Download for Older Adults - St. Catherine University Online Courses

LDI Curriculum:
Behind-the-Wheel
Refresher
for Older Adults
In Fulfillment of the St. Catherine University Occupational Therapy Program
Master’s Project Requirement
Jordan Wiertzema, Daniel Wackler, Mattea Wieberdink, Patrick Giblin,
and Emily Seymour
Under the mentorship of Dr. Catherine Sullivan
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Purpose of Curriculum
The purpose of this curriculum is to educate licensed driving instructors to help
mature- drivers refresh their driving skills. Safe driving requires optimal cognitive,
visual, and physical abilities; age-related changes in these functions can threaten
driving safety. However, these necessary skills for driving can be maintained or
improved through practice.
This behind the wheel refresher course curriculum is not intended to replace
driving rehabilitation for individuals who have clinical conditions affecting driving that
require medical and therapeutic interventions.
This version of the curriculum is a draft that will be revised following feedback from stakeholders. So no part of this current curriculum should be
reproduced. For information on the status of this curriculum contact Catherine
Sullivan, [email protected] or the Masters of Occupational Therapy Program
at St. Catherine University.
Curriculum Development
The approaches that are taught in this curriculum are based on the most current
research on how normal age changes affect driving safety, which maneuvers are the
riskiest for older adults, and which methods of assessment and interventions are most
effective. This content is also based on interviews of various stakeholders, including
LDI’s, driving rehabilitation specialists and older drivers.
Many recommendations in this presentation rely on a curriculum developed in
Australia for licensed driving instructors teaching behind the wheel refresher courses for
mature drivers. It is also partly based on the Safe Access to Destinations classroom
older driver education curriculum developed in the Occupational Therapy Department at
St. Catherine University over the past few years. The complete list of references can be
found at the end of this booklet along with additional resources. The reference list of
scientific articles us to develop this information is available upon request.
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Table of Contents
o Andragogy and Older Adult Education
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o Reason for Older Driver BTW Refresher Instruction
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o The Importance of Driving for Health/Well-being
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o Role of Driver and Vehicle Services,
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o Roles of OT, CDRS and MD
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o Normal Age-Related Changes and Impact on Driving
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o Self-Regulation
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o Clinical Conditions
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o Vision and Cognitive Screen
32
o Impact of Eye Diseases on Vision
36
o Medications and Driving
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o Retraining the Older Driver
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o Sample Outline of a Behind-the-Wheel Session with an Older Adult
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o Resources/References
55
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Andragogy and Older Adult Education
Andragogy is the method and practice of teaching adult learners. When working with
adult drivers, it is important to understand that they learn differently than teenage
drivers. Andragogy is shaped by a number of key principles:
○ Collaboration: Adults learn better when they are seen as part of a
collaborative effort between teacher and student.
○ Learn by Doing: Adult learners learn best when they are able to practice
skills they learn. As such, the behind the wheel refreshers are a natural
complement of classroom education for older drivers.
○ Immediate Application of Relevant Information: Adult learners want to
learn about things that are relevant and immediately applicable to their
daily lives. This concept is closely related to collaboration. Getting input
from adult learners about what they want to learn will help ensure that they
are learning information pertinent to their lives
○ Self-Motivated: Adults are often more self-motivated in their learning than
teens. This can result in greater attentiveness and initiative
When teaching older adults, a number of considerations should be taken into account:
○ Older adults are experts at aging. Most of them naturally adapt the way
they do things to compensate for the losses of functions due to age. For
example, they already self-regulate their driving by avoiding night driving
and adjusting their speed to their slower reaction time. Instructors should
build on those strategies by reinforcing the effective ones and offering
alternatives for those that are counterproductive.
○ Building on past experience vs. letting go of bad habits: It is important
to recognize that older drivers have many decades of experience driving
that can be capitalized on when refreshing their skills. On the other hand,
they may also have developed unsafe habits that will take longer to
unlearn. Teaching older adults will be more effective if both the helpful and
challenging consequences of experience are taken into account.
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○ Learning and attention: Changes in cognitive skills that affect driving
safety will also affect how they learn. Older adults may need more
repetitions before remembering certain rules or directions. Their difficulties
with paying attention to more than one thing at a time could make it
challenging for them to understand complex instructions while driving in
traffic. This curriculum will include ways to adapt teaching strategies to
those age-related cognitive changes.
○ Emotions: Age differences in emotional reactions to events will also
impact performance on the road and instruction methods. Anxiety is
common in older drivers, especially older women. This can cloud
judgment and affect the relationship with the driving instructor, On the
other hand, some older drivers, especially men, may be over confident.
Teaching strategies to address the range of emotional reactions should be
developed.
○ Brain training: There are common stereotypes that older adults cannot
learn new things and their brain is not plastic. New research in the science
of aging had shown that, except in the case of a degenerative disease, the
mind stays quite malleable into old age, although it may take more
repetitions of errorless trials before the new skill is learned. Strategies and
handouts provided in this curriculum build on this new research.
Keeping these concepts in mind will help create a better relationship between the LDI
and the older drivers and make the learning process more efficient.
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Reasons for Older Driver
BTW Refresher Instructions
Crash Rate Statistics
Teens and older drivers have a higher motor vehicle crash (MVC) rate per
mile driven. Because of the frailty of the older body, the risk of death from
a MVC also increases with age.
Crash Rates per Miles Traveled
http://www.nhtsa.gov/people/injury/olddrive/pub/Chapter1.html
Both the young adults and older driver population are at higher risks for
crashes and are in need of driving instruction and practice implementing or
refreshing safe driving skills
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The Importance of Driving for Well-being
Driving has many benefits, including
o Independence/Freedom
o Convenience
o Come up with a few examples on your own!
o
o
o
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Over 90% of the American population relies on driving for community
mobility and access to out-of-home activities.
Driving cessation has been linked to depression and an overall
decrease in well-being in older adults
http://www.cambridgecoa.org/about-us
There are a number of professionals involved in making sure older adults
are safe behind the wheel. These professionals and their roles are
described below.
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Role of Driver and Vehicle Services (DVS)
How do older adults renew their license?
● All drivers in Minnesota are required to renew their license in person at a
DVS office every four years and are also required to take a vision test at
that time
● Visual acuity of 20/40 or better, with either one usable eye or with both
eyes, with or without corrective lenses.
● Visual field of 105 degrees or greater in the horizontal diameter with either
one usable eye or with both eyes.
How is the DVS made aware of driving safety issues?
● A letter of concern is written to DVS from either a physician, individual,
family, friends or law enforcement
● In Minnesota, family members reporting an unsafe driver are kept
anonymous and are legally protected, but neighbors and friends are not.
What is the next step after DVS receives information on the issues?
● DVS asks driver to come for an interview – usually seen within 2-3 weeks.
● If concerns arise during the interview, the DVS may request written and/or
road test, a vision exam and a doctor’s statement on recommendations
about driving privileges. When the doctor requests a professional
evaluation by an OT or CDRS, the report of that assessment goes to him
rather than the DVS because in Minnesota, the MD is the only health
professional with the authority to recommend cancelling or restricting
driving privileges to the DVS.
