[Author's note: Recently in ADVANCE, Debbie Amini, EdD, OTR/L, CHT, devoted a two-part series in her Inside Occupation column to the important role of OT practitioners "as educators of our clients," assisting them to "reason, gain self-knowledge and independently problem solve through life challenges." (Read part I here [ADVANCE, July 30], and part II here [Sept. 24].) The hypothetical case of "Ms. Green" was used as an example to demonstrate how an educational model could benefit an independent, 75-year-old woman living alone and potentially at risk in occupational areas impacted by the aging process. I have continued Ms. Green's story here to illustrate the use of an educational model to address a common concern in late life: the challenge of preserving driving safety and independent community mobility.]
Driving a personal vehicle is recognized as both an occupation that fosters well-being and self-efficacy, and as an occupation enabler, providing access to participation in other activities.1 Research with older (age 65+) drivers links driving independence to feelings of personal freedom and connectedness to the community;2 conversely, driving cessation has been linked with negative consequences including social isolation, depression, health declines, and early admission to long-term care facilities.3-5 It is not surprising, then, that mature drivers and their families struggle with driving-related decisions when safety concerns begin to surface.
In overall good health, Ms. Green continues to be active in her community, driving five or more times per week without difficulty. Since most of her activities are within twenty miles from her home, the fact that she no longer drives at night or on long trips has not posed a problem in her daily life. However, her 75th birthday was a reminder that things could change for her. As a single person without family nearby, she wonders what would happen to her if she could no longer drive. When Ms. Green expressed this concern to the director of the senior center she regularly attends, she was encouraged to check out a free program for seniors called CarFit. She called the occupational therapist listed on the brochure and made an appointment.
Ms. Green's situation is not unusual other than the fact that she is exceptionally healthy for her age. According to the Centers for Disease Control, about 80 percent of older adults have one chronic condition, and 50 percent have at least two. By 2030, the number of adults 65 years of age or older is projected to double to about 71 million.6 Many are choosing to drive later in life, with the potential for one in five drivers to be over age 65. Especially for drivers over age 70, the cumulative effects of health and aging-related conditions on driving safety are associated with a correspondingly greater risk of vehicle crashes and serious injuries.7-10
Like many mature drivers, Ms. Green is careful to follow the rules of the road and to self-regulate her driving as necessary -- for instance, making the decision to limit her driving to daylight hours as her night vision declined. She is not in need of traditional medical-model OT, such as a comprehensive driving evaluation (CDE) by a certified driver rehabilitation specialist (CDRS), but would benefit from an educational treatment intervention focused on continued driver health and safety, and mobility planning as her needs change. Current research associates educational programs focused on the needs of older drivers with improved driving-related knowledge and on-road driving practices.11-14
Based on Ms. Green's health and occupational profile, CarFit and the Driving Decisions Workbook (DDW) were selected by the OT as the intervention method for Ms. Green because they have been established by research as effective and reliable instruments to improve driver self-awareness and knowledge related to driving safety.13, 15 CarFit optimizes driver-vehicle fit and improved use of vehicle safety features,16 while the Driving Decisions Workbook facilitates driver self-awareness, decision-making, and future mobility planning.17 Together, these evidence-based educational tools can be utilized with Ms. Green to achieve the following outcomes:
• Increased physical safety - Because Ms. Green's age places her in a high-risk category for both vehicle crashes per mile driven and fatalities when crashes occur, learning to properly use her vehicle's safety features (positioning of mirrors, driver's seat/seat belt, steering wheel, etc.) reduces her risk of serious injuries in the event of a crash.
• Continued safe driving and community independence - The effects of aging-related and health changes on driving can be anticipated and minimized, supporting Ms. Green's goal to continue driving for as long as possible.
• Self-directed mobility planning - Ms. Green can use the knowledge she has gained and resources provided by OT to choose suitable mobility options as she ages and advocate for her choices as her mobility needs change.
The example of Ms. Green illustrates how an educational intervention can be used to avoid or minimize the potential safety risks that increase as drivers age, especially when health or age-related impairment is involved. With a growing body of evidence to support the effectiveness of mature driver educational programs, it is clearly time to heed Dr. Amini's challenge to embrace our role as educators with our clients. As wellness and prevention programs replace the traditional healthcare emphasis on illness and rehabilitation, OTs as "life educators" can assist older adults to enjoy the freedom of mobility that enables productive aging.
