In This Issue:

1. Driving Skills Change With Age
2. Quiz:  Are You and At-Risk Driver?
3. Safe Driving Tips
4. Car Shopping Tips
5. "Hang Up and Drive"
6. Warning Signs for Senior Drivers
7. Driving Before and After
8. Ask Dr. Vanessa

This month’s newsletter is about driver safety. There is background information about the skills needed for driving, a brief discussion about driving risk factors, tips to promote health and safety when driving, and a short screening quiz to identify potential driving risk factors.  We included a “Useful Car Features” chart that can be used when shopping for a new car and a personal story about driving from guest author Mr. Harvey Doege. Dr. Vanessa suggests a driving safety solution. 

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1.  Driving Skills Change With Age by Vanessa M. Dazio, OTD, OTR/L

Driving makes “doing” possible, easier, safer, more convenient, faster and comfortable.  Driving transports us to work, stores, churches, hospitals, services, friends, families, social activities and community events. It decreases social isolation, has an impact on our self-esteem, and improves the quality of life. It is a cherished, important and valued daily life activity that feels like a right, but in fact, is a privilege.

A driver is responsible for assuring personal and public safety, when operating a vehicle. Lives depend on the driver’s abilities. As abilities change, driving skills should be continuously re-assessed. Driving requires complex skills that are primarily dependent on vision, cognition and motor function (physical abilities). These skills do change with age.

Required Skills for Driving

Vision
Vision is responsible for 95% of the information drivers must use to make safety decisions when operating a vehicle. Near vision is needed to see gauges and controls, and read maps inside the car. Far vision is needed to read signs, see pedestrians, roadways, turn lanes, traffic lights, etc. Visual field is needed to see cars coming from the sides, traffic signs, or pedestrians.

Another important aspect of vision is the ability to determine the foreground from the background, called contrast sensitivity. Contrast sensitivity is important when looking at lines, borders, curbs, pedestrians, signs, etc. This skill is needed to distinguish objects against a background. Drivers who have difficulty with contrast sensitivity may have even more difficulty driving at dusk, dawn or in stormy or poor weather conditions.

Accommodating to changing light can affect driving, especially at night when bright lights and high beams are suddenly used. Glare may also be a concern here.

Cognition
Driving requires memory, attention, and high level thinking skills. It also requires the ability to recognize, interpret, then correctly make decisions about all the visual information the driver sees.

A driver must remember how to operate the vehicle, while remembering traffic rules, the meaning of signs and signals, destinations and directions to get to destinations. A driver has to make split second decisions on how to prioritize attention, what must be attended to and what could be disregarded. Even higher level skills must be used when special life threatening situations happen.

Motor Function
Driving can be a very physical activity. It requires coordination, physical strength, range of motion, endurance, flexibility. Physical strength is required to maintain posture, control the steering wheel, turn to look in either directions and in the back, use the brakes and other foot pedals, and sustain the physical effort of driving distances. Flexibility helps to assure speed of response, a vital element of driving.

Range of motion is necessary to complete all driving tasks, including holding the head up, reaching for the steering wheel or emergency brake, adjusting mirrors, handling controls on the dashboard, etc.  Large gross motor coordination skills are needed to use arms and legs for steering and acceleration, getting into and out of the car. Fine coordination is needed to hold a key, turn dials, make adjustments, etc.

All these functions, working together are necessary to assure speed of reaction time. This is critical when split section decisions and speed are necessary to prevent accidents or injuries from occurring. Because not all highway factors can be controlled by the driver, this ability must be constant, because it is the driver’s duty to prevent accidents and injuries and to assure safety.

Age Alone Does Not Predict Driver Fitness
Statistics in the US clearly prove motor vehicle injuries are the leading cause of injury related deaths among 65-74 year olds. They are the second leading cause (after falls) in the 75 years olds and older age group. These age groups are more prone to motor vehicle crashes due to disease and medication related functional deficits.

The good news is age alone does not predict driving fitness. There are many related factors. But the key to safe driving at an older age is to recognize the changes, notice the resulting limitations, and find safe ways to adjust to them.

Pay Attention to Age Related Changes
Age related changes can occur over a long time. Declines in vision, strength, balance, range of motion, judgment or memory can affect driver safety. Combinations of any of these, can seriously affect driving ability. Changes can be subtle, difficult to notice, and deadly if undetected. Constant vigilance and attention to driving skills and abilities should be a priority for all drivers, but especially for the older driver. It could save lives.

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2.  QUIZ: Are You An At-Risk Driver?

Driving requires a certain set of physical and mental skills and abilities. Here is a little quiz you can take to help you to assess whether you might be an at risk driver. Please take a few seconds to honestly answer the following quiz.

Do you?