● If the DVS asks the driver to take a behind the wheel test, he or she is
given 30 days to comply or have the license revoked. It is during that time
interval that the older driver may request a refresher driving course with an
LDI to be able to pass the road test
Types of Restricted Licenses:
● Daylight only, no freeways, distance allowed, miles per hour, certain roads
and/or adaptive equipment
● Specific visual acuity can result in or be a factor in deciding which type of
restricted license a person may be issued:
○ 20/50 visual acuity = maximum speed 55 mph, 20/60 = 50 mph,
20/70 = maximum speed 45 mph (with no freeway, expressway or
limited highway)
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Generalist Occupational Therapist (OT) Role
Older drivers may be referred to Occupational Therapy for driving safety
because driving is an instrumental activity of daily living (IADL).
Instrumental activities of daily living (IADL) are more complex of daily living
than simple self-care. Examples include financial management, meal
preparation, medication management, care of pets, child rearing and
shopping. Individuals who struggle with one or more areas of IADLs are
more likely to also have difficulty with driving.
Role of the Generalist OT:
 Use specific screens or assessments that predict ability to drive safely
 Provide assessment and training with driving simulator
 Educate about risks and injury prevention
 Provide an intervention program to train skills necessary for safer
driving (i.e. improve range of motion, visual attention, physical strength
and flexibility)
 Provide options for promoting continued safe driving such as
suggesting simple adaptive equipment and teaching compensation
techniques
 Refer client for a comprehensive driving evaluation by a certified
driving rehabilitation specialist (CDRS) if needed
 Counsel client about transition to alternative community mobility
options and assists senior in finding those alternatives
 Since drivers who are seeing occupational therapists for evaluation
often have a medication condition, it is unlikely that the OT would refer
the driver to behind the wheel refresher courses with an LDI while
undergoing OT treatment. However, if the OT does preventive care
with well older adults, he or she may recommend both classroom and
behind the wheel refresher driving courses.
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Role of Certified Driving Rehabilitation Specialist (CDRS)
Clinical Assessment
 Review of driving history, driving needs, license status, medical history and
medications
 Visual/ perceptual assessment, range of motion, motor strength, coordination,
sensation, reaction time; and cognitive assessment
On-Road Assessment
 Assessment of ability to get in/out of car, mobility aid management, vehicle
control, adherence to traffic rules and regulations, environmental awareness and
interpretation, and consistent use of compensatory strategies.
Driver Training and Driving Simulators
 Off-street training – conducted in safe environments such as empty parking lots
 On-road training with adaptive driving instruction
 Driving simulators- used to assess driver readiness or for driver remediation and
training in a virtual environment
Communication and Recommendations
 Recommend to driver to return to driving, with or without adaptive driving
equipment
 Communicate with MD to recommend licensing restriction or driving cessation
 Referrals:
o A CDRS in Minnesota cannot make recommendations directly to the DVS,
only to the referring MD or patient/family if self-referred
o Refer to occupational therapy for training of driving-related functions such
as strength, mobility or attention.
MD referral is not required to see a CDRS
Length and Cost of Comprehensive Driving Assessment with CDRS
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Approximately 4 hours depending on presenting disabilities and driving needs
3 hours for clinical evaluation; 1 hour for on-road evaluation
Cost varies; typically $200 to $400+ for a full assessment
In general, Medicare does not reimburse for a comprehensive driving evaluation.
May reimburse following an acute medical condition in the context of
rehabilitation
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Physician Role
How are Older Drivers Referred to Physician?
 Voluntary referral of patient or by family/caregiver
 Compulsory referral by licensing office (DVS) or law enforcement
officials
What is the Physician's Role?
 Assesses driving-related functional abilities, both physical and
cognitive
o Health risk assessment/social history questions and gathers
additional information.
 Treat medical conditions underlying driving issues and/or
o Refer to OT for IADL assessment, rehabilitation of drivingrelated skills, assistive devices and/or education/counseling.
o Refer to Certified Driving Rehabilitation Specialist (CDRS) for
comprehensive driving evaluation (not covered by insurance)
 Recommend specific licensing restrictions to DVS based on own
assessment or recommendations by CDRS.
 For certain conditions such as insulin-dependent diabetes and
epilepsy, provide certification of fitness to drive to the DVS as a
condition for license renewal
 In MN, physicians have the authority (but not the obligation) to report
drivers who are not fit to drive to DVS. In some states that report is
mandatory.
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Normal Age-Related Changes and Impact on Driving
Physical Changes
Strength
Driving impact: Leg strength is important for
gas/brake pedal control. Similarly, a moderate amount
of handgrip strength is important to control the
steering wheel particularly while making sharp turns.
LDI Implications: Strength is linked to power. Teach
driver to break before it is needed so that does not
have to apply such power
Reaction Time
Driving impact: Fast reaction time is needed for
responding appropriately to traffic and traffic signals.
LDI Implications: Teach driver to increase following
distance and to be aware that faster driving speed
means that it will take longer to stop. Encourage
participation in racquet sports like tennis or badminton,
which are shown to improve reaction time. Apps such
as BrainHQ, Drive Focus, and Drivesharp (more detail
under cognition) can also help improve reaction time.
Range of Motion (ROM) and Driving impact: Neck/trunk flexibility is needed to look
flexibility
over the shoulder to check traffic. Shoulder flexibility is
needed to put on a seat belt, and to control the
steering wheel.
LDI Implications: Teach how to adapt the mirrors to
eliminate blind spots. If this is not enough, provide with
panoramic mirrors, or magnifying button mirrors on the
outside. If limited motion in the shoulder, provide
equipment that makes it easier to buckle the car seat.
Encourage involvement in yoga or Tai Chi courses
which can improve those two functions, as well as
decrease fall risk which has been associated with
crash risk
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Endurance
Driving impact: Endurance is needed for longer
driving trips. However, for some older adults, sitting
upright while controlling both the foot pedals and
steering wheel can become fatiguing even for shorter
trips.
LDI Implications: Encourage involvement in exercise
classes to improve endurance.
Solutions for physical changes:

Physical fitness improves strength, flexibility, endurance and brain health.

Research has found that people who enrolled in an exercise program had lower
risk of crashes than those who did not.

Develop a weekly routine that includes:
o Strengthening: Focus on your legs (flexion and extension of hip, knee and
ankle muscles).
o Range of motion: focus on neck and trunk rotation and shoulders
o Reaction time: Consider a racquet sport
o Cardiovascular health is linked to brain health: Gradually increase to at
least 75 minutes per week of aerobic exercise
o Balance exercises. Fear of falling can result in reduced activity and
decreased fitness (Matter of Balance and Tai Chi are both effective).
