Driving is an essential aspect of independence for older adults, as it allows them to maintain community mobility and access to resources and social activities. Without the ability to drive, older adults may experience a loss of independence and social isolation, as they may have difficulty getting to appointments, running errands, or visiting friends and family. Losing the ability to drive can also increase their dependency on others, including family and public transportation.
Older adults may find losing their driver's license particularly challenging for a number of reasons:
Limited options: Older people may only have a few choices for alternate modes of transportation depending on where they live. In some places, public transportation may be scarce or nonexistent, and older people may have trouble biking or walking long distances.
Social isolation: Whether driving alone or with friends or family, many senior citizens enjoy doing so. Being unable to drive can make it difficult to engage in these social activities and increase feelings of loneliness.
Loss of independence: Many older adults take pride in their ability to drive, so losing that ability can make them feel as though they have lost control of their lives and their independence. If they rely on other people for transportation, they might be less inclined to accept social invitations or make new friends.
Older adults may have trouble adjusting to new forms of transportation, such as learning how to use Uber or public transportation. For senior citizens who suffer from cognitive or mobility impairments, this transition can be difficult.
It's crucial to remember that older adults may be more susceptible to accidents and medical conditions that could impair their ability to drive. Therefore, they need to be assessed on a regular basis to make sure they can still drive safely and aren't a danger to both themselves and other drivers.
The American Occupational Therapy Association found that older adults who lose their ability to drive are at a higher risk of depression, social isolation, and cognitive decline.
Driver Rehabilitation and Regaining Independence
A driver rehabilitation program assists people with physical, cognitive, or visual impairments in relearning or learning new driving techniques. Driver rehabilitation includes evaluations of a person's capabilities and limitations, as well as instruction in the use of adaptive technology and safe driving practices. Driver rehabilitation aims to restore a person's independence and mobility by allowing them to operate or continue operating a motor vehicle. Programs offered by hospitals, rehabilitation facilities, or specialized driving schools can be used to accomplish this.
Different impairments can have an impact on a person's ability to drive. Several instances include:
Physical limitations can make it difficult to control the steering wheel, brake, or accelerator or to turn their head to look for oncoming traffic, such as arthritis, amputations, or spinal cord injuries.
A person's capacity to make prudent driving decisions, pay attention to their surroundings, or respond quickly in an emergency situation can be impacted by cognitive impairments like dementia or traumatic brain injury.
People who have vision problems, such as cataracts or glaucoma, may find it challenging to judge distances and speeds accurately or to see traffic signals, signs, or other vehicles on the road.
By offering assessments to identify a person's strengths and limitations as well as training on adaptive equipment and specialized driving techniques, driver rehabilitation programs can help address these issues. For instance, it may be possible to train someone with physical limitations to drive using hand controls rather than foot pedals. The use of specialized mirrors or camera systems can be taught to someone who has trouble seeing out of their peripherals.
Evaluating a Driver's Skills and Abilities
A person's visual perceptual ability, cognitive skills, motor skills, and psychosocial skills are all measured through a combination of assessment tools that are typically used to determine a person's driving prowess. A driver rehabilitation specialist, such as an occupational therapist, frequently conducts these evaluations.
Tests for visual acuity, peripheral vision, visual field, and visual reaction time may be included in this evaluation of visual perceptual ability. These examinations are intended to gauge a person's capacity for perceiving and comprehending visual cues, including traffic signals, signs, and other vehicles on the road.
Tests of cognition, including those for attention, memory, problem-solving, and decision-making, may be part of this evaluation. These exams measure a person's capacity for safe driving judgment, awareness of their surroundings, and emergency response time.
Motor skills: Coordination, strength, range of motion, and dexterity tests may be part of this evaluation. These assessments look at a person's steering wheel, brake, accelerator, and other vehicle control skills.
Psychosocial skills: This evaluation may include a road test, an interview, and a review of a person's driving history. This is intended to assess the person's attitude toward driving, capacity for managing stress, and driving behaviours and habits.
The outcomes of these evaluations are used to identify a person's driving strengths and weaknesses and to create a personalized rehabilitation plan that takes care of any problem areas. In order to ensure that the program addresses the individual's unique needs and goals and maximizes their chances of success, an individualized program is specially designed to the individual's impairments, functional abilities, and daily living needs.
The Road Evaluations
A road test, also referred to as an on-the-road evaluation, gauges a person's proficiency behind the wheel under actual driving circumstances. An occupational therapist will ride along with the subject during the evaluation and watch them operate the vehicle on a variety of highways, city streets, and country roads.
An on-the-road assessment considers the following elements:
Vehicle control is the capacity to steer, brake, accelerate, and use other vehicle controls while maintaining the appropriate speed and distance from other moving vehicles.
The person's capacity to scan the road ahead, identify potential hazards, and make safe driving decisions like signalling, merging, and yielding to other vehicles are all included in this.
Adaptive equipment: The evaluator will evaluate the person's ability to use any adaptive equipment they may be using, such as hand controls or specialized mirrors.
Reaction time, attention, and memory: The assessor may also look at how quickly the subject reacts to various situations, how well they pay attention to the road, and how well they remember traffic signs and signals.
