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Brief Description of our Project

Remediation Through Adaptive Equipment and Training

This three-year project funded by General Motors is currently housed at Maryville University in St. Louis, Missouri.  The principal investigator, Linda A. Hunt, OTR, is a 10-year veteran at testing and training the elderly on driving safety.  Formerly at the Washington University School of Medicine, Ms. Hunt moved the project to Maryville University in August 1997 where the research will be conducted until the project’s completion in March of 2000.

The primary focus of the project is to determine if and how adaptive equipment and training can be used to increase the independent mobility of the older adult.  This focus branches into three very distinct yet related areas: safety, quality of life, and education.
 
The first of these issues, safety, is of considerable concern to the public in general. With the onset and increased risk of various illnesses and disease, the elderly are a particularly vulnerable population to discrete and subtle changes that influence their driving ability.  Many of our elderly population consider themselves expert drivers based on their years of experience and deny other factors, such as having a stroke, as incriminating their ability to drive safely.  Because of this, many older adults are unaware that their driving has been impaired until a physician, relative, or friend notices that their driving ability is questionable, or in worse cases, they are involved in an accident.  Through this project, we hope to give reinforcement to those who are encouraging this population to be checked more frequently for driving safety.

Quality of life issues are likely to come into play whenever a loss of independence occurs.  Driving independently is one of those activities that most adults assume will continue to be a part of their life, and feel threatened when told it is no longer an option for them.  The results of denying an elderly person driving privileges may have severe effects on such things as: seeking sufficient medical attention, seeing family and friends as frequently as they would like, performing volunteer activities, and participating in hobbies or leisure activities.  For the older adult that will be able to drive safely with lessons or assistive devices installed in their vehicles, we hope that the regaining of driving independence will improve their quality of life.

The education of Occupational Therapists, Physicians, and other health care professionals on the benefits and availability of driver training for the elderly is essential to further its success and implementation.  The ongoing and final aspects of our project are dedicated to education through presentations, distribution of informational booklets and development of a home page available on the Internet.

Criteria for subjects included in this study are:
1) 65 years of age or older,
2) Have physical limitation(s) that impact driving ability, such as joint pain, hip or knee surgery, problems with walking, loss of sensation in hands or feet, or amputation
3) Have access to an automobile that can be altered with adaptive equipment
4) Have a valid Drivers License or the ability to obtain one
5) Have visual acuity of at least 20/50
6) Able to maintain a vehicle without financial hardship
7) Have no memory loss illnesses
8) Have no progressive eye diseases.

Recruitment efforts are being made through local news publications, flyers routed to health care facilities and health care professionals, presentations and inter-client recommendations.

Driving diaries, pre and post intervention surveys, the PGCM scale, the Hope Scale, Trail Mapping, the Short Blessed Test, and an on-road test in a specially adapted vehicle are all used to determine the driving ability and state of mind of the subject.  Specifically we are testing the visual acuity, memory, concentration, reaction time, and spatial awareness of the subject along with the consequences of having limited or no driving privileges.

For the duration of the project, all services to the subject as well as educational and community outreach programs are provided free of charge.  The cost of recruitment, evaluation, intervention (lessons and/or adaptive equipment), installation of any equipment prescribed by the principal investigator, and any follow-up or educational materials generated for the participants have been funded by General Motors.

The final tasks of the project include the design, production and distribution of educational materials for the purpose of professional awareness and training. Workshops on assessing the abilities and needs of the elderly or disabled driver are being held on a regular basis for local college students, and training videos for health professionals and motor vehicle licensing agents are in production.
 

What is Occupational Therapy?

Occupational Therapy is the rehabilitation profession that focuses on the
functional activities that occupy one's 24 hour day. When physical,
developmental, social, or emotional deficits impairs one's functional performance,
the occupational therapist works with the individual to rebuild or regain skill
components necessary for optimal daily living.
 

Commonly Asked Questions about Occupational Therapy

Q. What are the professional credentials of an occupational therapy practitioner?

A. Occupational therapy practitioners can be credentialed at either the professional (Occupational Therapist) or technical (occupational therapy assistant) level after completing a four year baccalaureate or two year associated degree program, respectively. The individual must graduate from one of the more 150 accredited programs at colleges and universities throughout the US which regulate the practice of occupational therapy.
 

Q. How are OTs registered?

A. Upon graduation from an accredited school, the individual must take and pass a national
registration examination. In order to remain certified, they comply with the minimum number of continuing education units required by the National Board for Certification in occupational Therapy.
They can be reached at 301-990-7979.
 