***See “Flexibility Fitness Training for Improving Older Driver Performance”
handout***
For additional information on physical fitness, please visit the following websites:

http://seniordriving.aaa.com/maintain-mobility-independence/keep-your-mindbody-fit/physical-fitness

http://www.nia.nih.gov/health/publication/exercise-and-physical-activity-getting-fitlife

http://www.mnhealthyaging.org/en/FallsPrevention/MatterBalance.aspx
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Visual Changes
Depth perception: ability to judge Driving impact: Judgment of the distance of
the distance between the car and approaching cars at intersections and lane
other objects (i.e. cars or signs)
changes
on the road.
LDI Implications: Teach the driver to leave
plenty of time to make a left turn. Choose
intersections with roundabouts, left turn signal or
protected left hand turn.
Disability glare: inability to see
an object due to oversensitivity to
a disruptive light.
Driving impact: Lower clarity of vision in sunny
conditions and greater sensitivity to headlights at
night.
LDI Implications: Instruct the driver to wear
sunglasses when sunny, and to avoid/limit night
driving when possible.
Difficulty adjusting from bright
to dark.
Driving impact: Increased blindness from
headlights, sunny conditions and contrasting
landscapes (i.e. tunnels)
LDI Implications: Avoid nighttime driving, chose
routes without tunnels if possible. When
crossing oncoming traffic at night look down to
the line on the pavement marking the edge of
the road to avoid being blinded by the oncoming
car.
Contrast sensitivity: ability to
Driving impact: Lower ability to see pedestrians
see objects under different lighting and bikers and with reading road signs when
conditions.
sunny or at night.
LDI Implications: Teach the driver to avoid
driving at dusk, when raining or other poor
visibility conditions.
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Visual Acuity: ability to see
clearly (both near and far)
Driving impact: Difficulty reading road signs
when moving.
Dynamic Visual Acuity: ability to
see clearly while in motion
LDI Implications: Make sure driver is wearing
his/her glasses or contacts. Clean windshield.
Peripheral vision: ability to see
objects to the side of the eyes
while driving.
Driving impact: Difficulty seeing the whole
environment particularly at intersections. Bigger
problem when head/neck flexibility also reduced.
LDI Implications: Teach scanning strategies
with head/neck; recommend wide-view mirrors
for blind spot reduction.
Visual Solutions:
● Routine eye exams can lead to early diagnosis and treatment of eye diseases.
● Wear sunglasses outdoors to protect from harmful UV rays.
● Wear protective goggles when working with certain tools or playing contact
sports to prevent injury.
● Regular exercise helps maintain eye health.
● Enroll in a smoking cessation program as smoking can cause severe damage to
the eyes.
● Monitor and control whole body conditions such as high blood pressure and
diabetes, as these can cause damage to the eyes.
● Foods rich in nutrients such as vitamin A, C, and E, as well as lutein and
zeaxanthin support eye health.
***Resources for Drivers: See nutrition for good vision handout below *****
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Nutrition to Maintain Good Vision
For Safer Driving
Vitamin
Vitamin A
What it does
Example of Food Source
 Allows for light detection,
 Fish liver oil
which helps with night
 Egg yolk
vision
 Fortified milk
 Helps prevent Xerophalmia
 Butter
(dry eye) and
 Yellow/orange fruits and
Keratomalacia (cornea
vegetables
damage)
 Dark green leafy vegetables
Vitamin C
 Antioxidant
 May slow progression of
eye problems and
diseases
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Citrus fruits
Cantaloupe
Green pepper
Tomato juice
Strawberries
Broccoli
Vitamin E
 Antioxidant
 May slow progression of
eye problems and
diseases
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Almonds
Sunflower seeds
Safflower oil
Peanuts
Peanut butter
Lutein and
Zeaxanthin
 Help fight cataracts and
other eye diseases
 They are the only
carotenoids (organic
pigments) found in the
macula
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Kale
Spinach
Broccoli
Peas
Orange pepper
Persimmons
Tangerines
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Other Senses
Hearing
Signs include not reacting to
instructions, asking to repeat
instruction or talk louder.
Sometimes one ear is more
affected than the other
Driving impact: Hearing impairment alone is not
considered individually predictive of increased
MVC. Impairment can be overcome the by relying
more on vision. However, when a person has
both vision and hearing impairment together, the
combined effect is increased risk of MVC than
vision or hearing alone.
Implications for LDI: Instruct to wear hearing
aids when driving. Make sure they are working
properly. Stop the car when providing instructions
to maximize comprehension and learning.
Vestibular system – important
for balance and coordinating
movement. Signs of impairment
include dizziness (vertigo), loss
of balance.
Driving Impact: People who are considered a fall
risk or have recently fallen are also at an
increased risk for MVC.
Touch.
Reduced sense of touch
accompanies certain medical
conditions such as diabetes.
One sign is the wearing of
large, soft footwear sometimes
provided to avoid foot injuries.
Driving Impact: Losses in the ability to feel
steering wheel, brake and gas pedal can affect
driving safety. This is most significant when the
loss of sensation is in the hands or feet, which
has implications for jerky and unsafe driving
maneuvers.
Implications for LDI: If vestibular system is
affected, it could impact the control of the car
following sharp turns. Teach to reduce speed in
places such as highway entrances. Recommend
fall prevention programs focusing on improving
balance and core/lower body strength; such
courses have been shown to also improve driving
safety (Pilates, exercise programs etc.)
Implication for LDI. If a person has a condition
such as diabetes that impacts feeling in the legs,
refer to a CDRS that can determine if hand
controls could be helpful. Shoes with a thin sole
can make it easier to judge the amount of
pressure applied to the pedals.
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Potential ways to overcome hearing loss
● Eliminating background noise in the car will help increase the focus on important
sounds.
● Alerting devices that use visual cues may be beneficial such as amplifiers or
greater visual cues for gas or turn signal reminders.
Tips on Preventing Hearing Loss
● Routine hearing checks are suggested if an individual is often exposed to loud
noise or is experiencing symptoms of hearing damage.
● Wear ear protection when exposed to loud noise.
● Take breaks from loud noise if possible.
● Listen to music at a lower volume setting.
Tips on Preventing Sensation Loss
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Monitor and control body conditions that can cause nerve damage such as
diabetes.
Avoid exposure to harmful toxins.
Avoid excessive alcohol intake.
Vitamins B and E are important for nerve health. Vitamin supplements may help
prevent sensation loss.
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Cognitive Changes
Decrease in fluid intelligence.
Fluid intelligence: general ability to
think abstractly, reason, identify
patterns, solve problems, and discern
relationships.
Decrease in working memory
Working memory: storing and
managing information required to
carry out complex cognitive tasks
such as learning, reasoning, and
comprehension.
Driving impact: Decreased ability to
problem solve while driving such as finding a
detour when initial route is blocked.
LDI Implications: Drive in familiar
environments when teaching new skills.
Gradually introduce more complex road
environments.
Driving impact: Decreased situational
awareness for surrounding traffic. Problems
with decision making involving complex
situations.
