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Options Across the Driving Spectrum
Many older adults regulate and limit their driving on their own. The Maricopa Association of Governments in Arizona describes this self-regulating behavior using "Mobility Mileposts to Dependence"33 as adapted below.
Because older drivers who take risks or are overly cautious often do not realize the danger they represent to themselves and others, close calls may be good "learning moments." Close calls may signal to the older driver that time has come to have an evaluation and to take a course to sharpen skills and refresh one's knowledge of the rules of the road.
The chart below describes the options available to increase safety across the driving spectrum.
Options Across the Driving Spectrum34
The following is a guide for professionals in health and aging services to the options for assessment, remediation, and referral of older adults at different degrees of the driving spectrum. Occupational therapists and physicians should refer to the materials developed specifically for them on these topics by the American Occupational Therapy Association and the American Medical Association.
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Well: Fully Able to Drive
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Specific Functional Impairments
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Serious Impairment of Mobility, Vision or Cognition
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Unable to Continue Driving
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- Refer to regular physician and occupational therapist with experience in assessing older drivers
- Conduct regular physical exams to assess visual, cognitive, and physical functions (including driving/mobility)
- Encourage classes to refresh knowledge of the rules of the road
- Recommend "car fit" inspections to identify preventive measures that will maximize driving comfort and safety
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- Refer to professionals for specialized care, and suppliers for basic adaptive devices
- Consult with physician to discuss treatment options
- Recommend in-clinic and behind-the-wheel assessments of impairments by certified driver rehabilitation therapist
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- Refer to targeted professionals for specialized care or services
- Involve the family
- Require in-clinic and behind-the-wheel assessment by driver rehabilitation specialist to determine ability to continue driving
- Advise the person that behind-the-wheel training may be necessary to teach the use of specialized adaptive devices (e.g., wheelchair seating and positioning equipment)
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- Evaluate family and community resources for transportation, in-home care, etc.
- Conduct psychosocial assessment of impact of driving cessation on quality of life
- Involve family, caregivers, and other professionals (MD, case manager, DMV, funding sources) as needed to develop transportation plan
Refer to healthcare professionals for focused remediation to maintain alternative mobility and quality of life For further discussion, see Chapter 3
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For drivers with functional limitations as indicated above, a professional assessment by an occupational therapist, a certified rehabilitation specialist, or trained healthcare professional may determine whether accommodations could permit them to continue driving safely. If they continue to drive in an unsafe manner - even with accommodations - then the individuals may be considered unable to drive, and options in the final column may be explored.
Chapter 2 explores more deeply the factors that affect driving as one ages, including physical, psychosocial, and environmental dynamics. Chapter 2 also outlines the driving risks for diverse groups of older adults, discussing differences in mortality rates by sex, race and ethnicity.
31 Maricopa Association of Governments (2001) Regional Action Plan on Aging & Mobility 32. Retrieved from MAG on the World Wide Web: www.mag.maricopa.gov/pdf/Elderly-Mobility-Plan.pdf.
32 Adapted from AOTA/NHTSA Older Driver Consensus Conference Report.
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