementia and driving resource center that is posted on the national association website that we’re showing here.
That includes videos, tips for having the conversation, planning, signs to look for related to unsafe driving, and then other resources.
Very interactive tool, and again these links will be available after the webinar. We won’t show all the tools. One of the other tools that we’ll show on the slide here is the [inaudible 16:30] Crossroads brochure that is put out by the Hartford, which also is a great resource for having discussions related to aging and driving.
You may be wondering, and you may be living through some of this. What are some of the warning signs that driving may be becoming unsafe, and that you may want to reach out to an occupational therapist or talk to your general practitioner?
Based on our research, I’ll read through some of these, and would love to get Marv’s perspective as well. Frequent close calls on the road. When you’re looking at the car and fences and mailboxes around the home, finding dents and scrapes. Getting lost in familiar locations. Missing or misunderstanding traffic signals.
Slow response to unexpected situations. The inability to move the person’s foot from the gas to the brake pedal. Confusing the gas and brake pedals in terms of their purpose. Misjudging gaps in traffic between your car and another’s car. Having road rage.
When you’re driving is causing others to honk or complain frequently, when you become easily distracted. When it’s difficult to turn around to check blind spots when you’re driving, then, also if you find you’re receiving multiple traffic tickets or warnings.
Marv, as you hear me go through these, just based on your experience, are there any that rise to the top as most common?
Marvin: Quite a few of them, actually. Everything that you’ve mentioned there are things
that we look for in our clinical assessment. We have a variety, a battery of assessments that generally address almost all of these things.
With the exception of actually looking at the person’s vehicle, and we do have that as well. We have something called a stationary assessment, which is a driver in vehicle sit.
Then when we do that, we are frequently examining the vehicle, and we’re especially looking at the corners, all four corners of the car, to see if there are scrapes or dents or any telltale signs that the person may be misjudging when they’re parking the car, for example, pulling into a parking space, a driveway, what have you.
Sometimes we look to see if there are scrapes, for example, let’s say just on the left front and the left rear. That could be an indication that the person has a visual field deficit, maybe from a TIA, a transient-ischemic attack, or a mini-stroke.
Or it could be something even more profound, such as their lack of ability to even recognize something on the left side. We look at those pieces for sure when we’re examining the car. We also do something called the delta integration braking response time monitor.
That actually measures braking response time within 1/100th of a second. There are [inaudible 19:35] values for that that a person 65 or older, that they should be able to meet. 1/100th of a second can mean the difference between being able to stop your vehicle and avoid an accident or not.
Also the one other thing there that we really watch for too is confusing the brakes and the gas pedal, because that can lead to really dire consequences.
Chris: Thanks, Marv. Again, the takeaway here is that there’s a science behind this. It’s
very difficult without the skill and the technology and the tools to really do an accurate assessment. You just heard how much detail and how much science goes behind that assessment process, so thanks again, Marv.
Chris: Let’s talk a little bit about the drive assessment. I think the upfront presentation
talks about the challenges. I think there’s good news, in that we can really remove much of the uncertainty and really help older adults and their families make informed decisions. Again, we’ll emphasize the importance of the role of the occupational therapist.
Marv, you’re doing this job every day. I’ve had the great fortune of working with Fox and many occupational therapists. On our slide here, we’re emphasizing the role of educating, evaluating driving skills, evaluating the car, planning, and also supporting the older adult.
If you could provide a snapshot, how would you describe your role as an occupational therapist? Particularly for an older adult and a family that are dealing with this issue?
Marvin: First of all, there are OT generalists who can do what we call community
mobility assessment. That is sort of like a screening tool that we use to determine whether or not the person needs to be looked at a little more in depth with a driving rehab specialist.
There are occupational therapists who go on and specialize, and that’s what I am, I am a DRS, which is a driving rehab specialist. We are trained in looking at all components of driving. It’s exactly a lot of the things that you pointed out before.