LDI Implications: Avoid giving instructions
at the same time as driving. Avoid complex,
high traffic situations.
Decrease in selective attention.
Driving impact: Decreased ability to ignore
irrelevant details such billboards or music on
Selective attention: the ability to focus
the radio while driving.
on a particular stimuli for a period of
time while simultaneously ignoring
LDI Implications: Reduce distractions in the
irrelevant information
car. Avoid giving instructions at the same
time as driving. Introduce complex situations
gradually. Recommend use of software to
train attention.
Decrease in divided attention.
Divided attention: the ability to focus
on multiple stimuli for a period of time
Driving impact: Decreased ability to pay
attention to important stimuli such as other
vehicles, the speed limit, and signaling while
merging into traffic.
LDI Implications: Reduce distractions in the
car. Avoid giving instructions at the same
time as driving. Introduce complex situations
gradually. Recommend use of software to
train attention.
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Decrease in processing speed.
Driving impact: Decreased ability to
interpret visual stimuli and react fast enough.
Processing Speed: the time it takes a
Examples include processing and
person to interpret and react to stimuli
responding to traffic lights, pedestrians, and
other vehicles.
LDI Implications: Recommend training with
computer games that train speed of
information processing (i.e. Wii fit). Practice
reaction time in safe driving environments.
Cognitive Solutions:
Ways to Improve Attention and Memory:
 Word puzzles (e.g. Sudoku, word finds)
 Visual search games (e.g. where’s Waldo?)
 Connect the dots
 Mazes
 Memory games
 Reading
 Getting enough sleep
 Physical Exercise
Ways to Train Speed of Processing:
 Playing catch or softball
 Racquet sports like ping pong or badminton
 Wii fit or Wii sports
*** Resources for Drivers: See Train Your Brain handout below ***
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Train Your Brain
Drive Focus
Drive Focus is an app designed by Drive Fit Inc. for individuals to practice
visual search skills for driving. It trains individuals to better notice, react to,
and identify critical items on the roadway (pedestrians, constructions signs,
brake lights, etc.)
Details:
o iPad driver training app with interactive videos
o Designed for both novice and experienced drivers
o Used to accompany behind-the-wheel training
o Measures attention, judgment, and reaction speed
o Available for purchase ($9.99) at http://drivefit.org/
brainHQ
BrainHQ is a brain-training system by Posit Science to assist individuals in
improving attention, memory, brain speed, people skills, navigation, and
intelligence.
Details:
o Online exercises that effectively address cognitive issues related to
healthy aging
o Provides personalized brain training
o Offers suggested activities each month to keep your brain fit
o Allows you to track progress over time
o Sign up for free brain exercises at http://www.brainhq.com/
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Drivesharp
Drivesharp is a software program designed by AAA Foundation for Traffic
Safety and Posit Science. It is clinically shown to help drivers see more,
react faster, and cut crash risk by up to 50%.
Details:
o Computer program designed for middle age and older drivers
o Train your brain while traveling to national parks across the USA
o To arrive at your destinations, you have to complete brain training
exercises that improve visual processing skills essential to safe
driving
o Completion of program may result in up to a 4.7% discount on auto
insurance for qualified insureds
o Drivesharp is available at a special AAA price of $49 for qualified
AAA auto club members.
o Purchase Drivesharp software at https://www.drivesharp.com/
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Self- Regulation
Self-regulation strategies behind the wheel are changes a person makes to his/her
driving habits in order to be safe. Self-regulation techniques that older adults use
should be encouraged if they are effective. Those techniques can also inform the driving
instructor about areas of concern for the older driver.
Think about it! What are some self-regulation techniques you have seen or heard of?
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Common Self-Regulation Strategies
●
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●
●
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●
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Avoid driving at night
Avoid rush hour traffic & busy streets
Avoid driving in inclement weather
Avoid left turns (turn right 3 times instead)
Take short distance trips
Take familiar routes
Plan trips in advance
Drive without passengers
Cut out excess distractions
Avoid highway driving
Drive at speeds that are comfortable
Follow the car in front of you at a greater distance to allow for increased stop
time
*Note- these helpful self-regulation strategies should not be mistaken for compensation
techniques that older adults use when their driving skills are failing. Some examples of
compensatory techniques include riding the break, using a “copilot”, and driving at
inappropriate speeds (most often too slow).
http://ottawakent.com/tag/safety-on-the-road-2/page/4/
● One important aspect of self-regulation is knowing about any medical conditions
that may impact driving. While self-regulation techniques may be useful for
some, those with progressive diseases may not be able to drive safely using
those techniques alone.
● It is very important for the LDI to refer the driver to a certified driving
rehabilitation specialist if clinical conditions interfere with driving safety.
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Clinical Conditions
Introduction
● There are some medical conditions that are more common for older adults to
experience than others.
● Diagnoses like arthritis, cataracts, and stroke (post rehabilitation), may affect
driving, but do not usually require close medical attention as they don’t evolve.
○ Unless the clinical condition is significantly affecting their ability to drive,
individuals with conditions like these can be taken behind the wheel for a
refresher course.
● Other diagnoses like Parkinson’s disease, Alzheimer’s disease, glaucoma and
macular degeneration are progressive diseases that will require close medical
attention and regular reassessment to determine fitness to drive.
○ Older adults with these conditions should be referred to a CDRS.
● Patients with diabetes are treated different by the DVS depending on whether or
not the patient is dependent on insulin. Patients with insulin-dependent diabetes
need a note by the MD at renewal time indicating if they are still fit to drive.
These drivers should receive regular check-ups on the progression of their
disease. Diabetes not controlled by insulin is less severe and could benefit from
LDI refresher courses.
● Medications can also affect a person’s ability to drive safely. Many older drivers
take medication so it is important for LDI’s as well as the older driver to be aware
of potential side effects of those medication.
● For the above reasons, it is recommended that the LDI ask the driver if he or she
has a progressive medical condition that could impact their driving safety. If the
answer is affirmative, then they should be given the contact information for a
Certified Driving Rehabilitation Specialist (see end of this document)
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Arthritis
Facts
● Arthritis is a common progressive disease that affects roughly 25% of older
adults aged 65 or older.
● Symptoms include joint tenderness, movement limitations, compromised
strength, ROM, and endurance, fatigue, stiffness, and pain.
● Arthritis increases a person’s risk for deformities, disability, and compromised
functional abilities.
Impact on Driving
● Having arthritis can make older adults’ joints swollen and stiff, which can limit
how far they can bend or move their shoulders, hands, head and neck. This can
make it harder to:
○ grasp or turn the steering wheel
■ Provide handout on exercises to improve muscle strength and
range of motion
○ apply the brake and gas pedals
■ Instruct them to leave extra room
between themselves and what is in
front of them so that they have time
to anticipate applying the break
○ start the ignition or vehicle features
■ Recommend adapted key holders
○ put on their safety belt or look over their
shoulder to check your blind spot.
