National Older Driver

1
National Older Driver
College of Health Professions
Research Training Center
University of Florida
Panel B Rehabilitation Preliminary Findings of
Panel
Cynthia Owsley, Donna Stressel, Maureen
Perterson, Julie Salvi, Mary Warren, Jerry
Wachtel, Peggy Gannon, Kathie Regan, Elin
Schold-Davis, Dennis McCarthy, Carol Wheatley,
Rich Marottoli, Michael Justice
2
Goals

• Applicable populations
• Prognostic indicators
• Strategies/techniques
• Effectiveness
• Outcomes
• Research
• Resources

3
Populations Seen

• Medically referred
• Medical condition
• Adverse advent (ie., falls)
• Well elderly
• DMV Referrals

4
Populations Seen

• Family referrals
• Law enforcement legal entities
• Auto Insurance company referrals
• Vocational rehab referrals

5
Prognostic Indicators whos appropriate for
rehab/training after assessment?

• Motivation to drive
• Means to drive
• Vehicle, financial
• Insight into deficits
• Cognitive deficits are mild/remediable or will
  not interfere with strategies for driving
• Capacity to learn new strategies

6
Prognostic Indicators whos appropriate for
rehab/training?

• Level of driving/driving goals/potential
• Driving competence prior to medical problem or
  limitation
• General endurance and stamina
• Stable/slowly progressive physical
  condition/impairment
• Stable/slowly progressive mild/moderate visual
  impairment

7
Strategies/Techniques

• Begin with accurate medical diagnosis and
  identification of specific functional limitations
• Remediation vs. Compensation
• Some interventions facilitate skill improvement,
  some compensate for skill limitations
• Often, rehabilitation is a blending of
  remediation and compensation efforts

8
Strategies/Techniques Remediation

• Medication review
• Referral to other health care professions
• Vision Corrective lenses, surgery
• Neurology
• Geriatrics
• Family Physician
• Vestibular
• PT/OT/Audiologist
• Other Medical Consults

9
Strategies/Techniques Remediation

• Cognitive/Visual training
• Visual attention and processing speed
• Scanning, proper lookout
• Simulators
• Retraining of sub-skills (i.e., right foot
  coordination, visual scanning)
• Self-awareness of capacities and limitations

10
Strategies/Techniques Compensation

• Person-vehicle fit
• Eye ellipse
• Seating
• Pedal reach
• Secondary controls
• Adaptive equipment
• Low tech ? High tech
• Assistive devices
• Visual and auditory

11
Strategies/Techniques Driving Fitness

• Public education Driving fitness as part of safe
  mobility for life
• General health maintenance to preserve driving
  skills
• Refresh and/or retrain driving skills
• Well-elderly
• Those that need to resume driving after change

12
Strategies/Techniques Education

• Classroom
• Rules of the road, safe driving tips, aging
  effects on driving skills, planning for
  retirement
• Therapeutic intervention
• Individual consultation
• Route restructuring, driving restrictions
• Integration of alternatives to driving
• Individual In-car
• Route restructuring, learning carryover, use of
  adaptive equipment
• Commentary driving
• Situational awareness
• Supervised driving (short-term)

13
Strategies/Techniques The Ultimate Compensation

• Let former drivers walk to the nearest bus stop

14
Effectiveness

• Establish effectiveness of strategies and
  techniques
• Evidence based
• Clinical experience

15
Outcomes

• Developing good outcome measures may be the most
  immediate research challenge
• In order to establish effectiveness
• Need to develop outcome measures that are
  relevant
• Driving performance measures
• Instrumented vehicles, observed driving
  performance,
• Driving habits
• Exposure, avoidance, difficulty

16
Outcomes

• Quality of life instruments
• Use of additional mobility strategies
• Psychosocial measures
• Address safety benefits
• Violations
• Crashes
• Insurance claims

17
ResearchWhat We Know

• Educational programs (classroom training)
• Imparts knowledge, self-restriction (lacks
  demonstrated safety transfer)
• Cataract surgery increases safety
• Certain medications affects driving
• Psychosocial effects of driving cessation

18
ResearchPromising Techniques

• Transfer of training for visual processing
• Driving simulator developing specific sub-skills
  and improving insight
• On road, behind the wheel training

19
Research Whats Needed

• Effectiveness of current interventions
• Development and testing of new interventions
• Develop new methodologies for assessing
  interventions
• Cost effectiveness and feasibility

20
Resources for Driving Rehab

• ADED Website www.ADED.net
• AOTA working on comprehensive database
• AAoA, senior centers, AAA, AMA Physicians Guide,
  Driver Rehab Services
• Need to determine scope of services offered
• clinical assessment only/BTW eval/rehab
• costs

21
Where can driving rehab services be found?

• Hospitals outpatient and rehab centers, VA
• Vocational rehab
• University center
• Specialized Driving schools
• Private Practice