We look at things from neuromuscular status to sensory, like for example if somebody has diabetes, we want to be sure that they’re not having neuropathy, especially in the right leg, the right foot, because that [inaudible 22:01] sometimes they get confused and they hit the gas pedal instead of the brake, because they’re not really feeling it.
If there’s a little bit of a cognitive component in there, confusion can very easily happen. These decisions are split-second decisions. Hit the brake, turn right, hit the brake, turn to the left. All of the assessments that we have pretty much let us know the person’s capability.
By the way, some of the deficits that we find are deficits that we can, through therapy, through occupational therapy and physical therapy, we can remediate and fix so that the person can continue driving safely.
That is not true with all deficits, but many deficits remediated.
Chris: Great perspective. Again, at the bottom of the slide here, we have two great tools.
One is actually a great directory where you just literally put the region that you’re from, and you can find a driving specialist like Marv, and also some driving testing centers in your area.
Then for the healthcare providers on the line, we’ve given you a webpage and link where you can either purchase or access the driving and community mobility guidelines for older adults. That is published and placed on the AOGA site.
Some of the key components of a driving assessment, and Marv captured some of this, but medical and driving history, vision and/or hearing, cognitive issues, memory, judgment, and speed of response. Motor function in terms of strength, range of motion, and flexibility.
Then an assessment of driving ability, which can be assessed online. Also on the road as Marv mentioned, and then also through a simulation.
We have a great tool that we’re going to show that is put out, again, by the Hartford. Basically what to expect with driving assessments, which gives you a great description of what a driving assessment is, what to expect with the evaluation.
I think it’s important when, if you’re a family caregiver bringing this up to an older adult, that they understand what a driving assessment is and what they can expect.
I think it’s much easier for them to process and almost look forward to the assessment if they understand what it’s about, what it’s going to look for, how long it’s going to take. I think that can really help with the adoption of that process.
There may be some of you on the webinar, again, older adults that are wondering should I take a driver’s test? We’re giving you two great tools here. The one that we’ll show, again by the Hartford, is the header basically says “all you need to know, are your driving skills good enough.”
As you look through the website, there are questions that are asked. Again, there’s a brief description of the driver’s assessment and where you can go to get those assessments done.
One of the questions that we get once we talk about the driving assessment, which again, we’re hoping today that we’re going to increase the awareness about the assessments, is how you pay for the assessment, particularly older adults who from a financial standpoint may not have the resources.
Marv, again, I know you’re dealing with this every day. We talked earlier about some of the ranges for the initial clinical assessments which we’re showing here, which could range anywhere from $150 to $200.
A full driving assessment, anywhere from $200 to $750, and then the one hour driving rehab and lesson, which could range anywhere from $80 to $150 an hour. We want to emphasize here the fact that these costs can vary based on your region and also based on insurance.
Marv, can you talk a little bit about how the payment process goes and how you support the client and family with understanding the payment process?
Marvin: Sure. We have the person, whoever the referral source is, be it the doctor or a
family member or the patient themselves, they call in. We handle that over the phone. They can either pay with the credit card, they can send in a check, do whatever they want.
Really all we’re asking for is just the assessment portion. It could be under $200 for the clinical assessment portion, and it’s going to vary from place to place. Then we explain that depending on how they do on the clinical assessment, that will determine whether or not we move onto the on the road, behind the wheel portion, for which of course there’s another fee for Fox Rehab for that.
In addition to that, there is a driving school feel. Now if you look at that full driving assessment, $2,750, all of this is included in that. Driving schools, their charges vary from driving school to driving school.
They have to have an accreditation for us. We have to have a contract with the school, that we have found them to be fully accredited and so forth.
Those fees can vary anywhere from probably $100 to $250, depending on that school. Around here, most of the schools that I use—I use one in particular. They generally charge locally about $150, but that could go up to $200 if they have to drive a long way from where they are based.
