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The United States Census Bureau projects that the number of Americans age 65 and older will grow from 35 million today to more than 62 million by 2025, nearly an 80 percent increase.

In addition, the National Institute on Aging (NIA) projects the number of people age 85 and older, currently the fastest growing segment of the older population, could exceed 10 million. This dramatic and impending change in U.S. demographics has led federal and professional health organizations to determine what impact senior mobility will have on society.

As the elderly population grows, the proportion of older drivers is growing rapidly, as well. According to the American Association of Retired Persons (AARP) the percentage of persons age 65 and older who are licensed drivers has increased from 61 percent in 1980 to 72 percent in 1990 and 80 percent in 2003. In 2003, about one in seven licensed drivers was 65 or older.

The American Occupational Therapy Association (AOTA) is committed to ensuring older drivers keep their ability as long as they can, and through proper assessment, intervention and refinement, many older drivers have the opportunity to stay behind the wheel longer than they … and society … realized was possible.

AOTA has developed an older driver initiative supported by the National Highway Traffic Safety Administration (NHTSA). Occupational therapy, as defined by the AOTA Web site, assists people in developing the "skills for the job of living" necessary for independent and satisfying lives.

Age alone is not a good predictor of driving safety or ability. Yet safety research clearly shows that declines in physical, emotional and mental abilities can signal a greater crash risk or unsafe driving.

"Seniors are living longer and healthier; they are surviving medical conditions," says Elin Schold-Davis, OT and coordinator for AOTA's older driver initiative. "These aging seniors are blessed with health but may also be living with a degree of impairment that may place them at risk as a driver. Without the appropriate assessment, some will drive that should not and some may no longer drive that could with the right training or equipment. The most at-risk senior is one experiencing changes associated with aging plus medical conditions (which may include medication)."

Schold-Davis believes that right now there is too little physician involvement with the issue and not enough safe driving programs to accommodate the growing senior population. NHTSA is funding efforts to increase the capacity to serve this need across the country through conferences, committees and public awareness campaigns to encourage better referral networks. AOTA works to raise awareness through its own members andby participating in projects with the American Society on Aging (ASA).

"The NHTSA is funding occupational therapy in order to increase the capacity to serve the growing number of seniors, to impact safety and health, resulting in keeping seniors mobile, and driving, for as long as safely possible," says Schold-Davis.

The ASA has a DriveWell program that acts as a community information forum to promote awareness about older driver safety and public transportation needs. In addition, ASA in conjunction with AARP, AOTA and the AAA (American Automobile Association) developed an educational program called CarFit. The program is designed to help mature drivers determine how well they currently fit their personal vehicle. The program is provided through scheduled events coordinated by healthcare providers or associations. Participants are taken through a series of checkpoints such as knowing how to properly adjust mirrors to minimize blind spots, good foot positioning on gas and brake pedals and how close one is sitting to the steering wheel. Drivers run a serious risk of injury if they are sitting closer than 10 inches to the steering wheel.

"I think education is power," says Schold-Davis. "A person cannot correct or compensate for something they are unaware of. I think the OT has a rich opportunity to help the person understand how their impairments may impact driving."

Physicians have many responsibilities to their patients. First, of course, is patients' immediate health –– however, research is also showing the need for physicians to be more involved in fundamental conversations about mobility and lifestyle with their senior patients. The American Medical Association (AMA) has supported older driver safety programs for years and provides doctors with a Physician's Guide to Assessing and Counseling Older Drivers.

"If a physician has a belief that driving need not be addressed until the person needs to stop, we may have missed a whole window of opportunity for intervention, identification of risk and possibly compensating with equipment or restrictions," Schold-Davis explains. "The physician commands a great deal of respect, and can be highly effective when delivering a clear message that a person must stop [or assess] driving."

Schold-Davis says the overall benefit to society by focusing on the issue of older drivers instead of dismissing all seniors into the bad-driver category is similar to how society handles alcohol.

"After years of public awareness, it is a sign of a 'responsible person' to give up the keys for the night," she says. "We need to acknowledge that recognizing that changes associated with aging may impair driving ability is not agism, it is a fact. We need to identify our own changes and be given the opportunity to do something about them. When you cannot change the person, sometimes you can change the demands of the task."

ie.
October 2006

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