Q. What is the difference between and OT and a Certified Hand Therapist?

A. Certified Hand Therapists are registered or licensed OTs or PTs with advanced continuing education, clinical experience and independent study who have taken and passed the Hand Therapy Certification Examination. For additional information call the American Society of Hand Therapists at 312-321-6866 or the Hand Therapy Certification Commission at 816-444-3500.

 
Q. Is there a professional OT association?

A. Yes, the American Occupational Therapy Association (AOTA). The therapist pays annual dues to the AOTA in return for necessary on-going literature and information which keeps the practicing therapist current in the field. The AOTA is a good resource to call regarding regarding ethical issues related to the practice of occupational therapy. The AOTA can be reached at 301-652-6611.

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HEADLINE: HOW OLD IS TOO OLD TO DRIVE?
 BYLINE: CHRISTINE  EVANS;  Palm Beach Post Staff Writer
 
Let's say you're 75. You visit your local motor-vehicles office, pass a
cursory eye exam and renew your driving license.

Six years later, if you have a good track record, you get to skip the exam
and renew by mail; six years after that, thanks to a new law, you get to renew
by mail again.

For 18 years, you go unchecked by the driving examiners who are supposed to
make sure you are fit for the road.  Finally, at the age of 93, you go back to
the licensing office for another test.

This is convenient. But is it deadly?

Florida, home to a greater proportion of seniors than any other state, has
one of the most lenient licensing laws for older drivers. This is not an
accident: Seniors forge a powerful lobby, and many do not want the law changed
to single out the elderly.

"You should have seen the hate mail," says retired Rep. Marian Lewis, who
twice proposed more rigorous testing for drivers over 80.

"We might have to look at that again," Rep. Kelley Smith, D Palatka, conceded
last week. "Don't get me wrong: Plenty of older people are very good drivers.
"But if we don't test them, how do we know?"
 

NORMAN POSSES, 62: My mother was 85 when she passed away; my father, 86. He had Alzheimer's, the early stages. In the car, my mother was his navigator, because he could never remember which way to go. He'd maneuver the car, and she'd tellhim, turn here, turn there.

That day, I think they were going to the library; my mother especially loved
to read.  So he was making a U-turn on Okeechobee Boulevard, going toward the
library, she probably told him to make that turn, but how do we really know?
He pulled directly into four lanes of traffic. Either he didn't see thecars, or he misjudged their speed; I think he misjudged.

The thing is, with my background, I used to teach drivers education and the
irony is I would absolutely preach to my adult classes about the effects of
dementia.  I should have known he wasn't fit to drive.  But my mother couldn't
bring herself to take away the car keys.  We tried to talk to her, but she said,
that's his freedom; she wouldn't hear of it. In hindsight, I should have pushed
it, but you can't go back.

My mother, it's sad, she was killed immediately, so we never said goodbye.  He
was just lucky to be alive.  The car flipped over a few times, and he wasn't
belted in.  He hung on five more months in a nursing home, but after a while he
shut down almost totally, wouldn't talk, wouldn't eat.  That's because my
mother was gone.  The doctors said with his disease he didn't even know it, but I
don't believe that.  Sixty-three-and-a-half years of marriage. I never saw him
leave the house without giving her a kiss. I think he starved himself to death.
 

CASE #94039158, Palm Beach County Sheriff's Office: On March 24th, 1994,
Samuel Posses was interviewed at the Royal Manor Care Facility. Mr. Posses was
in good spirits and very cooperative. Mr. Posses had no recollection of the
crash, any events of the day of the crash, owning a car, how he received the
injuries to his head, nor why he had been in the hospital.
Mr. Posses ... should have surrendered his driver's license prior to this crash.
 
 

JANET DENNIS, 42, Florida Department of Highway Safety and Motor Vehicles:
People ask me how do we regulate older people.  When they walk into our office,
they take a standard vision test, and if the examiner has any concerns about
their physical or mental abilities, he tells them to come back for a driving
test.  Or he might send them back to their doctor for a more complete exam.

A second mechanism is, any dangerous driver may be reported to us by a
physician or family member, and we will follow that up.  If it's a doctor, we
will immediately send a letter requiring that person to come in for a road test.
If it's a family member or neighbor, we will personally go out and visit the
person in question to make a finding.

The third way we monitor is, if somebody's in a crash, the investigating
officer fills out a crash report.  If he believes the driver's ability should be
re-tested, he checks a box, and that person will be required to come in for a
road test or else their license will be suspended.

