Home Modification

Safe and Steady in the Driver’s Seat

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aging in_placeBy Karyn E. Silvestri, OTR/L, DRS

People of all ages living in urban and rural areas have become highly dependent on meeting their travel and community mobility needs with the automobile. Driving is symbolic of independence and adult autonomy. The task of driving brings a sense of personal competence, provides access to vital services and social interactions, and can assist older people in their ability to “age in place” in customary environments. Maintaining independence in community mobility through driving can influence the roles a person assumes, and help individuals establish and maintain group ties. It also can allow for the performance of household and business activities, the quest for meaningful social activities, and the creation of positive self-esteem.

Conserving Community Mobility
The term Aging in Place is used to define “a senior living in the residence of their choice as they age, while being able to have any services (or other support) they might need over time as their needs change, for as long as they are able.” As an individual begins the aging process, it is important to consider how certain changes might affect one’s life. Decreased vision, muscle strength, and endurance, impaired cognition and slowed processing speed, increased falls and poor balance, hearing loss, and
decreased mobility are examples of age-related change. Driver rehabilitation specialists (DRSs) provide a valuable service to those who have chosen to age in place, with physical and/or cognitive impairments, to preserve their community mobility needs, and ensure safety of the individual driver and community.

According to the AMA’s Guide to Assessing and Counseling the Older Driver, “Life expectancy is at an all time high. By the year 2030, the population of adults older than 65 years will more than double to about 70 million, representing 20% of the US population. We can anticipate many older drivers on the roadways over the next few decades….”1 Of these older adult drivers, many have chronic medical conditions associated with driving impairment. The most common medical conditions include arthritis, heart disease, hypertension, impairments in hearing and vision, heart disease, orthopedic problems, and diabetes.1
Moreover, the use of many prescriptions and over-the-counter medications also may affect driving skills. Many older adults are prescribed more medications than the younger population and are often more susceptible to the effects of these medications on physical and cognitive skills.1

Adaptations to Driver Independence
A referral by a physician to a driver rehabilitation program may be key in determining driving safety and addressing community mobility needs of people with specific disabilities and the aging in place population. Many driver rehabilitation programs and community mobility services employ occupational
therapy practitioners trained in driving rehabilitation to assess safe driving skills. “Occupational therapists have expertise in assessing the individual’s holistic status, including an understanding of how medical conditions and impairments can impede driver readiness.”2 The occupational therapist serving as a DRS possesses the ideal professional background to perform predriving and behind the wheel evaluations of an individual’s driving skills. Occupational therapists/DRSs have an in-depth understanding of the complex and symbiotic body structures and functions that is necessary to accurately assess and assist clients in achieving driving and/or community mobility goals.2

When working with the aging population in a driving rehabilitation setting, a DRS will evaluate an individual’s driving skills, recommend rehabilitation intervention if needed, and may suggest vehicle adaptations to make driving safer and more comfortable. In the aging population, physical limitations and/or chronic medical conditions may be compensated for with proper modification to an individual’s vehicle, contributing to a greater sense of safety and confidence behind the wheel.

Some examples of adaptive equipment include:

• Steering: A steering knob, palm grip, and tri-pin are driving aids mounted to the steering wheel generally used with individuals having only one hand available for steering, or if the driver’s hand grip is impaired. These devices are useful in the cerebrovascular accident (CVA) and arthritis populations. Reduced/low effort steering devices can be installed to the vehicle power steering system, reducing the effort needed to turn a standard power steering wheel. These modifications are helpful to individuals with severe arthritic shoulders, as well as neurological diseases and injuries such as multiple sclerosis and spinal cord injury.

• Accelerator and brake controls: A left foot accelerator is a driving aid that is mounted on the floor of the vehicle to the left of the brake pedal to allow the left foot to operate the vehicle’s accelerator. This device is often used for drivers with CVA and right hemiplegia in addition to right LE amputees. A gas pedal block is a metal plate positioned over the vehicle’s original accelerator to prevent the driver from depressing it when using a left foot accelerator. Hand controls are mechanical devices attached under the vehicle’s dashboard, which connect to the accelerator and brake, allowing a driver to control these functions with a single hand. Drivers who use this aid typically have little or no use of the lower extremities.