However, when we have the conversation with the family or with the physician, and with the person themselves, they realize that if they want to continue driving in some cases, it’s pretty much mandatory that they have this test, because something has precipitated the physician or family to request this.
That could be they’re noticing that the person is maybe getting lost, or they have had a couple of fender benders. Or in some cases, we’re actually getting a lot of referrals now from the police department, from the highway police. Because somebody might make a mistake at a light, they may run a light, they may be driving too slow down a roadway or looking tentative.
Or for whatever reason, sometimes those referrals now are coming from the police department themselves. When they understand the importance of this . . .
Because what we’re talking about here is really public safety. It’s a safety issue for the driver themselves, for any passenger in their vehicle, and for people on the road and on the sidewalks.
You can go on YouTube, and if you just enter “older driver driving the wrong way,” it’s very frightening, some of the mistakes that people make on the roadway, sometimes leading to some pretty serious consequences and accidents.
What we try to do is identify these drivers beforehand and see if there’s a way that [inaudible 29:04] is, that we can re-mediate, and if not, make other arrangements for transportation.
Chris: Again, great perspective. From a brand writing standpoint, we would love to hear
from any older adults that have actually taken driving tests. Any other OTs or driving specialists that are on the webinar, hear your perspective as well. Both related to taking a driver’s test and then any tips for others around paying for the driving specialists and driving test.
Let’s put together a plan, and again, this is really for those of you that are living with this today. It may seem like an abyss to you in terms of having a direction. The first step is really from your safe driving care team.
Obviously we’ve emphasized the important role of the occupational therapist and driving specialist. As Marv mentioned, a key player in this whole process is really the primary care provider, who really helps to coordinate many of the care needs.
We talked about the driving testing center. From an emotional standpoint, there are some older adults that benefit from counseling, meeting with a geriatric care manager who can help with planning.
We’ve spoken about the importance of the advocacy and support group. Obviously the family and friends are critical from the standpoint of morale and support. In a bit we’ll talk about the important role that the area agency and aging can play in terms of offering resources by county.
We want to focus now on, I think, a really important topic. That is even if an older adult is struggling with some of the aging related changes that we’ve discussed, that there are great innovative technologies and adaptive equipment that an occupational therapist can assess for, and really coach the older adult and the family in terms of helping them to integrate some of these into their car and into their driving situation.
Marv, as you look through the list here, could you just give us a brief description of some of these technologies and speak to how impactful they can be?
Marvin: Yeah, sure. A lot of times just adapting the vehicle can mean the difference in
someone being able to continue to drive or having to stop driving.
What I’ve seen happen over my career is the advancement in things that . . . You can purchase a new car with so many of these safety pieces of equipment. It’s amazing. Many times, one of the testee things that happened, and many of the older people in the audience can certainly attest to this, is that we get shorter as we get older. People lose height.
Especially women, I’ve had so many older women who can no longer reach the gas pedal and the brake unless they have their seat right next to the steering wheel. Now that presents a problem because of course for the last 20 or 25 years, now we have airbags.
The car fit itself is no longer good, because if you’re too close to that airbag and you even have a minor accident and that airbag goes off, if you’re too close, that can be pretty awful as well.
By having a gas pedal and a brake that’s able to come to you instead of your foot having to go to that those pedal extensions can mean the difference between driving and not driving.
Also the swivel seat cushions are excellent, and I will tell you from my own experience, once you have and learned to use a back-up camera, it is amazing what a difference it can make, learning to use a back-up camera.
It increases your safety in reverse gear, backing up, exponentially. You realize all the things that you have not seen in the years that you’re driving. You think to yourself it’s amazing I didn’t hit something backing up, because you don’t realize what you don’t see until you have that back-up camera.
Chris: No, go ahead.
Marvin: I was going to say navigation systems are amazing. Something as simple as
adapting your mirror, because you need 50 degrees of cervical rotation to be able to access the mirror on each side of your vehicle, approximately.
