Motor Skills

To older adults, driving equals independence. But normal changes in vision, hearing, physical abilities and reaction time, along with illnesses, stroke, declines in cognitive abilities and other age-related conditions, can make staying behind the wheel unsafe. Yet even when driving abilities decline, determining when to hang up the car keys can be a devastating decision for seniors and their loved ones. “Age alone is not a good indicator of driving skills,” says Michele Luther-Krug of the International Association of Driving Rehabilitation, based in Rustin, La. “Determinations should be made on a case-by-case basis.”

That’s when the nation’s 300 driving-rehab specialists can help. When driver safety is a concern, an evaluation by these professionals — who work in hospitals, rehab facilities, in private practice or with state motor vehicle departments — can assist in determining if an individual can safely keep driving.

They are trained to provide a comprehensive assessment of the range of factors that affect the ability to operate an automobile. They also offer driver refresher training, recommend adaptive equipment and provide suggestions on changing driving patterns, such as avoiding highways or not driving at night or in bad weather. Most are occupational therapists or occupational therapy assistants or former driving professionals.

“Our goal is to keep seniors on the road as long as safely possible,” says Luther-Krug, the organization’s former certification chairman.

For good reason. The National Older Driver Research and Training Center says restrictions placed on driving can have significant negative consequences for the elderly. When older drivers hang up their car keys, they can experience decreased access to social activities, medical services, shopping and other services crucial to living independently.

“In many cases, individuals who lose the ability to drive end up in nursing homes or assisted-living facilities,” says Luther-Krug, who has been a driving-rehabilitation specialist for 12 years at the Shepherd Center, a rehab hospital in Atlanta.

Warning signs include driving too fast or too slow, not observing signs or signals, needing help or instructions from passengers, getting lost (even in familiar areas), drifting across lane markings, making slow or poor decisions, confusion, frustration and accidents or near-misses.

Medical conditions, medications and slower reaction times all affect the ability to drive. Even mild arthritis in the hands, shoulders, ankles or feet can make it difficult to turn or control a car. Diabetics can experience decreased sensations in their feet, making it difficult to operate — or even discern the difference between the gas and brake pedals.

Driving-rehab specialists check visual perception, range of motion, balance and coordination, do a thorough assessment of driving skills and make recommendations based on the results. Evaluations, which usually take two to three hours, cost between $250 and $500.

Organizations such as the National Highway Traffic Safety Administration, AARP, the American Automobile Association and the Administration on Aging are also working to keep the public informed. A new Web site, www.aota.org/olderdriver, developed by the American Occupational Therapy Association, targets senior drivers and their families. It includes lists of driving refresher courses, driving self-tests, consumer tip sheets and a links to driver rehabilitation specialists.

“Many older adults on the road today never had any formal instruction. A relative, usually a parent, taught them how to drive, and the roads have changed since then,” says Luther-Krug. “We can help orient them to new traffic signals, teach them new techniques to compensate for physical limitations and let them know about adaptive equipment.”

Sometimes, though, driving-rehab specialists must deliver bad news.

“We don’t issue or revoke licenses, but we have a strong influence,” says Luther-Krug. “We make recommendations to the referring physician, to the state department of motor vehicles, to the individual or the family. We’ll only suggest people stop driving when it is absolutely necessary.”