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THE SILVER TSUNAMI –
SUPPORTING OHIO’S
AGING DRIVERS
Elin Schold Davis, OTR/L, CDRS, FAOTA
American Occupational Therapy Association
Bethesda, MD
TOWARD ZERO DEATHS –
SAFETY NETWORK
Thank you!
• To Michelle May (Highway Safety Program- Program Manager)
• Ohio DOT for the foresight and wisdom to address these needs proactively
• To the numerous providers, programs, associations, academic institutions, advocacy groups, and state agencies for their dedication to senior safety, mobility and community engagement.
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Today’s discussion will address:
• Changing abilities to drive as we age
• What the data tells us
• The role of screening & evaluation
• Key considerations for developing a
statewide plan
• Resources to build on
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Risk due to Frailty and Fragility
“At crash speeds of 31 mph, the risk of sustaining a serious
injury increases dramatically.
• A 50-year-old female has about a 10% risk of serious
injury in a frontal crash, but
• an 80 year old female has about a 40% risk.”
2013 DOT HS 811 864 www.NHTSA.gov
“they sustain injuries more easily & are more frail which reduces their odds at recovering from injuries.”
Changes associated with Aging
• Aging
– Changes in Vision, Cognition, & Physical
– Resilient survivors who are experts at change
• Medical Conditions
– Medically related changes are not to be
confused with “normal aging”
– Certain medical conditions impact V,C & P
significantly, impacting DRIVING FITNESS
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Changes and Medical Conditions
• Diabetes
• Stroke
• Dementia
• PD, …
www.NHTSA.gov
Quality of Life
• Driving ... primary mode of transportation• Driving ... sponteneity
• Studies show a relationship between health, sense of autonomy & the ability to drive.
• Loss of mobility can lead to depression, low life satisfaction, health problems, isolation, and loneliness.
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The Data
• Drivers over 65 will be 25% of drivers in 20301
• Majority of older adults live in suburban & rural America2
• Driving will remain the primary choice and personal
mode of transportation3-4
• Decision to stop driving has adverse consequences5
• Public and private services need to be prepared to meet
the needs of older adults wanting to “age in place.”
1-NHSTA, 2009; 2-Rosenbloom, 2012; 3-Coughlin, 2012 ; 4-Dickerson et al.,2007;
5- Eby, Molnar, & Karje, 2009
World Population Growth (Source: GeoHive.com)
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11Scripps Gerontology Center 2015
Demographic Trend
Data In Ohio
• Crashes 65+ account for approx 18%
percent of deaths & 16 % serious injuries
• Increase projected as U.S. pop ages
• About ½ at intersections
• Highest: 1-4 p.m.
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Reseach with Universal Design
• Carefully consider the impact of “canceling
licenses”
– Intersection crashes - modify the intersection
design
– Time of day – improve signage size and
contrast
• A non-driver, less involved in community
spends less with negative consequnces to
the economy
Why the Research on Tests?
• Aging in place is the most desired plan
• Projected that Life expectency will exceed
“driving expectency” by 7-10 years (Foley 2002)
– Supports demand for fair criteria
• NHTSA recognized the networking
priorities in Guideline 13
How would you manage
today, in your home, if you
turned in your keys?
How would you manage
today, in your home, if you
turned in your keys?
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NHTSA’s Guideline 13
• The highway safety
program should
include a
comprehensive
older driver safety
program that aims to
reduce older driver
crashes, fatalities,
and injuries.
NHTSA’s Guideline 13
• Should address driver
licensing and medical
review of at-risk
drivers, medical and
law enforcement
education, roadway
design, and
collaboration with
social services and
transportation services
providers.
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NHTSA’s Guideline 13
• Guideline
recommends the
key components of
a State older driver
safety program, and
criteria that the
program
components should
meet.
Strategies:
• Education for Older Driver, Family and Caregivers
• Roadway Designs
• A coordinated mesage of safety
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The Role of Screening & Eval
Video
Define
• Screen
• Test
• Evaluation
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DRS
MAB
Pathways- Right Services Right Time
Multiple Entry Points
• Pulled over, a ticket
– Law Enforcement http://treds.ucsd.edu/law-enforcement
contact (858) 534-9330
• Family concern
– Self screening, family screening
• Medical appointment
– Physician screening that leads to Driving
Rehabilitation (4 minutes)https://vimeo.com/user16212450/review/232069693/cb8f14cb75
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Medical Expertise
in Driving
Rehabilitation
• Experts at evaluating Fitness to Drive.