If you don’t have that, you can put an adaptive little mirror on your side mirrors, and that can compensate for your lack of range of motion in your neck so that you can access those mirrors and keep yourself safer while you’re driving your vehicle to see the vehicle behind you if you need to change lanes or whatever.
All of these different pieces of adaptive equipment can contribute to longer driving life and a much safer driving life while you’re doing that.
Chris: Great. Again, when we were talking earlier, Marv had pointed out a great tool, an
organization called Car Fit [SP]. We’re showing a navigation map where you can actually find a Car Fit organization or location in your area and schedule a car assessment.
That way, again, they can assess some of the adaptive equipment needs that Marv just talked through.
Marvin: Right. I also wanted to mention too, remember we talked about the spinner knob
yesterday, I think. That’s another device. If someone has limited use or no use of one of their arms, sometimes a spinner knob can be the difference in continuing to drive or having to give up driving.
There’s all kinds of pieces of adaptive equipment to consider.
Chris: Great. Again, the two tools that we’ll share here can help people search for those
and learn more about them. Thanks again, Marv.
Some other things you can do just every day to improve and maintain driving skills. Obviously staying physically fit and active. Being proactive in taking driving courses, which can happen in person, online, or through simulation.
Then we have a tool that we’ll show really quickly that actually provides exercises that actually specifically can assist with improving strength and ability to drive. Exercise for mature drivers, which is a great webpage put out by the Hartford.
We’re going to shift to our last section and probably the most important. That is the fact that when driving is no longer an option, it’s a very emotional situation for the older adult, the family, and even the healthcare providers. Having been in this discussion, it’s gut-wrenching for healthcare providers as well.
We’ve given a number of quotes here, and these all came from our literature review. The first one just speaks to the fact that when you’re in an accident, many times as an older adult it’s really not the best time immediately after to have the conversation, because people tend to be more defensive, which I think is just human nature.
We have another article by Angela Curl, a great article that basically says when driving is removed from an older adult, basically there’s a huge impact on their ability to volunteer and work. Both of those activities are highly valued.
Also when older adults are not able to drive, individuals can risk social isolation, depression, and just lack a general sense of control. They’re not able to pursue things that they’ve pursued all their lives. We want to emphasize that we understand it’s a huge loss.
Some of the strategies that can help, number one, is talk about it. Again, this sounds like we’re simplifying this and we’re definitely not at all minimizing it. The first step is really getting it out and talking about it respectfully, about concerns, fears.
Trying to have one to one conversations tends to work better than having a large family intervention, because those large interventions tend to create defensiveness.
Try to stick to the facts. What has happened? What have you seen? That’s really where the driving assessment can come into play versus any assumptions or stereotypes that a person may have, or a family may have about older adults.
Try to be positive. Understand if you’re a family caregiver that it’s really a huge amount of grief and anger that comes with an older adult having to give away the keys and accept the fact that they’re not driving.
There’s a great social worker and author by the name of Dr. Elisabeth Kubler-Ross who developed the stages of grief, and we tend to apply these stages to end of life.
There are a number of articles today that say this is actually the emotional process that older adults go through when they’re having driving issues and have to accept the fact that they’re not able to drive.
Denial, avoidance, anger, depression, bargaining and reaching out to others, and then also people have to move through this at their own pace. If they’re allowed to, and if they’re educated and supported, they eventually get to acceptance. I think this is a great model.
Some of the other strategies for coping with emotions are again, just allowing time for grieving and acceptance: Joining a support group for peer-to-peer learning, talking about your feelings. Seeking counseling.
I think sometimes people need professional counseling, particularly if there’s someone who’s been very active and it’s a sudden change.
I think the people that I’ve seen have the most success, the older adults, took it as a challenge. They wanted to fight back. This whole idea of when one door closes, another opens.
On that note, we wanted to make sure that you were aware of other ways to get around. Again, we did our research. These were things that were put out on social media, through literature, public transportation, talking to family and friends, walking, using a taxi.
