#6 Independence and Driving Through Life

Driving is often the key to independence with many older adults and family members struggling to make the best decisions around this ability and resource. Terry Cassidy, Occupational Therapist, certified Driver Rehabilitation Specialist for Fitness to Drive and owner of Health Promotion Partners shares this discussion with Maile Gray, Executive Director of Drive Smart as they talk about signs that driving may be at risk, the evaluation processes they use and most importantly how to transition out of driving and yet keep on living. Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Learn more at Pikes Peak Area Agency on Aging. Transcript: Today's episode is about transit and independence. My name is Michaela Nichols and I'm here with Terry Cassidy and Maile Grey. Terry is a licensed occupational therapist and a certified driver rehabilitation specialist at Health Promotion Partners. Miley is the Executive Director of Drive Smart Colorado. Q - Can you both give a short introduction about what you do? A – Sure. I'm the director like you said of a small community traffic safety education program. We’re a non-profit and we've been around since the 1980s. We have a series of programs, kind of from birth on up through you know teenage years, working with communities and we have a very, very, robust program geared toward the older driver. Our entire focus, our mission for the nonprofit, is to reduce crashes. Thus, reducing injuries and fatalities. So, our work with the older driver, is to focus on making sure that they drive as long as they can safely do so. So, we have some little tips we give presentations, we partner with Terry, and basically have a good time with the aging population. Michaela - Thank you Terry - I'm Terry and I'm the owner and operator of Health Promotion Partners. Our main program is the Fitness to Drive Program. And so, through that problem, we do driver evaluations. I really see our role as helping individuals and helping families to make decisions around driving. So, certainly when we’re talking about older drivers, really looking at skills related to driving, really helping people make decisions. Do they need to cut back, do they need to change some things, or maybe they need to find alternatives to driving in order to get around in the community? Q - As people age, they can begin to experience decreased ability to safely drive. Can you talk about some of the signs that people may be losing the ability to drive safely? Terry - Sure. You know there are definitely warning signs, and there's a list of them available, there are some good lists, we can give you some resources for those. but one piece I would like to mention, is it's not to me that ability or losing the ability drive, isn't related directly to age. so, there are factors like are physiologically that tend to be more common as people get older, but certainly when I’m looking at someone's ability to drive it's really about function more so then the date they were born. but in terms of the driving ability things that are commonly changing with age would be things like vision. the amount of light someone needs to have good vision. also, that reaction time, making quick decisions in the moment. sometimes some physical changes, neck range of motion can really impact safe driving in terms of being aware of what's going on around your vehicle. and even moving hand and foot movements can be issues there. I think in terms of warning signs that a family member would notice, or maybe someone drivers themselves, and things we ask families to keep an eye out for would be dents or scratches on car that there's maybe not an explanation for. certainly, somebody getting lost in a familiar environment is a warning sign the third should be a little more investigation done. and you know one that we mention a lot is if there's people in your life who are not wanting to ride with you. so that might be your child sometimes it could be a very good friend who is trying to help you out there so listening to people around you sometimes and Maile - to tag on a little bit to Terry, oftentimes the family members don't necessarily notice the changes in mom or dad driving because say you go to visit them it's pretty typical for the younger, the adult child the adult family member, to actually take over the driving while they're visiting or such. and so sometimes you might say well yeah my mom or dad is just doing great, well when was last time you actually let them drive? you know so that might be something to keep in mind that periodically, you as a family member, let that person drive you around a little bit. and then you might have a better understanding of where they're at when it comes to their ability to safely drive. and like Terry said, I think I think most people can drive from their house to the grocery store, or their House or to the doctor's office, in the perfect world. but we don't live in a perfect world, and there are people out there who are who do things like run stop signs and run stoplights and are very distracted these days and for that reaction time to really be keen you know to be able to really slam on their brakes, or to be able to really maneuver out-of-the-way of somebody else. might not be your driving, but to be able to protect yourself and people in your car. That's kind of a tricky situation. Q - Can you talk about the process of assessing someone's driving and the steps that you take? Terry - Sure, so as you mentioned in the beginning my background is as an occupational therapist so really my evaluation all comes from that standpoint. but we're really looking at the skills related to driving. so, some of those warning signs or factors that I mentioned earlier we do a really thorough evaluation of vision. so not just the eye chart, but an interesting vision piece is contrast sensitivity, and something that's not measured very often, and that is a visual skill that does tend to decrease with age. There is actually more evidence linking contrast sensitivity to crashes than acuity. so it's just kind of interesting. Maile - Can you explain Terry what contrast sensitivity is? Terry - I can try, yes. so, I explain contrast sensitivity as really being able to tell foreground from background. so, I think of somebody driving, around here, I think of seeing a deer at dawn. like you're going down the street, if your vision is crisp and you're awake, you'll notice it- but it would be easy to drive by and not even notice that there was a deer on the side of the road, or somebody in a dark sweatshirt in the evening. so really pertains to low light conditions and so that's just one piece of what I could look at. So, what I would look at but a lot of times somebody would decrease contrast sensitivity in my recommendation might be that may not drive at night, for example. Maile - so, it does not necessarily mean you can't drive at all it just means you might need to self-limit or have some serious suggestions made to you about where you should drive and when you should drive Terry - so aside from vision. I would look at strength and range of motion. some of those things I talked about. movement, being able to check your blind spots, or turning your head. and then I do have some equipment that looks at brake reaction time. so really just testing that motor speed of going from gas pedal to brake pedal, based on what that person is seeing the red or green lights there. I always do some sort of cognitive assessment. so, it's just a screening, but really looking at memory. working memory and cognition to some extent as part of it. really because it's driving involves so much brain work. We just, it's such an overlearned task we don't realize that we're working so hard when we're driving, but really there's a lot to it Q - Can you talk about some of the small adjustments that can be made to help assist with safer driving? Terry - yeah, I’m going to let Maile talk about car fit for little bit here Maile - So, car fit. I actually was taught car fit by Terry, but she's been real busy doing all of our other things. For the most part I kind of have done a lot of car fit trainings and events in our community. Car fit is an international program that was developed in 2006 by AAA, the American Occupational Therapy Association, and AARP. So those folks got together and thought, can't we just do something that helps seniors, or really anybody, make sure that they fit in their car properly. That they can do things simply, like eliminate the blind spot, which really helps in the range of motion for your neck. If you eliminate blind spots out of your sideview mirrors, you don't have to careen your neck so far in order to see a car coming up on your side. That does a couple things, in these days of extreme distracted driving, the longer you take your eyes away from the windshield and from what's in front of you, even to look behind you to see who's coming up on the side of you, could mean the difference of a crash or not. So, the less time that you take your eyes away from the road the better. So, we have little tips. You know, simple, simple, things that all, and i really want to stress this, is really for all ages. When people buy a car these days, they're taught about Bluetooth, they’re taught about the little blinking lights for, you know in the side view mirrors, they're taught about all the info-tainment section, on maps. They're taught about all this...