• Comprehensive driving evaluation – Clinical assessment
in motor, sensory, perceptual and cognitive
– On the road – most ecologically valid assessment
Components of The
Comprehensive Driving Evaluation
• Interpret clinical assessments of V, C, P
• Consider clinical data during functional
performance, in context, “on the road”
• VIDEO
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Outcome & Recommendations
• Continue to Drive (Transportation Plan)
• Potential – evaluate w/ equipment and/or training
• Driving with Restrictions (state specific)
– With dementia, periodic review
• Retire from driving (soon or now)
– Provide referral and/or access to assistance with community mobility
Find Specialists Through:
• American Occupational Therapy
Association www.aota.org
Specialty Certification in Driving & Community Mobility
(SCDCM)
• Association for Driving Rehabilitation
Specialists www.aded.net
Certified Driving Rehabilitation Specialist
(CDRS)
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Driver RehabilitationMeredith Sweeney, OTR/L, CDRS
Ohio State University Occupational Therapy Driver Rehabilitation Program
Services Provided by OSU OT Driver Rehabilitation Program
• Clinic assessment of cognitive, visual, perceptual, behavioral and physical limitations
• Integration of the clinical finding with assessment of on-road performance
• Advise client and caregivers about evaluation results and provide resources, education and/or intervention plan
• Interventions may include training with compensatory strategies, vehicle adaptions and safety procedures
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Services Provided (2)• Prescribe equipment and collaborate with
Mobility Equipment Dealers
• Present resources and options for continued community mobility if recommend driving cessation or transition from driving
• Present education for novice drivers and their parents/caregivers to address visual search skills as an active passenger prior to on-road training sessions
• Assist with navigation of the Ohio BMV driver license compliance
Medically Impaired Drivers
4501:1-1-01; Ohio Administrative Code
• Approximately 11 million drivers in the state of Ohio
• Approximately 75,000 drivers have a medical case imposed
• Cases are initiated upon receiving information giving “good cause to believe” the driver is incompetent or otherwise incapable of safely operating a motor vehicle
• Action cannot be taken based solely on a person’s age or hearsay
• https://aging.ohio.gov/resources/publications/1_BMV_%20Dianna_McConnaughey_ALL.pdf
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Why Occupational Therapy?
OTs help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).
Occupational therapy services typically include:
individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,
customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
outcomes evaluation to ensure that goals are being met and/or make changes to the intervention plan.
150,000+ occupational therapy practitioners in the US
The Right Tool at the Right Time
Different Services
Different Providers
Different Outcomes and Implications
License Status Determination
Measure of skills and Knowledge
Driving Tests
DI/DMV
Self Awareness
Screening Tools
Medically at Risk
Comprehensive Driving Evaluation
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National Highway Traffic Safety
Administration & The American
Occupational Therapy Association
• Initiatives to expand services for the
medically-at-risk.
Building CapacitySpecialists & Generalists Collaborate
Screening, consider criteria for referral
Awareness and Education
Ethics: Duty to Inform/Warn
D&CM as an IADL
Increase capacity through collaboration
• Outreach, Rural
• Inspire pursuit of D&CM education!
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Dickerson, Reistetter,
Schold Davis, &
Monahan. (2011).
Evaluating driving
as a valued
instrumental activity of
daily living. American
Journal of Occupational
Therapy, 65, 64-75.
Pathways
Generalist
Non-driver Impairments clearly
exceed threshold for
safe driving.
Able to DriveNo impairment
indicators to
report/restrict license.
Lower Risk:
Evidence is
Weak; Below
thresholds in
most areas.
Higher Risk:
Evidence is
Strong; Above
thresholds in
most areas.
Interventions for Generalists: Plan & Build Options for Mobility
Maximize Skills & Abilities
Self Awareness
Mobility preservation: Driving
Refer to specialized services
Develop transportation alternatives
Mobility preservation: Transition
Medical issues with increasing complexity
Occupational Therapy Intervention:
Evidence, Clinical Judgment, and Risk
Dickerson & Schold Davis, 2013
Risk: Degree to which
impairment affects
fitness-to-drive is unclear.
On-road evaluation is justified.
Promote Driving Retirement,
Mobility preservation: Implement
supportive transportation
Normal Aging
GeneralistGeneralistDRS Specialist
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Spectrum of Driver Rehab Services
Types:
Community Based
Medically Based
Specialized Driver Eval & Train
Descriptions of:
Program type
Providers & Credentials
Provider’s Knowledge
Provider’s services
Outcome
Provider’s services
Outcome
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Wife of a stroke survivor;Has not driven much for years or since they moved to Florida.
Husband had stroke;Wants to know if he can drive again
“it takes a village”• Education
• Screening & Assessment
• Evaluation & intervention
(rehabilitation)
• Planning & Transition
• Appropriate alternative
mobility options
Screen
Evaluation and Intervention
MD Role
Licensing
Resume/continueTransition
Appropriate transit options
Education
CarFit
Self-aware
Warning signs
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Take Aways
• Driving is the word, mobility is the goal
• Triage of “screens & assessments”
– Right tool at right time
– Family screening to professional eval
– Appropriate conclusions
• Good things ARE happening
pathways pull the thread
A Statewide Plan will:
• Serve individual drivers, families and caregivers
• Distinguish function from age
• Provide the right service – at the right time
• Value safe mobility & participation as driver or non driver
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Transportation’s Role
Aging in Place
• The “lynch pin” to aging in place
– Choice and Control
– Engagement and Participation
– Options support the individual to limit or cease
driving and stay in home
• As we plan for finances and funerals…
– Personal access to safe transportation
– Walking, driving, transit user and passenger
AOTA ODI Impact Statement
Pathways between stakeholders facilitate the use of core
services & components of a local/regional/national “safety
network” that supports medically at-risk older drivers to
remain safely mobile & engaged citizens.