• have difficulty walking?
• have difficulty getting into/ out of chairs, furniture or your car?
• have difficulty with visual tasks?
• have difficulty with concentration, memory or attention span?
• have any medical conditions that could impair driving skills?
• take multiple medications?
• have joint pain, stiffness or muscle weakness?
• ever get lost while driving?
• ever suddenly lose consciousness or feel faint?
• ever feel overly fatigued when driving?
• ever drift into another lane when driving?
• ever stop at a green light or stop at the wrong time?
• ever drink and drive?
• usually avoid driving at night?
• usually avoid changing lanes?

If you have answered YES to any of these questions, your safety and the safety of others may be at risk when you drive.  

TIP: Talk to your health care professional to have a more detailed and careful screening. This could be a vital important first step to improving your safety and the safety of those around you.

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3. SAFE Driving Tips

1. Make sure your car is in good health!

• Keep your mirrors and windshield clean.
• Replace worn wiper blades immediately.
• Tires should have good tread and be filled properly.
• Make sure oil and all fluids are changed regularly

2. Drive with care

• Always wear your seat belt.
• Stay off the cell phone.
• Avoid distractions such as listening to the radio or having conversations.
• Leave a big space, at least two car lengths, between your car and the one in front of you. If you are driving at higher speeds or if the weather is bad, leave even more space between you and the next car.
• Make sure there is enough space behind you. (Hint: if someone follows you too closely, slow down so that the person will pass you.)
• Use your rear window defroster to keep the back window clear at all times.
• Keep your headlights on at all times.

3. Car safety

• Drive a car with features that make driving easier, such as power steering, power brakes, automatic transmission, and large mirrors.
• Drive a car with air bags.
• Check your windshield wiper blades often and replace them when needed.
• Keep your headlights clean and aligned.

4. Driving skills training tips

• Take a driving refresher class every few years. (Hint: Some car insurance companies lower your bill when you pass this type of class. Check with AARP, AAA, or local private driving schools to find a class near you.)
• Screen regularly for subtle changes that could affect driving safety.

5. Personal Health Tips for Driver Safety

• Make regular preventive health visits:
• Eat well balanced, nutritious foods and drink lots of water.
• Exercise to stay fit, keeping muscles and joints flexible and strong.
• Never drink and drive.
• Always wear your seat belt.
• Don’t drive when you are angry, ill, upset, sleepy or under the influence of alcohol or medications.

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4. Car Shopping Tips by Vanessa M. Dazio, OTD, OTR

Purchasing or leasing a car usually requires a long term financial commitment. For older drivers, no purchase decision should be made without thinking about the potential for future changes in health and abilities due to normal aging.

Normal age related changes can significantly affect driver safety. Vision, strength, balance, coordination, range of motion, and cognitive abilities can and do decline with age. Any one of these changes in abilities, or any combination can be a serious safety risk for the driver and any one else on the road.

Having awareness of risks or possible risks, before purchasing a vehicle could make a life altering difference.

Take a few minutes to think about your future before buying or leasing a new car.

1. How do you see your health 2 years from now?
2. How about 4 years?
3. Do you have any medical conditions now that could cause loss of abilities in the future?
4. Could you foresee or predict changes in your physical or mental health that could cause driving difficulties such as changes in strength, movement, flexibility, vision, etc.?

While you really never know exactly what your future will bring in terms of your health or wellness, you can identify potential risk factors, and choose "enabling" options. Enabling options can make a task easier to do. There are lots of them!

The following is a very brief generic list of options you can choose to help compensate for some normal age related changes that have an affect on driving capabilities. Choosing senior friendly features now can make a huge difference later!

Here are some friendly features that work for all ages, but are especially nice for the older adult.

Read Car Shopping Tips for the Older Adult- PDF

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5. “Hang Up And Drive” by Dr. Vanessa

Ever hear “Don’t drink and drive?” How about “Hang up and Drive?” There were never wiser bumper sticker words of wisdom! Hang up and drive should be an international mantra. “Hang up and Drive!” “Hang up and Drive!” “Hang up and Drive!”

Other than using the phone for emergency calls, cell phones are a major driving distraction. Research studies are already demonstrating significant delays in braking reaction speed; lane drifting, driving through red lights, not seeing and responding to signs and signals. These problems are all high risk actions that only take ONE time to cause deadly consequences. “Hang up and Drive!”

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6. Warning Signs for Senior Drivers

Pay attention to changes in driving habits. Here are some warning signs for senior drivers.

Many senior drivers "self regulate," by intuitively changing driving habits.

