1.  Audience (for this presentation): ◦ Law Enforcement Training Officer  Objectives: ◦ Persuade law enforcement that having older driver information in law enforcement training is essential ◦ Offer the information that is important for law enforcement officers to know  Time: ◦ 15-30 minutes  Success: ◦ The training officer that saw this presentation wanted the PowerPoint to use for a highway patrol officer class!

2. Your names and affiliations

3.  Summarize facts about older drivers and their impact in your state  Highlight facts about driving evaluations in your state  Emphasize the importance of law enforcement’s knowledge of older drivers impact on safety in your state  Solicit the State Highway Patrol’s ideas about older drivers and how the your organization can assist.

4.  78 Million Baby Boomers  Driving is a privilege, but Baby Boomers act as if driving is a right.  Learning to drive is right of passage; life changing event  Losing license is just as life changing

5. The Baby Boomers will affect the distribution of older adults

6. Driving & Demographics The number of older licensed drivers in the US is expected to increase – from ~20 million today to ~40 million in 2020. – Graph is for drivers 70 years and older

7. Driving is and will remain the primary mode of transportation for older adults. Driving represents the ability to maintain connections and contribute to the community. Studies of older drivers show there may be a relationship between health, sense of autonomy, and ability to drive. Loss of mobility can lead to depression, low life satisfaction, health problems, isolation, and loneliness.

8.  Involves  Performance Skills  Client Factors ▪ 80% cognitive ▪ 18% visual ▪ 2% motor/sensory

9. Good drivers, but gradual changes in: ▪ Vision ▪ Visual scanning ▪ Cognition ▪ Attention ▪ Physical fitness ▪ Coordination ▪ Response time increases

10.  Less visual acuity  Decreased speed in focusing  Poor color discrimination  Increased sensitivity to glare and bright sunlight  Reduced peripheral vision  Decreased depth perception

11.  Decrease in hearing ability  Decrease in strength and flexibility  Reaction time slowed  Cognitive changes  Ability to retrieve information slows  Divided attention decreases  Difficulty dividing attention

12.  Diabetes: affects vision, physical function, and cognition  Parkinsonism: physical abilities, later cognitive  Cardiovascular disorders  Side affects of medications  Dementia

13. Crash Involvement

14. Fatalities http://search.cga.state.ct.us/dtSearch_lpa.html

15.  Drivers 75 years or older are involved in significantly more accidents and by 2025, more than 40% of all fatal crashes will be associated with age-related frailties.  In two-vehicle fatal crashes involving an older driver and a younger driver, the vehicle driven by the older person was nearly twice as likely to be the one that was struck.  In 46 % of these crashes, both vehicles were proceeding straight at the time of the collision. In 25 %, the older driver was turning left — 5 times more often than the younger driver.

16. Men outlive their ability to drive by 6 years; women outlive their ability to drive by 10 years. Source: Foley, et al (2002) More than 600,000 people age 70+ stop driving each year. Question: When? How do I know? Question: When? How do I know? Older drivers begin to self-restrict – Women often stop prematurely

17. Act to Promote Driving Retirement Act to Maximize Ability

18. Physically or Mentally Competent Perceived Competent Appropriate Perceived Incompetent Inappropriate restriction Physically or Mentally Incompetent Perceived Competent At Risk Perceived Incompetent Appropriate Restrictions

19.  Individuals with cognitive deficits who do not always make the appropriate decisions with regards to driving modification or cessation because of lack of insight, poor judgment, and loss of reasoning ability (Adler & Kuskowski, 2003).  Studies have also shown that up to 25% of older adults continue driving after a physician recommendation for driving cessation (Dobbs, Carr, & Morris, 2002).

20.  Individuals with dementia are at increased risk for unsafe motor vehicle operation  Becoming lost in familiar areas  Incorrect turning & lane deviation  Impaired signaling  Decreased comprehension of traffic signs  Unaware of not being a responsible driver

21.  NIH - 1 in 7 over 71 years of age have some type of dementia (Plassman et al. 2007)  North Carolina Do the math for your state!  In 2000, 969,048 over 65  138,435 with dementia  143 DMV offices  968 per office

22.  Dementia - special issues with driving  North Carolina - 11 Driving Specialists  12,585 dementia referrals for each evaluator  34.5 a day, 365 days a year.  Need to have a system in place to deal with these issues  Need law enforcement’s assistance!  Tickets are critical to the process

23. Varies depending on state, setting, staff, training DMV or licensing authority Structured, “same for all” Pass/fail Medical review board Specialists in Driving Rehabilitation Individualized Screen or evaluate sub-skills Performance in Context–On Road

24.  Specialized training  ADED – Association for Driver Rehabilitation Specialist  80% of DRS are occupational therapists  CDRS – Certification administered by ADED  American Occupational Therapy Association  Specialty Certificate in Driving and Community Mobility

25.  Your definition  ADL, IADL, work, leisure, education, social participation  Community mobility is under IADL  Rural communities: Driving is the only community mobility option

26.  Occupational Therapists:  Understand the critical demands of driving  Have science-based knowledge to understand progressive conditions and life changes affecting driving  Understand how community mobility affects quality of life

27. Provide objective data regarding abilities required for driving Assure that abilities are within state regulations Relate abilities to skill performance of the actual driving task Help client and family think about driving safety for the present and future

28.  Does Screening  Licenses all drivers  Occupational therapy evaluations required by law in North Carolina when medical functional concern  Occupational therapy evaluations require physician’s order http://www.dmv.org/nc-north-carolina/department-motor-vehicles.php

29.  Law Enforcement Officer: Based on observed driving behaviors. Initiates the request – medical review branch of DMV  Medical review staff meets  May ask for a driving evaluation by an OT  Makes final determination

30.  Educate about older adults  Support their duties  Offer resources  Other ideas

31.  Your name  email  Phone number  Parts of this presentation was developed by Dr. Anne Dickerson, PhD, OTR/L, FAOTA, East Carolina University