Grocery stores that deliver, if you’re relying on your car for grocery shopping. Community shuttle buses, taking trips with places of worship. Non-medical homecare, which can help with accompaniment and also driving, then also adult day care from the standpoint of socialization and trips.
A great resource that Marv pointed out when we were prepping for the webinar yesterday is that the area agency on aging in most counties puts out a tool like the one that we’re showing here, which is from the [inaudible 39:39] County office on aging.
Which is a publication actually dedicated to all the transportation services in that county for older adults who may or may not be able to drive. A great, great tool. From a brain writing standpoint, we would love to hear those of you, the family caregivers, older adults, professionals, how have you dealt with the driving issue emotionally?
Also, what are some of the things that helped you if you’re an older adult or a family to cope with the changes that come with the driving cessation?
We want to close with some key takeaways. Again, want to thank Marv for his tremendous expertise and time. It’s a very busy holiday season and we really appreciate his time.
Number one, aging can affect driving skills. Two, many older adults are safe to drive, as we’ve discussed. As you heard, occupational therapists can help to assess driving challenges and recommend solutions.
Older adults who stop driving are at risk for developing depression and isolation, so it’s important to maintain driving as long as possible. Then also as we said, make sure that people have alternate transportation.
As we said, it’s important to consider other forms of transportation when a person is no longer able to drive.
Derek: Fantastic. Thank you both, a lot of great tools. Again, those tools, we have a lot of
comments, people asking if they can have the links. Some great resources there we will send out.
We also have a number of questions here. We want to take a few minutes here, if you have any questions, comments, we’d love to hear those. Again, for our panelists, the way you want to enter questions is to use the GoTo Webinar panel. There is an orange arrow button, probably in your right hand corner if you’re on the webinar.
You click that, the panel will expand, and you can type your questions into the chat bar at the bottom of the GoTo Webinar panel.
Again, any questions you have on driving, if you’re currently going through this issue, if you have tips and advice, maybe you’re a healthcare professional and have tips and advice you would like to share with the audience, or if you have any questions for our panelists.
We’ll take just a moment and we will compile the questions.
Okay, we have a great comment here. This comment comes from John Boen [SP]. “As a social worker in a large retirement community, I feel the responsibility to others in town to ensure any concerns we learn about drivers are addressed.
What are the actual legal and ethical ramifications we should keep in mind, i.e., are we really liable if an independent living resident hurts themselves or others if family members, doctors, are also aware?”
I just want to say we don’t have any attorneys on the line, but I’m sure our panelists can assist with that question.
Chris: Yeah, Marv, I know you’re working a lot or you may be working a lot with
facilities. Is this something that you’ve experienced, and do you have any insights that you can share?
Marvin: I really don’t know the legal ramifications of something like an accident or
something like that in an ILS. We did have one in an ALS, an assisted living facility. I do not know the outcome of that.
This was an older driver who’d confused the gas pedal with the brake, and it resulted in the death of a resident there. I’m sure it went to court, but I’m not sure of the legal ramifications or exactly what happened. That’s a legal question and I really don’t feel qualified to answer that.
Derek: John, we have your contact information. We will follow-up with, if we are able to
find any resources or links where you might be able to find some more detailed information. Great question, and John, thanks again. It sounds like already as a social worker you’re cognizant of this issue. Really appreciate everything you’re doing to help keep drivers safe.
We do have a comment from Lenny [SP] Smith, who just makes a comment that “Car Fit also is a great way to begin the conversation with older residents in the community.” Thank you, Lenny.
Chris: Marv, next question. How accepting are older adults when you’re called in as an
occupational therapist to provide your driving assessment, typically?
Marvin: How accepting of the fact that they need to have this assessment and evaluation?
I’m assuming that’s what the question means? It runs the gamut from people can’t wait for you to come to the door because they feel very prepared, and a lot of times maybe it’s one of the adult children pretty much insisting that they have this test, and they want to prove to their child or whomever that they are capable of driving.