■ Recommend adapted safety belt
http://www.arthritissupplies.com/grips-adaptersfeatures
holders.htmlimprove range of motion
■ Provide handout on exercises to
● If arthritis affects their hips, knees, ankles or feet, they also may have difficulty
getting in and out of their car.
○ Recommend a leg lifter
○ Provide handout on exercises to improve muscle strength and range of
motion
● If they take medicine to treat their arthritis, it may cause drowsiness.
○ Recommend the Rx review website
If arthritis is significantly impacts their ability to drive, a referral to a CDRS may be
warranted.
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Diabetes
Diabetes Facts
● In Minnesota, it is required by law that drivers with insulin-dependent diabetes
submit a written statement within 30 days of diagnosis from his/her physician
indicating whether or not the diagnosis interferes with his/her ability to drive
safely.
● Diabetes affects nearly 27% of adults over age 65 and is characterized by the
insufficient production of insulin which results in the inability to correctly
metabolize glucose.
● Diabetes can result in limb amputation and sensation and vision impairments
such as cataracts, glaucoma, and diabetic retinopathy.
● Diabetes can be managed through maintaining a healthy lifestyle through a wellbalanced diet, regular exercise, and sometimes taking drugs like insulin.
● The key to preventing diabetes-related eye problems is good control of blood
glucose levels, good blood pressure control and good eye care. A yearly exam
with an eye care professional is essential.
Impact on Driving
● Diabetes can make glucose (sugar) levels too high or too low and make you feel
○ Sleep or drowsy
○ Confused
○ Have blurred vision
○ Lose consciousness
● Over time, diabetes may cause nerve damage in hands, leg, feet or eyes which
can impact driving.
● Individuals with complications of diabetes were found to have longer response
time, breaking difficulties, compromised driving behaviors, and higher rates of
accidents.
● Discuss with the driver the importance of carrying their medication and blood
glucose meter as well as having snacks in the car.
● If their blood sugar is low, have them eat a snack, wait fifteen minutes, check
glucose level again, and drive after a safe level is reached.
● To increase driver confidence, recommend that they drive with a friend, family
member, or loved one.
● Consider alternative transportation options if no longer desire to drive.
● If an individual has insulin-dependent diabetes, they would likely benefit from a
referral to a CDRS
● Those with medication dependent diabetes can be taken behind the wheel as
long as their condition is not significantly impacting their ability to drive.
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Stroke
Stroke Facts
● Also known as a cerebral vascular accident (CVA).
● The most common type of stroke is an ischemic stroke, where an artery becomes
blocked and can no longer supply blood to the brain.
● In a hemorrhagic stroke, an artery of the brain bursts and brain cells in that area.
● Stroke is a leading cause of mortality and long-term severe disability in the US
● Acute symptoms of a stroke may be unexpected numbness on one side of the
body, difficulty speaking, problems understanding others, a lack of balance, an
intense headache, and vision issues.
○ If these symptoms are occurring, seek medical attention immediately.
● A stroke is not a progressive disease, but will usually have symptoms that last a
lifetime which are called residual symptoms. If the stroke caused left sided
weakness, you may see the following residual symptoms:
○ Memory issues
○ Impulsive behaviors
○ Hemi-neglect, where individuals are unable to pay attention to the left half
of their visual field
● General residual symptoms of a stroke that result in right sided weakness can
include:
○ Problems with memory
○ Problem understanding directions
○ Problems expressing oneself (problems in grammar, fluency etc.)
○ Reading and writing difficulties
○ Cautious behavior
Impact on Driving
● Most individuals who have had a stroke will undergo rehabilitation and get
medical clearance to drive.
○ Be sure that any older adults who have had a stroke have been cleared to
drive before you take them behind the wheel.
○ Because a stroke is not progressive after it occurs, patients are not
generally closely followed by an MD and could practice their driving skills
with you as LDI.
● The symptoms and impact on driving of a stroke will vary greatly depending on
the location and severity of the stroke (see table below).
● If symptoms of stroke significantly interfere with an individual's ability to drive, the
condition is progressive, or they require complex adaptive equipment, refer them
to a CDRS
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Parkinson’s Disease
Facts
● Parkinson's disease (PD) is a progressive movement disorder that affects the
central nervous system.
● Around 1% of the senior population is diagnosed with PD.
● Motor symptoms often experienced by those with PD include:
○ Tremors, or involuntary shaking movements, while at rest (often in their
hands)
○ Rigidity, where the person's muscles become stiff and oppose movement
○ Bradykinesia, or slowness of movement
○ Postural instability, where balance is compromised
● Cognitive symptoms are also very common in PD and can include:
○ Executive functioning problems including the ability to solve problems,
start and complete tasks, and multitasking
○ Issues with memory, attention, processing visual information, and slowed
thinking
Impact on Driving
● Both the motor and cognitive symptoms related to PD can impact driving ability
(see table below).
● Due to the disease’s progressive nature, older adults with PD should be referred
to a CDRS for a driving evaluation.
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Mild Cognitive Impairment (MCI)
Facts
● Mild cognitive impairment (MCI) is a term used to describe a cognitive disorder
that affects a person’s memory and reasoning ability.
● MCI symptoms can improve, stay the same, or get worse depending on the
cause. If it is due to dementia (i.e. Alzheimer’s disease), symptoms will get
worse as the disease progresses.
● New diagnostic criteria includes MCI as a part of what is known as “Mild
Neurocognitive Disorder.”
○ The term Mild Neurocognitive Disorder also includes the early stage of
dementia
● MCI is believed to affect ten to twenty percent of people over the age of 65.
● Symptoms of MCI can include forgetting recent events and difficulties with
attention, judgment, and visual processing.
● They often are difficult to distinguish from normal age changes and many people
with MCI go undiagnosed for years.
● It is possible, or even likely, that drivers will MCI will be on your caseload as
driving instructors. If you notice memory and attention issues that are mild, it is
fine to refresh their driving skills. However, if those problems are significant,
include poor judgment and interfere safety, they need to be referred to a driving
rehabilitation specialist (see dementia information below).
● Below you will find an observation tool that can help you determine possible
memory problems.
● You can also recommend that they use the self-assessment tools such as the
SAFER mentioned elsewhere in this curriculum.
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Dementia and Driving
Dementia is not a particular disease. It is the deterioration in cognitive functioning that
renders a person unable to remember, think and plan effectively in everyday life.
Dementia is also called neurocognitive disorder. There are many types of
neurocognitive disorders. The most common type of dementia is Alzheimer’s disease.
Alzheimer’s Disease (AD)
●
●
●
●
More than 5 million people in the United States have AD
About 1/8th of people over 65 have Alzheimer’s Disease
Almost 1/4th of people over 85 have the disease.
The impact of the disease on driving depends on the stage.
Stages of Alzheimer’s Disease and Link to Driving
Mild (Early Stage)
The individual is generally still independent but has difficulty with usual things like
word finding, misplacing objects, remembering new information, and taking
longer to accomplish everyday tasks. Driving is usually still possible during this
stage but the driver should get used to other modes of transportation and have a
plan for the driving cessation process.
