geriatrics
Interventions With the Older Driver
Driving rehabilitation programs
Although some older drivers can benefit from driving refresher courses (eg,American Association of Retired Persons [AARP] Driver Safety), most should be referred to occupational therapists who specialize in driving rehabilitation (called driving rehabilitation specialists). Driving rehabilitation specialists can be located by contacting local rehabilitation facilities, theAssociation for Driver Rehabilitation Specialists, or theAmerican Occupational Therapy Association. Occupational therapy driving rehabilitation specialists usually do comprehensive driving assessments that include clinical tests of vision, motor, and cognitive skills as well as on-road evaluations. During on-road evaluations, the specialist goes in a vehicle with the older driver to evaluate actual driving skills in varied traffic conditions. The vehicle used during the evaluation should be equipped with features that allow the specialist to maintain safe control (eg, passenger-side brake). At the conclusion of the comprehensive driving evaluation, the specialist provides recommendations regarding the individual’s driving ability. These specialists can also assist by Recommending a tailored rehabilitation plan to increase motor skills, cognition, and perception in the driver’s daily life Providing adaptive driving equipment and training in using the equipment (eg, a spinner knob to help with one-handed steering, more complicated devices such as hand controls) Evaluating the response to the rehabilitation plan and providing feedback to the driver, involved relatives, and the physician as to whether the driver's driving abilities are adequate to continue driving or whether driving restrictions are indicated Providing mobility counseling or advice on alternate modes of transportation In most states, the cost of a rehabilitation driving assessment is not covered by insurance (Medicare or private) and is an out-of-pocket cost. If a driving rehabilitation specialist is not in the area or costs are prohibitive, options include referral to a local occupational therapist who specializes in older adult medical conditions and/or a referral to the state drivers licensing department for complete retesting of vision and written and road testing. 