Sometimes they’re absolutely right and sometimes they’re not. I’ve had many situations where I’ve received phone calls on the side from power of attorney, from a child of the parent. It goes two ways. They say, “No matter what happens, I don’t want you to pass my mother, because she’s not safe.”
I have people say to me, “No matter what, you have to pass Dad, because I can’t be around to take him where he needs to go.” I get it both ways. My response is always the same.
The person does not pass or fail because you want them to. People pass or fail the clinical assessment and/or the on the road portion based on their own performance, based on their own ability.
Tests do not lie. If you pass you pass, and if you don’t, you don’t. Then we have to make other recommendations. You can be absolutely certain that if I’m doing the evaluation, I do not take into consideration what someone wants to have happen but rather what needs to have happen, based on their performance.
Derek: Fantastic, Marv. Thanks. We have another question here. This question is from
Donna Kushi [SP]. “We work with individuals with intellectual disabilities who go through an assessment to see if they may be able to drive. Is this assessment a permanent diagnosis of never being able to drive?” Marv, we’ll throw that back to you.
Marvin: That’s a really good question. I’m assuming that this is something like traumatic
brain injury. Traumatic brain injury is very interesting. I have done assessments and evaluations on people who’ve had traumatic brain injury as early as 29 years old, and up through people post retirement.
It’s really individualistic. It depends on the particular brain injury. It depends on if they had surgery, how successful the surgery was. If they can learn to adapt whatever their disability might be. I would tell you probably more often than not, these people do well and do pass the assessments.
Does that answer the question, I hope?
Derek: Yeah, I think that’s great, Marv. One more question, two questions in one
question. Number one, how long does the driving test typically take, and do and can family members join for the driving test?
Marvin: Really good question. The clinical assessment generally lasts around two hours.
It’s very comprehensive and people usually say, for example, “Wow, I’ve never had anybody look at my vision like this before.” Because it is very comprehensive.
That clinical assessment is about two hours. The on the road portion is only about one hour. What we’re doing right now is about three hours, unless we discover maybe a problem that we feel like is remediable through therapy.
Then we’ll ask the person, we’ll say hey, let’s enroll you in a course of physical therapy for four to eight weeks or whatever it is and work on this problem. Then we’ll retest you.
In that circumstance, that’s very few cases that that occurs. Sometimes, maybe 10 to 20% of the cases, that’s the case. Then it can be longer.
The second part of the question, absolutely we do encourage family members to be present during the assessment, so that they can have a better understanding of exactly what we’re looking at in all components of the assessment.
Derek: Awesome, Marvin. Next question. Are there guidelines for how frequently an
older adult should be retested? I think the spirit of this is if someone has been tested, and let’s say they passed the test, is there a protocol or guideline for how frequently someone would then come back and be retested?
Marvin: This goes back to our earlier question, talking about someone who has a diagnosis
of dementia. These patients, if they pass the test and let’s say they’re early on in dementia and they have mild dementia, they do the test and they pass.
Like I said before, we would then probably request that they be retested in six months to a year to be sure that all systems are still working well enough that they can remain safe on the road.
Again, it depends on the individual person and what their particular disability or problem might be. There’s no steadfast rules. Suffice it to say if someone has moderate to severe dementia and they are still thriving, and we determine that it’s moderate to severe dementia, we already know through a battery of tests . . .
One of them is called Trailmaking Part D, which is the gold standard in sustained attention and concentration. This is a gold standard throughout the world, not just in this country. It is considered the gold standard throughout the world.
That test lets us know someone’s capability or incapacity with that problem of sustained attention and concentration, which is a vital component of driving. In those cases, we probably would say that our recommendation would be that the person retire from driving, and then start considering other forms of transportation as opposed to being retested in six months to see if it gets better.
As we know, dementias are chronic, progressive diseases that do not get better.
Derek: Great, fantastic. Thanks, Marv. We have a great comment as well from Katie
Arnold. Katie says, “My experience as my area agency on aging’s mobility manager has showed me that adults who have to give up the keys respond to community education given to them on local transportation options.
