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The physical and mental changes that come with aging can be hard for anyone to handle. Many adults struggle with routine daily activities, like driving, as they grow older. As adults age, driving a car can become less of a mode of transportation and more of a symbol of independence.
When mishaps and moments of confusion happen on the road, it may be time for a clinical driving evaluation to help older adults continue to drive safely. To understand what’s involved in clinical driving evaluations, we spoke with Aubrey Kohler at AdventHealth Sports Med & Rehab Adanson
Kohler is an occupational therapist who completed specialized training in driver rehabilitation, earning her the title of driver rehab specialist. Any occupational therapist who receives this training can offer clinical driving evaluations as part of their practice.
What Is a Clinical Driving Evaluation?
Different from an assessment at the Department of Motor Vehicles (DMV), a clinical driving evaluation is done by a driver rehab specialist, who may be an occupational therapist like Kohler. A clinical driving evaluation assesses an older adult’s physical and cognitive abilities and offers solutions for continued safe driving.
“A driver rehab specialist has extra training and a clinical background, which someone at the DMV wouldn’t have,” Kohler explains. “We’re looking at driving abilities from a medical standpoint and assessing how a potential disability could impact their safety on the road.”
Who Needs Clinical Driving Evaluations?
A person can get one of these evaluations as they grow older, or following an injury, Kohler says. “Many of my patients come to the clinic after some sort of disability, whether it’s a stroke, dementia, Parkinson’s disease or a concussion.”
She recommends driving evaluations for older adults to get a baseline for their driving skills that they can come back to as they age.
“For example, for someone who’s newly diagnosed with Parkinson’s and isn’t showing any impairments yet, it’s still good to have this evaluation done just to get a baseline of their reaction time, strength, balance and coordination while they feel healthy,” she explains.
“As they get older, they can come in for check-ins to see how they’re doing, and if we start to notice that anything’s changing, we can give them recommendations.”
However, healthy older adults can benefit from a driving evaluation, too. “Any time that someone starts to realize that maybe they’re getting a little slower to react, or hitting some things while driving or maybe not as aware of their surroundings, it’s always OK to have this evaluation,” she explains.
Kohler understands the hesitation and apprehension that older adults may have about getting an evaluation but reassures them that it’s not as scary as they think. “A lot of people are very nervous coming into a driving evaluation. They think that they’re going to come see me and I’m just going to take their license away, but that’s not the case.”
After age 65 is when Kohler recommends getting a clinical driving evaluation, but there’s no particular age when it’s necessary. “I’ve seen people who are 90 years old and still driving and doing great.”
Clinical Driving Evaluation Steps
Typically, a doctor will refer patients to get a driving evaluation at a facility like the Sports Med & Rehab Adanson clinic to ensure that they’re safe on the road. At the Adanson clinic, Kohler determines whether older adults are safe to drive by completing evaluations without a vehicle.
After reviewing a patient’s medical history, Kohler assesses:
- Ability to multitask
- Cognitive skills
- Physical strength
- Reaction time
- Sensation throughout arms and legs
- Upper and lower body endurance and coordination
- Visual processing skills and acuity
After the evaluation, Kohler advises on follow-up appointments, gives recommendations for safer driving or refers patients to another specialist for an on-the-road evaluation. The therapist who conducts the driving test on the road can then determine if the patient needs adaptive equipment, adaptive driving techniques or if driving is no longer appropriate for them.
Kohler thinks of these evaluations as wellness checks, just like an annual doctor’s appointment.
“I’ll say come back in six months or the next year and we’ll do a wellness check, or if you have any changes, come to me sooner rather than later, because we can keep you safer for longer the sooner you come in.”
For patients who are just starting to show impairments while driving, Kohler may recommend a temporary hold on driving. “At this point, I may refer them to the necessary therapy, whether this is occupational therapy, speech therapy or physical therapy services to address the skills needed,” she says. “I tell them that we’ll work on these driving skills here in rehab and then do a follow-up evaluation to see if they’re ready to be on the road again.”