• Mirrors: These aids may be added to or replace original vehicle mirrors to assist the driver checking their blind spots or to help broaden peripheral vision for those individuals with limited neck and/or trunk rotation as well as visual limitations.

• Seating and positioning: The addition of cushions may be used to improve vision in and outside of the vehicle. Replacing the seat with a swivel base to extend the seat beyond the vehicle threshold can help the driver transfer without maneuvering around the steering column.

• Handibar: A removable grab bar, which hooks onto the door latch, gives a driver a firm handle to hold while transferring in/out of the vehicle.

• Leg lift strap: A device that helps those with joint replacements or weak lower extremities safely and comfortably lift the leg(s) over the vehicle threshold during transfer.

• Navigation: Wireless and GPS technology offers navigation services in the event a driver becomes lost in addition to emergency service assistance in the event of a crash.

• Backup camera: A wireless system, in which the rear view of the vehicle is projected onto an LED screen mounted on the vehicle dashboard, is particularly helpful with individuals with limited physical mobility who can not turn to see what is behind the vehicle.

A wide variety of adaptive vehicles and equipment is available to assist passenger transport. Many conversion vans are equipped with automated wheelchair ramps, powered wheelchair/scooter lifts, lowered floors, removable front seat bases, and wheelchair docking systems, which allow wheelchair users to ride as passengers in the vehicle. Some mini-vans can be modified to have lowered floors and rear entry wheelchair ramps. Turning seats and lift-up and transfer seats are also available to make passenger travel easier. Wheelchair and scooter power lifts and storage devices are available for cars, vans, pick-up trucks, and SUVs.

Improving Access and Ensuring Safety
When modifying or purchasing a modified/wheelchair accessible vehicle, the National Mobility Equipment Dealers Association can provide drivers and their families with information on manufacturers and dealers that specialize in vehicle modification. Older drivers may find CarFit is a helpful tool. This educational program offers older drivers the opportunity to assess how well they “fit” into their vehicles. Another helpful tool is “Road Wise Review,” a computer-based program that allows older drivers to assess driving-related skills in their own home.

For those aging in place, much effort is needed to ensure the safety of older drivers and the community in which they live. The collaboration of driver rehabilitation programs, older driver educational programs, and driving equipment and adaptations can assist older drivers with the appropriate support they need to maximize their safety on the road. RM

Karyn E. Silvestri, OTR/L, DRS, is a staff occupational therapist and driving rehabilitation specialist for Centegra Health System-Neuro-Rehabilitation Center and Driver Rehabilitation Program in Crystal Lake, Ill.

REFERENCES

1. American Medical Association. Carr DB, et al. AMA Physician’s Guide to Assessing and Counseling Older Drivers. 2nd ed. Chapters 1, 2, 5. 2010. Available at: http://www.ama-assn.org/ama/pub/physician-resources. Accessed January 10, 2013.

2. Pellerito MJ Jr. Driver Rehabilitation and Community Mobility. St Louis: Elsevier Mosby; 2006:3-4, 242-249. Bibliography AAA. Program Goals and Outcomes. Car-fit.org. 2013. Available at: http://www.car-fit.org. Accessed January 9, 2013. AgeInPlace.com. Age In Place Basics/What Is Aging in Place. 2013. Available at: http://ageinplace.com/aging-in-place-basics/what-is-aging-in-place/. Accessed January 10, 2013. American Occupational Therapy Association. Thursday: Equipment That Can Empower Drivers. AOTA.org. Available at: http://www.aota.org/DocumentVault/Driving/ODSAW/Thursday Accessed January 9, 2013. Carr DB. The older adult driver. Am Fam Physician. 2000;1:141-146 Odenheimer G. Driver safety in older adults. The physician’s role in assessing driving skills of older patients. Geriatrics. 2006;61(10):14-21. Redepenning S. Driver Rehabilitation Across Age and Disability. Bethesda, Md: AOTA Press; 2006:41-42.

Other Resources: The Association for Driver Rehabilitation Specialists (ADED) 2425 N Center St, #369 Hickory, NC 28601 www.aded.net American Occupational Therapy Association (AOTA) 4720 Montgomery Lane Bethesda, MD 20814 www.aota.org National Mobility Equipment Dealers Association (NMEDA) 3327 West Bearss Ave Tampa, FL 33618 www.nmeda.com