Moderate (Mid-Stage)
Individuals in this stage need a higher level of care from others and have issues
expressing themselves through language and completing simple tasks.
Symptoms can include forgetting important parts of their personal history,
increased confusion about their surroundings, wandering/getting lost, impulsive
behavior, mood and personality changes, delusions and hallucinations. Driving
should be discontinued at this stage.
Severe (Late-Stage)
During the late stage, severe Alzheimer's disease, individuals need 24-hour care.
Most individuals have lost their ability to communicate or respond to their
surroundings, and, eventually, can no longer control their physical movements.
No driving is safe during this stage.
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Drivers with Dementia
● Drivers with dementia have nearly double the crash risk of others.
● Higher risk of becoming lost is linked to a significant risk of death.
● Driving is an over-learned skill: in good conditions, the driver with dementia may
appear to be a competent and safe driver.
● Dementia causes delayed reaction time and impaired ability to process complex
information.
● Dementia is linked to lack of insight about driving risk and abilities.
● 25% continue to drive after a doctor recommends they stop.
Recommendations
Following the diagnosis of dementia, it is recommended that drivers use an advanced
directive to give caregivers permission to take away the keys if driving becomes unsafe.
(See Alzheimer’s Association website in “additional resources”)
Signs Driving Retirement Should Occur
● Difficulty maintaining lane position
● Confusion at exits
● Recent traffic tickets or warnings
● Getting lost in familiar places
● Repeated accidents
● Failure to make stops
● Confusing brake and gas pedals
● Stopping in traffic for no apparent reason
The following handout (adapted from Dr. Tom Meuser’s Youtube video at UMSL) could
be helpful to screen for both vision and cognitive problems.
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Vision and Cognition Screen
Please Circle
1. Why are you here today?
Correct
Incorrect
2. Do you know where we are right now?
Correct
Incorrect
Ask for his/her license and check it for accuracy in response to the following questions:
3. Please state your full name for me.
Correct
Incorrect
4. Please state your full address.
Correct
Incorrect
Write down license number. Give back license and ask him/her to read license number:
5. What is your license number?
Correct
Incorrect
6.a. What is the date today? (Month and day)
b. Year?
c. Day of the week?
7.a. What is the make and model of your car?
b. Year? (can look at insurance card if needed)
Correct
Correct
Incorrect
Incorrect
Correct
Incorrect
Correct
Incorrect
Correct
Incorrect
8. I’m now going to ask you to operate some vehicle controls without hesitation.
(Correct = no hesitation and correct operation. Incorrect = hesitation and/or incorrect operation)
a. Headlights.
Correct
Incorrect
b. High beams.
Correct
Incorrect
b. Windshield wipers.
Correct
Incorrect
c. Front defroster.
Correct
Incorrect
9. I’m now going to point to some objects in the car and I would like you to name them
(Point to the following objects and indicate if the individual correctly identifies the objects)
a. Steering wheel.
Correct
Incorrect
b. Glove compartment.
Correct
Incorrect
c. Rearview mirror.
Correct
Incorrect
d. Windshield.
Correct
Incorrect
10. Ask driver to read from an external sign. Able to read it?
Yes
No
*** IF MULTIPLE INCORRECT ANSWERS, THERE MAY BE VISUAL OR COGNITIVE ISSUES
AFFECTING SAFETY. GETTING ASSESSED BY A CDRS WOULD BE WARRANTED***
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Medications and Driving
The majority of older adults take one or more prescription or over the
counter medications a day.
Common medications used by older adults include medications to address
difficulties with: pain, allergies, sleep, blood pressure, depression, diabetes,
seizures, and muscle spasms.
Many older adults are unaware of potential side effects that medications
may have on driving.
Both medication and characteristics of diseases and disorders can increase
motor vehicle crash risks in older adults.
Taking a combination of medications may increase risk for motor vehicle
accidents.
It is important to observe possible side effects of medications (listed below)
when taking older drivers behind the wheel to determine if there are any
red flags that may require a referral to a driving rehabilitation specialist
(CDRS)
Common medications that may impair driving:
Medication Type:
Common Drug Names: Side Effects:
Pain medications
codeine, hydrocodone
may result in sleepiness
and slowed reaction
time
Allergy medications
Benadryl
may result in sleepiness
and slowed reaction
time, dizziness
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Sleeping
medications
Ambien, Sonata
may result in sleepiness
and slowed reaction
time
Blood pressure
medications
Lisinopril
may result in low blood
pressure, dizziness
Antidepressants
Zoloft, citalopram
may result in sleepiness
and slowed reaction
time, dizziness
Anti-diabetic drugs
metformin, glyburide
may result in low blood
sugar, dizziness
Seizure medications
Tegretol, phenytoin
may result in moving
difficulties, dizziness,
sleepiness and slowed
reaction time
Muscle relaxants
cyclobenzaprine
may result in dizziness,
sleepiness and slowed
reaction time
After the first session, you can give your clients the following handout
regarding medications.
Encourage them to visit the Roadwise Rx website to find out how any
medications they may be taking could affect their driving safety.
*** Resources for older drivers: See 2-page Medication Handout ***
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Medication Handout
It is a good idea to:
● Keep an active list of medications.
● Create a dosing schedule and carry your next dosage with you if you
will be out of the house.
● Use the same pharmacy every time & ask your pharmacist questions
about over the counter medications.
● Ask your doctor or pharmacist how medications will affect driving and
don’t drive until you know how a medication will affect you.
● Avoid driving if you feel dizzy, sedated, or have blurred vision.
● Make alternative transportation arrangement with friends or public
transit while using potentially driving impairment medications.
Notes:
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A tool for understanding how Medications
may affect you and your driving.
 Medications have both intended and unintended effects on the body.
o These effects change based on the other medications that
someone is taking, the foods that someone eats, body weight,
and metabolic rate.
 Medications can also impact your ability to safely drive.
 Roadwise Rx is an online tool designed to help you learn more about
your medications and how they may affect your driving.
 Any information that you enter in this tool is completely confidential
and cannot be viewed by any other party.
 To access Roadwise Rx go to http://www.roadwiserx.com/index.aspx
o Begin typing the name of a medication that you are currently
taking and then select it from the list.
o Once you have entered all your medications, both prescribed
and over-the counter, click "View Results."
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Retraining the Older Driver
Assessments
Before starting the behind the wheel process, a self-assessment can be taken by the
driver to identify specific driving areas of need that can be addressed by the LDI. The
Driving Decisions Workbook was created by the University of Michigan and provides
direct feedback for the following areas: on the road driving, vision, cognition, mobility,
and health. A free PDF version of the Driving Decisions Workbook can be found at:
https://deepblue.lib.umich.edu/handle/2027.42/1321.