Behavioral Warning Signs

• does not anticipate potentially dangerous situations
• driver is easily distracted while driving
• failure to stop at stop signs or red lights, or stopping for no apparent reason
• failure to notice signs
• feels decreased confidence when driving
• gets lost in familiar places
• has near misses
• hits curbs, parked cars, garage doors, etc.
• incorrect signaling

Driver changes driving habits

• avoids rush hour traffic
• avoids making left hand turns or trouble navigating turns
• avoids night time driving
• drifts into other lanes
• drives at inappropriate speeds
• drives in only one lane
• drives less
• only drives with a passenger (co-pilot) who can provide assistance, etc.

Other Obvious Signs

• car accidents
• scrapes or dents on the car, mailbox or garage

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7. Driving Before and After by Harvey Doege

It began on my sixteenth birthday. I got my driver’s license! I drove until my arthritis got the best of me. I had my first spinal surgery in 1978. I wore a halo for nine months, a contraption that did not allow me to turn my head any which way.

When the halo was removed, I wanted to drive but could not turn my head as well as before. With the help of extended car mirrors so I could see better, I began to very cautiously drive again. I eventually added a wedge cushion that helped me to sit upright and balanced. These things helped me to safely drive longer.

I also got a scooter and a lift, which helped me to get around once I got to where I was going. As my arthritis got worse, I realized I had to stop driving on my own.  This was a difficult decision. I gave up one of my privileges that I really enjoyed. I have not driven for the past three years.  

Not driving makes me feel left out of many things.  I would like to do volunteer work, but feel uncomfortable always-asking people to pick me up or take me home. I have to be able to get someone who can accommodate a scooter in the car or on the back with a lift.  

I am very thankful that my wife of 53 years is still able to drive me places we have to go. I feel very fortunate to be a happy go lucky type of person. I have always had a positive attitude about my arthritis. My motto has been, “I do what I can when I can.” 

Mr. Harvey Doege and his wife Joanne live in Tarpon Springs, Florida.  They are both an inspiration and a joy to know! They have worked together as a team for 53 years to creatively find workable solutions to manage home and life challenges due to arthritis.

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8.  Ask Dr. Vanessa

Question: I am concerned about our father's driving safety. He denies having any difficulties, but different family members have seen him back into two parked cars, run over a curb and through a red light all in one week! Dad says people are getting more aggressive on the road because they are constantly honking their horns at him. We are concerned about his safety. What should we do?

Answer: You are doing an important first step, and that is "becoming aware." You and your family have apparently noticed some driving actions that are serious causes for concern.

Dad's backing into parked cars, running over curbs and through red lights are serious warning signs of high risk driving behaviors. Furthermore, he has noticed other drivers are honking their horns at him! Another warning sign!

It is now important to know why. Why are these actions happening? They could be caused due to a wide variety of reasons.

The first step should be to talk to Dad about your observations. See if Dad is aware of changes in his driving abilities. Avoid blame or shame. Just talk. Let Dad know you care about him. If he has noticed changes, ask him when he is most concerned about driving? This will help to open the discussion.

Together, try to find the basic reason behind driving changes. Could it be visual changes? If so, what? When are the problems most apparent? If vision is a concern, make an appointment with an optomotrist or ophthalmologist. Vision can often be correctable. Because vision is such a vital sensory skill for driving, it is most important to check visual skills every year.

Could problems be related to the car itself? Are mirrors adjusted properly? Is the seat height adjustment just right? Is Dad sitting too low in the driver seat? Is he able to see at least 10 feet in front of his car when sitting in the car seat? Sitting too low could be a cause for not seeing parked cars. It could be part of the reason for missing red lights, and even cutting curbs! So, something as simple as a car seat adjustment could change driving abilities.

What about Dad's health? Does he have an undiagnosed medical condition? Is he taking medications, a new medication or combinations of medications? Does he have new physical complaints? Is the doctor aware of his complaints? Has Dad been eating properly?

What about muscle strength and flexibility? Is Dad strong enough to twist completely around to see behind? If not, this could make seeing parked cars difficult. If this is a problem, a fitness program could help. Or, special mirrors that extend the visual field could be another option that reduces his need to turn his head or rotate the trunk.

Could problems be related to changes in cognitive abilities? Is Dad having or noticing problems with judgment, attention, memory, in other daily life activities?

Driving requires a variety of very complex skills and abilities, in a constantly changing environment. Before making life changing changes, talk about it! Look for the root cause of Dad's difficulties. Seek the assistance of your physician, or ask for a referral to an occupational therapist or certified driver rehabilitation specialist to do a comprehensive driver assessment. It could save Dad's life and the lives of others! Thanks for your question!

For more information refer to: http://www.aota.org/featured/area6/docs/DriversFact.pdf

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Internet Resources
 

• The Hartford: Warning Signs for Older Drivers
• AMA: Physician's Guide to Assessing and Counseling Older Drivers
• AMA: Why are older drivers at risk?
• AMA: Patient Resources

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