Solutions for Safer Driving
During the clinical driving evaluation, a driver rehab specialist can recommend a variety of automobile modifications and equipment to help seniors continue to drive safely.
“So, if someone isn’t able to reach their seatbelt, can’t maneuver some of the buttons in the car or get in and out of the vehicle as well anymore, there is a lot of adaptive equipment that is really affordable and easy to use,” Kohler explains. “There are ways that you can adapt your vehicle to you and still keep your independence.”
Depending on a patient’s needs, a driver rehab specialist may recommend adaptive equipment and provide the necessary training with the equipment, such as:
- Cushions for inside the car
- Left-foot accelerators
- Seatbelt extenders
- Spinner knobs for the steering wheel
Kohler also recommends attending CarFit events, which are popular in the Central Florida community. CarFit is a volunteer event where people can park their cars and a volunteer technician can look at how seniors sit in their vehicles and make any necessary safety changes. The technician can ensure that their steering wheel is adjusted accordingly and that mirrors are adjusted based on blind spots. Older adults can earn insurance discounts with these adjustments as well.
Does My Loved One Need a Clinical Driving Evaluation?
If you start to notice small mishaps and moments of confusion while your parent or loved one is driving, it may be time to have a conversation with them about driving evaluations.
Kohler recommends driving evaluations if some or all of the following warning signs occur:
- Anxiety while driving
- Confusion on entrance or exit ramps
- Confusing turn signals or pedals
- Difficulty navigating turns
- Driving in the wrong lane
- Driving violations or tickets
- Frequent falls
- Getting lost in familiar areas
- Hitting curbs
- Impaired or declining vision
- Inhibited mobility getting in and out of the car
- Issues doing more than one thing at once
- More dings on a car
- Recent accidents
- Slower reaction time
While many older adults can drive with in-car modifications and therapy, not all should be on the road. “For someone who has a dementia diagnosis or a progressive diagnosis, we know that, unfortunately, those skills don’t have the potential of getting better, so we will then focus on family education and training to support their loved one.”
Talking With a Loved One About Driving
A conversation about safe driving with an older parent or loved one is challenging, and it’s normal to feel apprehensive about offending or alienating them.
Kohler works with family members to develop a plan to help the person keep driving safely or have the difficult conversation if the person is no longer safe to drive. “What I tell families and loved ones is that at the end of the day, this recommendation is coming from me and their doctor. Having the blame on the therapist can ease the caregiver burden since it is not their fault.”
Before the conversation, Kohler recommends looking at a few tip sheets from national organizations like AAA and AARP who are dedicated to helping seniors drive safely. Kohler recommends these specific pieces:
- Driving Safely as You Age
- Talking About Driving With an Older Driver
- Driver Planning Agreement
- Driving and Transportation Options for Older Adults
“When you have the conversation, I’d start by bringing up the concerns that you have and see how they react to statements like, ‘Did you realize that you’ve been falling more lately?’ or ‘Did you realize that there was a stop sign there?’ and gauge their reaction.”
“You can also call their doctor ahead of this conversation and let them know that you’re having these concerns, so that maybe the conversation can come from the doctor instead of you, which could make it easier.”
“The more you talk about it, the less taboo it will seem,” Kohler says. “Most importantly, let them know that you’re still supporting them and you’ll help them through it and that you’ll do what you can to make the transition as easy as possible.”
Whole-Hearted Clinical Driving Evaluations
“At AdventHealth Sports Med & Rehab, we are like a family, and we will help you as a caregiver with whatever you need to make this process as easy as possible,” Kohler says.
We are dedicated to helping you keep your parents or elderly loved ones safe. We offer clinical driving evaluations at our Central Florida South location, AdventHealth Sports Med & Rehab Adanson.
Our team includes specialists in physical, occupational and speech therapy, all working together to help older adults not only stay safe on the road but feel healthy and whole in body, mind and spirit.