So those are our three mechanisms.  However, let me say driving is not a
right, it is a privilege in the state of Florida.  Therefore, anything you do
that shows that you are not operating a vehicle safely could be cause to remove
that privilege.
 

It sort of amazed me, frankly, because at the time I didn't know if I was
coming or going.

Unfortunately, I know several people who shopped around for an eye doctor who
would pass them for their licenses.  The doctor they had been going to said, "I'm
sorry. I can't OK you."  So somebody told them about this other doctor, way down
in Broward County, and they went to him, and he said, "OK, you pass."

Sometimes AARP gets the bad rap. People think we're just interested in
protecting elderly drivers, but we're not. We've always been consistent on this.
We do support more rigorous testing  for everyone. We'd like to have in-person
renewals every four years for people of all ages. That way everybody is tested
the same. If the older people fall out, so be it, but to castigate a whole age
category is just not right.

I recall this very well, because I voted for it both times. I thought it was
long overdue. So after Marian Lewis left the legislature, I picked up the idea
and sponsored a bill in 1994 to test drivers 75 and older every three years.
Originally, the only objection I heard was from AARP.  They sent an individual
who spoke about how discriminatory it would be to pass such a law, and I
rebutted his presentation. But my courageous colleagues said, "Oh, we can't pass
this! It might cost a vote!"

 I recently had an older gentleman call me. He said, "You've got to help me.
All I want to do is go from my condo to the library." So I did a background
check; he failed the test three times. He said, "But it's just to the library."
I said, "But between your place and the library, there are a lot of vulnerable
people."

 We were just sitting there talking and suddenly I saw this car coming.  This
woman always came to pick her husband up every day at noon.  We thought she was just going to park, but instead of the brake, she hit the accelerator and in the
blink of an eye, she went over the parking bumper, through the hedges, up a step
and hit my friend.  She just crushed her right up against the wall.  I got a
terrible push in the back  my spine's been ruined  and then I got hit on the
left side of my hip and I flew up and came down about 8 feet away from where we
were.

 I was lucky. She didn't kill me.  But Anne  they turned her over to give her
a tracheotomy and her hand fell on my leg.  I felt for her pulse but I couldn't
get one. It's more than a year now, and I'm still mourning her.  The woman driver
was my age.  Her husband called to apologize.  He called me up and said forgive
us, forgive us.

The only problem is, the elderly people don't really want to give up the
driving privilege, so they drive perhaps longer than they should.  But we've got
bigger problems as far as I'm concerned  I don't think we need to keep on
looking to penalize the elderly.  Most of them have been driving for 40 or 50
years, and some of them have a perfect record as safe drivers. They have eye
checks . I think that's sufficient.  I'll tell you what, when I feel I'm unsafe to
drive, I'll just quit.

 Some of the incidents I remember off the top of my head  how can you forget?
An elderly man hit what he thought were three garbage cans and he just kept
going, but they were really three children; an elderly lady in a Lincoln-type
car hit a guy who was jogging, but she didn't feel the impact and she kept
driving with him on her hood.  The other thing is, a lot of police officers'
wives would call because when their husbands were directing traffic, they'd get
hit.  They'd say, "My husband is laying here disabled, and the old guy or lady is
still out there driving."

However, by another measure, if you control the data taking into account that
older people don't drive as much, then you find that on a per-mile basis older
drivers  say 75 and older  become a much higher risk.  And in terms of fatal
crashes, some data show that for every 100 million miles driven nationally, the
driving group aged 16 to 19 has five fatalities; whereas for people 85 and
older, it's about 30 fatalities.  So at that range, the elderly are six times
more likely to be killed than teens.
 

You have to watch all the time, because these teenagers, they think they own
the road.  So I stay over in the right lane and mind my own business and let them
do all the running around on the other side.  I drive by my mirrors and I don't
keep my eyes forward, I keep them this way and that way, checking for what
everybody else is doing, drinking coffee, putting on lipstick.  So I'm very
careful.  My grandson John is a traffic investigator and I told him, the day
comes, take my license  but you better be prepared because guess who's going to
take me shopping?

Then this year, she was on her way home from the doctor.  I had been trying to
call her all day, and I never got an answer, which was very unusual.  Finally, my
son called me.  He said I have terrible news, grandma's been killed in a crash.  I
was just in shock  the most astonishing part was, she was not the one who
caused the accident.  The other driver was 83.  He pulled right out in front of
her.

I don't care how politically incorrect it is, I think they should change the
law.  My mother was privileged to have 90 terrific years. But to go like that?
It's awful.

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