Sample Page of the Driving Decisions Workbook
A computerized later version of the above self-assessment is called the Self-Awareness
and Feedback for Responsible Driving (SAFER) and takes about 15-30 minutes to
complete. It provides the test-taker with a list of possible driving health concerns,
specific driving skills impacted, and recommendations and safety tips for action. The
SAFER self-assessment can be found at: http://www.um saferdriving.org/firstPage.php
***We recommend that drivers take this self-assessment and bring a print out of
the results to the first behind-the-wheel refresher session. ***
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Starting the Behind the Wheel Process
As with younger drivers, behind the wheel instruction time with older adults
should start with more basic aspects of driving and grow more complex
over the course of the session. Along each step of the process, instructors
should communicate next steps with the driver and ask them if they feel
comfortable progressing onto a more challenging driving activity (e.g. rural
streets onto a county road). However, it is most important to use your
judgement about whether or not an older driver is capable to safely handle
more complex driving scenarios.
It is also important to keep in mind some of the previously discussed
andragogy principles when working with older adults. Since adults learn
differently than teenagers, it is important to keep in mind how they learn
when working with them. Some of examples of how to incorporate these
principles during your training include:
● Asking if there are any driving skills the older adult specifically wants
to work on during your time together. This will create buy in from the
older adult, help establish rapport, and help keep the driver engaged
during the session.
● Determine the lesson length they feel the most comfortable with.
Many older adults fatigue more easily so two 1-hour lessons may be
more conducive to learning than one two-hour lesson.
● Starting with many prompts and a lot of structure provided by LDI,
and gradually reducing over time
● Provide opportunities for older adult drivers to practice a skill several
times until the driver has proven he has it down. It is easier for older
adults to learn by doing, which allows them to tap into their
procedural or muscle memory. Provide opportunities for drivers to talk
through their actions right after having handled complex situations
(intersections/roundabouts) so they can learn from it when it is still
fresh in their memory.
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Most importantly, keep in mind that providing feedback/directions
while an older adult is driving can tax their divided attention skills and
can potentially lead to unsafe driving.
Divided attention is focusing on more than one aspect of the environment
at a time while executing more than one action at a time. Teenagers can do
this very well, but older adults struggle with this and it is a main reason why
older adults struggle with driving in general.
Therefore, feedback/instruction is best given:
● Before a task requiring high divided attention (intersection)
● After a task requiring high divided attention
● When a driver is pulled off on the side of the road/parked
In general, try to keep directions short and focused, trying not to give more
than 3 steps in a single direction. If an older adult seems to be having
trouble following directions, reduce them to two or one step directions.
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Sample Outline of a One-Hour Behind-the-Wheel Session
with an Older Adult
0-10 minutes Parking Lot Check:
Introductions: Spend the first few minutes getting to know your driver by
asking them about their driving experience and the reason he/she came to
see you today. Look through the SAFER information or other selfassessment results if the driver has brought it. This will help you establish
some rapport with the driver and give you initial insights into what areas
he/she needs or wants to work on.
Eye glasses check: Check the license to see if it indicates the driver
needs to wear corrective lenses while driving. If it does, make sure the
driver has those glasses/contacts before the driving begins.
Vision, cognitive and physical check:
 In order to check for potential memory and cognitive losses, ask them
to complete a brief cognitive and vision screen (see page 33 of this
curriculum for a suggestion). Instead of looking at a sign when
conducting the brief vision screen, stand 10 feet in front of the car
and holding up one to five fingers. Ask to driver to sit with their hands
on the wheel as if they were driving and call out each number as you
hold it up.
 For the physical check, ask the driver to do the following. Ideally the
LDI should be trained as CarFit technician and be able to identify
problem areas and educate the driver on how to fix them.
● Put on their seatbelt, to see difficulty with shoulder movement.
● Step alternatively on the gas and brake pedals, to see efficiency of
movement and correct distance from pedal.
● Turn the car on/off to assess fine motor skills.
● Observe ability to turn neck to look at you over the shoulder if you
are not in the side-view mirror, to test neck mobility and need for
mirror adjustment to eliminate the blind spot. i.e. CarFit protocol.
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If they are showing hesitations, or confusion in responding to your requests
and performing those tasks, make a note of it, as it could indicate problems
affecting driving safety
However, keep in mind that using an unfamiliar car and/or nervousness
about the session could impact performance on this simple test.
The parking lot session is also a good opportunity to check and teach the
river about the importance of a clean windshield and regular car check-ups.
10-20 minutes:
Basic maneuvers: Have the driver practice basic moves in the parking lot
such as driving forward, backing up, turning and getting in and out of
parking spaces. Use this information to anticipate whether or not the driver
will be able to navigate a low traffic road safely. Things to look for during
this time:
 Backing up - Is the driver using only the mirrors to look back? When
turning trunk and neck, is there enough rotation to get a good sight
line out of the back of the car?
o Older adults may only use their mirrors due to a loss of
flexibility/strength in the neck and torso
 Turning - Is the driver able to grip the wheel tight enough to complete
these turns at a reasonable speed?
o Older drivers may suffer from arthritis in their hands which
could impact their grip on the wheel
o Or shoulder pain can impact where an older driver holds the
wheel while turning the car. Pain holding the top of the wheel,
or crossing midline can affect ability to control the vehicle.
 Driving Straight - Is the driver able drive the car in a straight line
when moving forward and backward?
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o Research has shown that older drivers have difficulty
maintaining lanes. If they struggle in this environment, bringing
them out on a road with multiple lanes may be unsafe
20-35 Minutes:
Side Road: Unless the parking lot maneuvers reveal significant difficulties,
take the older driver out onto a low traffic road, such as in a residential area
or any area where the speed limit is relatively low (25-35 mph) and both
pedestrian and vehicle traffic is minimal. Have the older driver attempt the
following maneuvers:
 4 way stop intersection - Does the driver understand how the four
way stop works? Does the driver stop at the appropriate time and in
the appropriate place? Does the driver appropriately scan the
environment before proceeding?
o Visual deficits and attentional deficits are more common as
people age. Divided attention in particular decreases with age.
This can significantly impact a driver’s ability to safely manage
intersections.
 Stop and right turn at intersection with larger road - Is the driver
checking both ways before he turns right at the intersection? Is the
driver able to safely judge the distance of traffic coming from the
driver side? Is he checking for pedestrians and bikers on the
passenger side?
o Intersections are one of the areas where older drivers are most
susceptible to getting into crashes. One of the main reasons for
this is that older drivers have a hard time judging safe gaps in
traffic in which to enter. Another contributing factor is that older
adults are less able to attend to information in their peripheral
field of view than younger drivers
 Suggestion for Entering Traffic Safely: Instruct the older
driver to be extra cautious when judging gaps in traffic,
making sure to give themselves enough space to enter
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safely. Better to be patient and safe than rush and be
unsafe!
 Suggestion for Reduced Peripheral Field of View: Instruct
the driver to completely rotate their head to check
oncoming traffic. Give them to goal of trying to touch their
chin to their shoulder when they check. If neck flexibility is
an issue, instruct them to lean forward and rotate their
entire trunk in order safely check for oncoming traffic.