“Seniors and older adults feel empowered to solve their own needs. Plus I always point out the financial advantages to not having a car. That is also positive and can be encouraging.” Great comments, great feedback there, Katie.
Marvin: I would just say I love the area on aging offices. They are a wealth of information
and knowledge on alternative transportation.
I’ll just say really quickly, I did have one situation where a person who did not pass the test said, “You know what? I’ve always wanted to move back into the city. Now I can move back into the city and I can take the bus, I can take the subway. I’ve always wanted to do that anyway.” That’s what she did.
Sometimes it can be the catalyst for a move into another part of life that people may not have considered prior to having [inaudible 51:38].
Derek: Fantastic, Marv. Fantastic. That will conclude our question and answers. Marv,
why don’t you tell us a little bit about Fox Rehab, and how if anybody wants to get in touch with Fox how they might reach out specifically to any occupational therapist that could assist with the driving test?
Marvin: Okay. We’re based in Cherry Hill, New Jersey. We’re at 7 Carnegie Plaza in
Cherry Hill, New Jersey. We have been in existence for about 15 years. I’m in my 11th year with the company now. We’ve had the driving program for many years.
They can call Fox Rehab at 877-407-3422. Just explain what they’re looking for and they’ll be directed in the correct way. They can also find us at foxrehab.org on the web, on the Internet.
We have many, many options for people out there with anything having to do with transportation, be it driving or being able to access any other form of transportation. We’re constantly working and revising and revamping our community mobility and driving programs to address the needs of the people out there.
That’s what we’re here for. We are a Medicare Part D company. Driving right now is primarily, in this area, unfortunately it’s a private pay service. In some areas Medicare is still covering driving assessments to some degree.
I would urge all people out there to contact your congressmen, contact your legislators, and let them know the importance of Medicare covering the vital services. In some cases this is not just a service to keep someone happy that they can continue driving,
But it is public safety, and it can be in some cases—as we discussed earlier—a matter of life and death. It’s really that vitally important, I think, that Congress gets on the ball and starts really realizing how important these assessments are to the public safety.
We try to look at all those things, we have a political action committee here. Driving is very important to me, and as you can tell I’m super-compassionate about it. I’ve been to Washington, DC probably four times advocating for older drivers. It’s just really important.
That’s what we look at here. We look at the older population and try to keep people vital and moving and living their optimal lives and functioning at their optimum capacity for as long as possible.
Derek: Fantastic, thanks, Marvin. We’ll just make the comment on the Griswald
Homecare side. We’re very thankful to have Marv and Fox Rehab [inaudible 54:35] to call on. Their reputation obviously is a big reason why Chris asked Fox Rehab to join the call.
Again, appreciate all the insight, Marv.
Marvin: You’re very welcome.
Derek: Lastly, Griswold Homecare, we are a national, non-medical homecare company.
Specifically with the topic of driving, we refer caregivers into the home to assist with activities of daily living, including incidental transportation to hair appointments.
Maybe older adults are able to drive locally but maybe don’t have the stamina to drive maybe on a vacation, or multiple hours to a family vacation. We were founded here in Philadelphia in 1982 by our founder, Jean Griswold, who actually founded the company after a diagnosis with multiple sclerosis.
After being denied several work opportunities, decided to start her own business helping vulnerable older adults in the community. Today we have over 250 territories and about 40 states. We can be reached by calling 1-800-GRISWOLD 24/7, or going to griswoldhomecare.com.
With that, again, really want to thank Marv and Chris for their expertise on the webinar today. We hope everyone has a happy, safe, fantastic holiday season. Safe travels while you’re out there.
Again, we will send out all the links, the recording to the webinar, and all the tools within about two to three days after the webinar.
Thanks to the audience as well. Thanks to Chris and Marv, and everybody have a great day.
For more information, please review our Aging & Driving Resources.