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In Ohio - ALL Modes
Seniors, Alcohol & Medications
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Frailty and Fragility
Awareness-
• How to wear
• How to adjust
• Comb w/ airbag
Physical limitations
Comfort and Fit
Education!
www.Car-Fit.org• Safe, positive, anonymous
• Nothing to do with “taking
away”
• 12 points of education
(ONLY!) about person-
vehicle fit
• Injury prevention, safety
and comfort
• 1:1 at their vehicle
• Goody Bag of Resources
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ChORUS: Shared Research & Resources
National Highway Traffic Safety Administration
& Federal Highway Administration:
https://roadsafeseniors.org
ChORUS is a centralized, user-friendly, dynamic and up-to-date source of
information to support safe driving by our aging population. Built as a
comprehensive resource, it covers all three major components of highway
safety: safe roadways, safe vehicles, and safe road users.
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www.aota.org/older-driver
Elin Schold Davis, OTR/L, CDRS
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Older Driver Initiative
Elin Schold Davis, OTR/L, CDRS
NHTSA.gov/Driving+Safety/Older+Drivers
http://www.nhtsa.gov/Driving+Safety/Older+Drivers
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NHTSA.gov/Driving+Safety/Older+Drivers
www.NHTSA.gov/senior-driver
Free resources for professionals and
consumers (some available in print
copy, all free for download)
http://www.nhtsa.gov/staticfiles/nti/images/
OlderDriverVideos.jpg
Clinician’s
Guide
Supports medical
professionals addressing
medical conditions that
impact Driving
Resource provides screening
& counseling tools
Guidance for referral to
specialized evaluation &
intervention
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Education and Self Screens
Fitness to Drive
Screening MeasureUniversity of Michigan
AAA
Resources by researchers, AARP, AAA, AMA and others
www.thehartford.com/talkwitholderdrivers
• The brochure (free, in quantity)
• Preparing for the conversation
• Having the conversation
• Help beyond the conversation
• FREE on-line version for seniors/families and practitioners
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FREE Webinar Training:
June 23, 2015 at 3:00 PM EST
Repeated Sept 16 and 17
See AOTA.org
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www.thehartford.com/talkwitholderdrivers
The brochure (free, in quantity)
Drivers with dementia
Guide for caregiver
education
Family preparation
“When, not If”
Strategies when refusal to
stop is the concern
Support
Cessation
68
NO
DRIVING
Strategies:
Alter the keys
Move the hook
Disable car
Loan/ give/ sell
Physician note
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Older Driver Safety Awareness Week (First week in December) aims to
promote understanding of the importance of mobility and transportation
Throughout the week, AOTA will bring attention to a different aspect of
older driver safety:
• Monday: Family Conversations
• Tuesday: Screening/Evaluations
• Wednesday: Driving Equip/Adaptations
• Thursday: Taking Changes in Stride
• Friday: Life After Driving
• Get Involved!!
Thinking Outside of the Box
https://www.boredpanda.com/3d-
pedestrian-crossing-island/
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What can I do?
• What can I do to make myself smarter and safer?– LE (Dosci)
– City planner (the purple book, how the size of signs makes a difference)
– Caregiver- develop a transportation plan, explore screening tools, stay fit!
– DOT- broaden transpiration options, roads reflect universal design
– Silver Alert is a counter measure
– Providers – build a network. Go to each others meetings.
Thank You!!
Elin Schold Davis, OTR/L, CDRS, FAOTAAmerican Occupational Therapy Association
[email protected]
1-800-729-2682 X2200
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On-Line Resources
AAA-Senior Drivers http://seniordriving.aaa.com/
AARP-Driver Safety info, online course at http://www.aarp.org/home-garden/transportation/info-05-2010/Warning_Signs_Stopping.html
National Highway Transportation & Safety Administration (NHTSA) Older Road Users http://www.nhtsa.gov/Senior-Drivers
The Hartford Center for Mature Market Excellencehttp://www.thehartford.com/mature-market-excellence/family-conversations-with-older-drivers
On-Line Resources
The American Occupational Therapy Association
www.aota.org/older-driver
National Center for Senior Transportation
http://seniortransportation.easterseals.com/site/PageServe
r?pagename=NCST2_homepage
The Beverly Foundation
www.beverlyfoundation.org