Judy Dressner, MS, OTR/L is an occupational therapist, geriatric consultant, and CarFit technician/coordinator in Juliette, GA. She is currently a student in the doctorate of occupational therapy program at Chatham University, Pittsburgh, PA. Readers can contact her at firstname.lastname@example.org.
1. American Occupational Therapy Association. (2010). Statement: Driving and community mobility. American Journal of Occupational Therapy, 64(suppl), S112-124.
2. Gardezi, F., Wilson, K.G., Man-Son-Hing, M., Marshall, S.C., Molnar, F.J., Dobbs, B.M., et al. (2006). Qualitative research on older drivers. Clinical Gerontologist, 30, 5_22. doi: 10.1300/J018v30n01_02
3. Freeman, E.E, Gange, S.J., Munoz B., & West, S.K. (2006). Driving status and risk of entry into long-term care in older adults. American Journal of Public Health, 96(7), 1254-1259.
4. Marottoli, R.A., Mendes de Leon, C.F., Glass, T.A., Williams, C.S., Cooney, L.M., Jr., & Berkman, L.F. (1997). Driving cessation and increased depressive symptoms: Prospective evidence from the New Haven EPESE. Established populations for epidemiologic studies of the elderly. Journal of the American Geriatrics Society, 5, 202-206.
5. Ragland, D.R., Satariano, W.A., & MacLeod, K.E. (2005). Driving cessation and increased depressive symptoms. Journal of Gerontology: Medical Sciences, 60A (3), 399-403.
6. Centers for Disease Control (2012) Chronic Disease - Healthy Aging - At A Glance. Retrieved from http://www.cdc.gov/Features/PreventiveServices/
7. Insurance Institute for Highway Safety. (2008). From http://www.iihs.org/research/ fatality _facts_/olderpeople.html
8. Li, G., Braver, E.R., & Chen, L.H. (2003). Fragility versus excessive crash involvement as determinants of high death rates per vehicle-mile of travel among older drivers. Accident Analysis and Prevention 35, 227-35.
9. National Safety Council. (2009). Injury facts, 2009 edition. Itasca, IL: National Safety Council.
10. Vrkljan, B. H., Cranney, A., Worswick, J., O'Donnell, S., Li, L.C., Gelinas, I., & Byszewski, A. (2010). Supporting safe driving with arthritis: Developing a driving toolkit for clinical practice and consumer use. American Journal of Occupational Therapy, 64, 259-267.
11. Ball, K., Edwards, J. D., Ross, L. A. & McGwin, G., Jr. (2010). Cognitive training decreases motor vehicle collision involvement among older drivers. Journal of the American Geriatrics Society, 58 (11): 2107-2113. doi: 10.1111/j.1532-5415.2010.03138.x
12. Bédard, M., Porter, M.M., Marshall S., Isherwood, I., Riendeau J., Weaver B,. Miller-Polgar, J. (2008). The combination of two training approaches to improve older adults' driving safety. US National Library of Medicine, National Institutes of Health. Traffic Injury Prevention, 9(1):70-6
13. Eby, D.W., Molnar, L. J., Shope, J.T., Vivoda, J.M., & Fordyce, T.A. (2003). Improving older driver knowledge and self-awareness through self-assessment: The Driving Decisions Workbook. Journal of Safety Research, 34, 371-381. doi:10.1016/j.jsr.2003.09.006
14. Stalvey, B. T., & Owsley, C. (2003). The development and efficacy of a theory-based educational curriculum to promote self-regulation among high-risk older drivers. Health Promotion Practice, 4(2), 109-119. doi: 10.1177/1524839902250757
15. Stav, W. (2010). CarFit: An evaluation of behaviour change and impact. British Journal of Occupational Therapy, 73(12), 589-597. doi: 10.4276/030802210X12918167234208
16. CarFit. (2011). Retrieved from http://www.car-fit.org/
17. Eby, D.W., Molnar, L. J., Shope, J.T. (2000). Driving decisions workbook. University of Michigan Transportation Research Institute, Social and Behavioral Analysis Division. Retrieved from http://deepblue.lib.umich.edu/handle/2027.42/1321