Overall driving ability: The evaluator will also evaluate the person's overall driving ability, which includes their capacity to adhere to traffic regulations, maintain proper lane positioning, and control the vehicle in a variety of weather and road conditions.
Adaptive Equipment for Driving
Any devices or adjustments that can be made to a motor vehicle to allow a person with a disability or impairment to operate safely are called adaptive driving equipment. Hand controls, pedal extenders, specialized mirrors, steering wheel knobs, and left-foot accelerators are a few examples of adaptive driving equipment.
Advanced driver assistance systems (ADAS), like lane departure warning, lane keeping assist, adaptive cruise control, and automatic emergency braking, have been proven to reduce the risk of accidents by providing an extra layer of safety for drivers of all ages and abilities.
Hand controls are devices used to operate a vehicle's accelerator and brake pedals. They are made to be used by people whose disabilities make it difficult for them to press the pedals with their feet. Push-pull controls are typically hand-operated and mounted on the car's steering column. On the hand control, the driver pushes forward to accelerate and pulls back to brake. As an alternative, a joystick or a button on the steering wheel is used to operate the electronic hand controls. When accelerating or braking, the driver presses the joystick or button with their hand and then releases it.
For people who are shorter in stature or have mobility issues, pedal extenders are accessories that can be fastened to the gas and brake pedals.
For people with limited hand mobility, steering wheel knobs can be fastened to the steering wheel to make it simpler for them to control the vehicle. It gives the hand an additional grip and leverage point, enabling the driver to steer the car more easily. It can also help people whose grip strength is compromised by conditions like arthritis or tremors when they try to use a standard steering wheel.
Convex or wide-angle mirrors, which are also referred to as specialized mirrors, are made to offer a wider field of view than regular mirrors. They are installed in cars to improve the visibility and safety of the driver. Similar to this, cameras mounted on the back of the car can show what's behind it on a monitor inside. People with limited mobility and those who have trouble turning their heads to look behind can benefit from them.
Last but not least, left-foot accelerators also referred to as left-foot gas pedals, are made to help people who find it difficult to press the gas pedal with their right foot. The location of left-foot accelerators on a vehicle's floor is typically to the left of the brake pedal. They are wired to the existing gas pedal so that it will activate when the driver depresses the accelerator with their left foot. This enables the driver to keep their right foot on the brake pedal while using their left foot to control the vehicle's speed.
Role of Occupational Therapy and Driving Rehabilitation
Occupational therapy plays a vital role in assessing and rehabilitating individuals with impairments that affect their ability to drive. Occupational therapists are qualified to diagnose and assist people who suffer from a range of visual, cognitive, and physical impairments. They assess and treat patients holistically, taking into account each person's overall health, functional capacity, and needs for daily living.
Common roles include:
Conducting evaluations: In order to determine a person's capacity to operate a motor vehicle safely, occupational therapists will evaluate their visual perceptual ability, cognitive abilities, motor abilities, and psychosocial competencies.
Occupational therapists will work with individuals to teach them how to use the adaptive equipment mentioned above.
Specialized driving techniques: To help people make up for any limitations they may have, occupational therapists will work with them to develop specialized driving techniques.
Cognitive retraining: Occupational therapists will work with clients to enhance their cognitive abilities, which are necessary for safe driving and include attention, memory, and problem-solving.
Occupational therapists may use simulation training to offer people a secure and controlled environment in which to hone their driving abilities.
Gradually progressing to solo driving when the person is ready, occupational therapists will work with individuals to create a graduated driving plan that begins with supervised driving.
Review of driving habits and history: Occupational therapists will examine a patient's driving habits and history to find any patterns or problems that should be addressed during rehabilitation.
Occupational therapists will assist the person and their family in identifying alternate modes of transportation and will offer instruction and support for using those modes of transportation. This will aid in the transition to other forms of transportation if needed.
Overall, occupational therapy in driver rehabilitation aims to help individuals regain their independence and mobility by enabling them to drive or continue driving a motor vehicle safely.
The use of virtual reality technology for driver rehabilitation is becoming more common. It allows individuals to practice driving in a safe and controlled environment, and can be used to evaluate and improve cognitive, visual, and motor skills.
Canadian Association of Occupational Therapists, CAOT Position Statement Occupational Therapy and Driver Rehabilitation (2009), https://caot.ca/document/3704/O%20-%20OT%20and%20Driver%20Rehab.pdf
Dickerson, A. E. (2013). Driving assessment tools used by driver rehabilitation specialists: Survey of use and implications for practice. The American Journal of Occupational Therapy, 67(5), 564-573.
Driving and Community Mobility Toolkit, Driving rehabilitation program development. American Occupational Therapy Association (2023), https://www.aota.org/practice/clinical-topics/driving-community-mobility/driving-rehabilitation-program-development Pellerito, J. M. (2006). Driver Rehabilitation and Community Mobility: Principles and Practice. United Kingdom: Elsevier Mosby. Unsworth, C. A., & Baker, A. (2014). Driver rehabilitation: A systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive. Accident Analysis & Prevention, 71, 106-114.