 Stop and left turn at intersection with road without stop: Is the
driver checking both ways before he turns right at the intersection? Is
the driver able to safely judge the distance of traffic coming from the
driver and passenger side? Is he checking for pedestrians and
bikers?
o See explanation as above relating to problems with peripheral
vision and judging of gaps in traffic. This difficulty becomes
significantly worse when traffic is over 40 mph. By testing an
older driver’s ability to manage intersections in lower speed
environment, you can gage whether or not it is safe for the
driver to move on to higher speed and higher congestion
environments.
35-50 Minutes:
Take the older driver to a higher traffic area, such as on county roads or
major arterial roads. Try to access areas that require more demands on the
driver’s attention, such as stoplights with potential pedestrian crossings,
areas where traffic is merging onto the road, and roundabouts. Have the
driver do the following maneuvers:
 Protected left turn: Turn left at an intersection with a stop light that
has a protected left turn with a dedicated light signal and a dedicated
left turn lane. Does the driver understand what the arrow means?
Does the driver proceed to turn at the correct time?
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 Unprotected left turn: Turn left at an intersection with a stop light
without a protected left turn with a dedicated light signal. Does the
driver know how to position their car in the intersection to prepare to
turn left? Does the driver turn left at a time that is safe for him/her and
other drivers? Is he/she proceeding to the correct lane when he/she
completes the turn?
o Turning left at a stoplight without a green arrow has been
shown to be another common area for crashes among older
adult drivers. This is due in part to the difficulty older drivers
have with judging speed, safe gaps in traffic and potential
issues with depth perception. All of these factors can be made
worse by trying to managing them in the complex environment
of an intersection that requires strong divided attention skills.
For this reason, it is best to have the driver attempt to complete
a left turn at a light with a protected left turn with a dedicated
light signal and a dedicated left turn lane arrow before
proceeding on to an intersection without one.
 Suggestion for Completing Left Hand Turns Safely #1:
Instruct the older driver to be extra cautious when judging
gaps in traffic, making sure to give enough space to enter
safely. Better to be patient and safe than rush and be
unsafe!
 Suggestion for Completing Left Hand Turns Safely #2: If
drivers admit this is a problem for them, a self-regulation
technique of finding alternative routes that avoid these
challenging turns may be appropriate
 Lane change: Have the driver go on an arterial road or county road
that has two lanes of traffic going in both directions. Have the driver
change lanes at least one time. Can the driver maintain the
appropriate speed? Can the driver maintain their position in their
lane? Does the driver appropriately used mirrors and turn his/her
head to check traffic?
o Maintaining lane positions and changing lanes are two other
common reasons for crashes among this population. Slower
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response time, potential physical inability to check mirrors and
blind spots correctly and a smaller peripheral field of view are
just some of the contributing factors to this issue.
 Suggestion for Changing Lanes Safely: See parking lot
suggestion for following protocol to eliminate blind spots.
This should be done before taking the older adult on a
major artery where lane change will be needed. Another
option is to suggest they purchase an extendable wide
angle rearview mirror and/or a convex blind spot mirror
 Roundabout: Have the driver navigate either a single lane or
multilane roundabout. Before having the driver do this, ask the driver
if he has any familiarity with roundabouts. Despite their increasing
presence in Minnesota, many drivers both young and old do not know
how to navigate these intersections. If the driver is unfamiliar, it might
be appropriate to either pull over and explain how one works, or avoid
this part of the session and train the driver on this during any potential
classroom time you may have with the driver - particularly how to
respond to a yield sign
o Along with the unfamiliarity of roundabouts, they also require
merging into traffic which is a common problem for older
drivers. These two factors combine to make roundabouts
problematic for older drivers. However, the silver lining is that
roundabouts reduce overall crashes and fatal crashes
significantly compared to traditional intersections, especially for
older drivers.
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Resources for Educating Drivers on Roundabouts:
Youtube MnDOT Video: https://www.youtube.com/watch?v=BbfPebLjNec
How to navigate a multi lane roundabout:
http://www.wsdot.wa.gov/safety/roundabouts/
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Single Lane Roundabout vs. Multi lane:
http://safety.fhwa.dot.gov/intersection/innovative/roundabouts/fhwasa10006/
50-60 Minutes:
If you and the driver feel comfortable, take the driver onto the highway. It is
possible the driver may already be avoiding highways. If this is the case,
and the driver feels confident that he can get where he wants and
accomplish what he needs to without using them, then omit this section.
● Highway merging: Have the driver merge onto the highway. Does the
driver accelerate appropriately to match the speed of highway traffic?
● Highway lane change: Have the driver maintain their lane and then
change their lane at least once. Does the driver feel comfortable doing
this maneuver at this speed? Is the driver checking his blind spots
before changing lanes? Does the driver maintain the appropriate speed?
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A checklist of Problematic Maneuvers/Situations for Older Drivers and your
recommendations:
● Backing up
● Yielding to
oncoming traffic in
right turns
● Yielding to
oncoming traffic in
left turns
● Maintaining lane
position
● Changing lanes
● Highway merging
● Navigating
roundabouts
● Other:
Keep in mind that a majority of these have to deal with navigating
intersections. Therefore, it would always be best to start with basic
intersections (Stop signs, 4 ways stops) before moving on more complex
intersections.
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References
Brain HQ. (2016). Brain training that works. Retrieved from http://www.brainhq.com/
Drive Fit. (2016). Brain training for driving. Retrieved from http://drivefit.org/
Drivesharp. (2016). See more, focus better, and react faster. Retrieved from
https://www.drivesharp.com/
Eby, D. W. (2012). Older driver self-screening and functional assessment [PowerPoint]
Homesley, S. &Reshel, N. (n.d.). Nutrition and vision: Teaching you how to eat right for
your eyesight. [Brochure]. San Diego State University: n.p.
Meuser, Tom. Univeristy of Missouri in St. Louis Driver Examiner Training video
https://umsl.mediaspace.kaltura.com/media/Driving+Test+with+MO+State+Highw
ay+Patrol+Examiner+++Woman+with+Vision+Loss/0_my0ht6c1
NRMA-ACT Road Safety Trust (2001) Teaching Older Drivers: A Handbook for Driving
Instructors. La Trobe University, Tasmania, Australia
St. Catherine University MAOT (2015) Safe Access to Destination Curriculum.
Vision Eye Institute (n.d.). Couple Driving [digital image]. Retrieved from
http://www.visioneyeinstitute.com.au/page/14/?page_id=0
Additional Resources

AAA: http://seniordriving.aaa.com/

National Highway Traffic Safety Administration. http://www.nhtsa.gov/Senior-Drivers

Alzheimer’s Association Dementia and Driving Resource Center
http://www.alz.org/care/alzheimers-dementia-and-driving.asp

Hartford driving safety guides. https://www.thehartford.com/resources/maturemarket-excellence/publications-on-aging
For Referrals
To find a Driving Rehabilitation Specialist near you, look at the following website:
http://www.aota.org/olderdriver
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