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Functional Assessment of The Older Driver

 

 

Introduction

Driving is a highly integrative task that depends on psychomotor, cognitive and sensory-perceptual functions. It is normal for our functional driving abilities to change as we grow older.  It is important to know our driving abilities and to incorporate safe driving practices to reduce risk of injury to self and others. We must learn to make appropriate adjustments for functional limitations that interfere with our driving safety as we age.

Functional Assessments

Vehicle operation requires the interaction of sustained visual attention, adequate speed of mental processing, timely and accurate responses and adequate sensory motor controls for safe driving. Therefore a functional assessment is essential to know whether a person still can continue or to cease driving.

Indications:

Functional assessment need to be carried out if there are symptoms of decreased physical fitness among older drivers. It may be time to look at driving ability when an older person experience:

  • Difficulty in looking over the shoulders to change lanes or looking left and right in order to check the traffic
  • Trouble of moving the foot from the accelerator to the brake pedal or turning the steering wheel
  • History of fall (once or more in the previous year)
  • Reduced mobility or walking less than one block per day
  • Inability to raise arms above the shoulders
  • Concerns from others about? (family member, relatives, friends, or others)

Functional Limitations

The common functional limitations that can impact on safe control of car as we grow older are motor, visual and cognitive as listed below:-

  • Reduction in musculoskeletal
    • deteriorated strength (diminished grip strength causing hard to turn the steering wheel quickly and effectively)
    • limited mobility (limited range of motion of shoulder, wrist or elbow can affect steering)
    • reduced joint flexibility (limited mobility of neck may restrict view field)
  • Pain:
    • difficulty in exerting force (moving foot from accelerator to brake)
  • Poor coordination:
    • reduction in dexterity
  • Cognition function impairment:
    • older person may not fully-recognize cognitive limitations
  • Slow motor reflexes:
    • increased reaction time (slower to spot vehicles emerging from side streets and driveways, or to realize that the vehicle ahead of you has slowed or stopped)
  • Inattention:
    • inability to divide attention between multiple activities (road signs, signals, other traffic and pedestrians)
  • Proprioceptive difficulties:
    • judgemental errors
  • Decreased vision:
    • poor visual performance such as visual processing speed
  • Impaired hearing:
    • unable to apprehend warning signals such as horn

Apart from those, we might have to adjust to functional loss caused by a sudden change such as stroke or having a chronic condition that gradually worsens with time.

Recommendation/Modification for Safe Driving

Getting older doesn‘t mean losing of driving ability. Many things can be done to continue driving safely, including modifying the car, the way of driving, and also  understanding and rectifying physical issues that may interfere with driving. Below are some tips of driving safely for older driver:

  • Regular check (to keep you in the best possible driving shape)
    • Getting eyes check (make sure that corrective lenses are current /tinted eyeglass lenses to reduce glare)
    • Hearing check (if hearing aids are prescribed, make sure they are worn while driving)
  • Keep the windshield, mirrors, and headlights clean, and turn brightness up on the instrument panel of the dashboard
  • Sleep well (getting enough sleep is essential to drive well)
  • Find the right car and use any aids / car adaptations you need for driving
    • Choose a vehicle with automatic transmission, power steering, and power brakes
    • Keep your car in good working condition by scheduled maintenance
    • Seek advice from occupational therapist for prescribe equipment to make it easier to steer the car and to operate the foot pedals
  • Drive defensively
    • Hand phones and music players are distracting (need to take extra steps to drive safely)
    • Leave adequate space for the car in front
    • Paying extra attention at intersections (make sure driving appropriate to the flow of traffic)
    • Avoid distractions, pull over instead (such as when talking on the phone while driving or trying to puzzle out a map)
    • Allow sufficient braking distance (even more if the road is wet)
    • Know your limitations (do not drive if a driving situation makes you uncomfortable such as night time, fast, heavy moving traffic situations or bad weather)
    • Plan route before leaving to an unfamiliar place (to feel more confident and avoid getting lost)

Getting a professional evaluation

Recognize that changes can happen as we aged. Get help and be willing to listen if others voice concerns to continue driving safely.

Doctors should also be able to provide an opinion about your ability to drive safely, or refer you to an occupational therapist for more intensive evaluation and recommendation of car modifications or tools to keep someone driving as long as possible. It can also help diffuse accusations from family by providing a neutral third party perspective.

Older unsafe drivers are recommended to retire from driving and choose for alternative mode of transportation.

References:

  1. Mark HB, Robert B et al. The Merck Manual of Geriatrics, 3rd ed. Merck and Co, 2000.
  2. Helena L, Catarina L, Torbjorn F et al. A Swedish survey of occupational therapists’ involvement and performance in driving assessments. Scandinavian Journal of Occupational Therapy 2007 vol. 14;4:215-220.
  3. Mary AF, et al (2004) Geriatric Secrets. 3rd ed. Mosby: Pennsylvania (Older Driver 231-236)
  4. http://www.helpguide.org/elder/senior_citizen_driving.htm ( Access on 25/4/2013)
  5. http://www.cdc.gov/Motorvehiclesafety/Older_Adult_Drivers/adult-drivers_factsheet.html (Access on 25/4/2013)
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915446/  (25/4/2013)www.aota.org/olderdriverhtml (Access on 25/4/2013)
Last Review : 16 July 2013
Writer : Thillainathan a/l Krishnan