To Drive or Not to Drive: Where Do We Begin?
When a friend, loved one, or aging parent begins to show difficulty with driving, it can often be a sensitive situation to address. Where do we begin? How can we tell if Dad is still safe to be behind the wheel? And what do we do if he isn’t? For some, making a decision on whether it is safe to drive or not can be a relief, while for others, it can mean a complete loss of independence, identity and role change, and what may seem like a future of isolation.
Driving represents one of the most complex Instrumental Activities of Daily Living (IADLs) that we engage in most of our adult lives. When done well, it can allow us to engage with the rest of the world outside of home, whether it be a job, school, shopping, vacations, or visiting family. When done poorly, it can lead to major injuries and fatalities. As people age, many changes can occur which directly impact their ability to safely operate a vehicle.
Without being able to drive, we would become dependent on another person or service for going to the grocery store, going to church, making our doctors appointments, visiting family and friends, or taking a vacation. As people age, we are facing the inevitable question, “Is my loved one still able to drive safely?” This is a commonly asked question, with rarely a simple answer. Many people wonder when is the best time to begin addressing the safety of driving issue with the older adults in their lives. The best time is always now.
For safe driving to occur, certain performance factors are necessary, and they include adequate or intact:
- Physical strength—needed for sustaining a brake at an intersection or accelerating appropriately; sustaining a grasp on steering wheel; maintaining appropriate posture for ease of reach and controls.
- Range of motion—to comfortably look both ways when pulling out; maintaining comfortable positioning for prolonged times.
- Sensation—to appropriately feel accuracy with use of foot pedals or use of hand controls.
- Reaction timing—for recognition of traffic signals, responding appropriately, avoiding collisions.
- Visual acuity/full visual fields—these have legal limits that are set in each state.
- Cognitive and perceptual skills—needed for anticipating potential hazards, sequencing; sustained attention and ability to maintain awareness of potential distractions. As people age, commonly impacted performance factors include decreased physical strength, delayed reaction timing, decreased vision, and impaired memory.
Other potential concerns are important to consider in regards to your friend or family member in question:
- Is there a history of seizures?
- Is my loved one living with diabetes? If so, is it well controlled?
- Does my love one have a neurological condition such as stroke, Parkinson’s, Multiple Sclerosis, or brain injury?
- Do they have a history of recent and/or multiple falls?
- Is there a history of crashes, multiple crashes, or even minor crashes?
Common situations that often raise questions about safe driving include recovering from surgery when a surgeon may place a temporary restriction on driving; receiving a new diagnosis of a chronic condition such as type 2 diabetes or heart disease; receiving a new neurological diagnosis such as a stroke or brain injury; and experiencing signs or symptoms outside of driving—such as confusion, forgetfulness, or needing additional assistance to complete tasks like meal preparation or laundry.
So where do we start when trying to answer that question, “Is my loved one still able to drive safely?”
A clinical assessment by a licensed occupational therapist can be sought out. This occupational therapy evaluation is known as a Driver Risk Assessment. This involves taking a medical history, as well as testing in areas of physical skills, visual skills, and cognitive/perceptual skills that are common to driving. This is a good starting point for a client or family who wants to be more proactive, or just know what their driving risk is.
The benefits of seeking out a Driver Risk Assessment is that it is covered by most insurance. To have this service covered, a written referral to Occupational Therapy specifying Driver Risk Assessment is needed from your doctor. The results of this assessment will determine level of risk as low risk, moderate risk (there is risk as well as potential for improvement), or high risk. These results will always be shared with the referring physician, and recommendations may include a referral to an OT Driving Rehabilitation Specialist (OT DRS), consulting with physician on consensus on driving retirement, or ongoing therapy to improve driving related skills needed for improving driver readiness. This is not adaptive driving training nor does it include an on the road assessment.
A physician referral to Occupational Therapy for Driver Risk Assessment can be sent to Oaklawn Physical Rehabilitation—Marshall clinic, phone (269) 781-6030, or fax to (269) 789-7547.
A Comprehensive Driving Evaluation completed by an Occupational Therapy Driving Rehabilitation Specialist (OT-DRS) can also be sought out. The benefit of this evaluation is that it will include an assessment of driving skills through an on the road assessment. It also will include additional adaptive training should any modifications be needed to safely operate a vehicle. This type of program can directly test the skill of driving with more specific recommendations on driving potential, possible restrictions on driving, as well as specific skills training. This evaluation is typically not covered by insurance. To learn more about options for this service, click here for a listing of available Driver Rehabilitation Specialists in the State of Michigan.
Final thoughts worth sharing on safe driving:
If you are a caregiver or a family member, have open conversations about safe driving with the older adults in your life. It is typically a topic many like to avoid. This is a sensitive topic for many older drivers, so show compassion and empathy when discussing these issues.
If the older drivers in your life are encouraged to talk openly about their feelings about driving, they can be part of a solution which can extend their time of safe driving. Or it may help them to become more likely to accept a solution of driver retirement.
