National Older Driver Research and Training Center

Examining issues surrounding older driver assessment, remediation, rehabilitation, and the use of alternatives to the car.

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Results of the AOTA Older Driver Evidence Based Literature Review

Presenter: Stav, Wendy

Abstract

The evidence based reviews conducted by the American Occupational Therapy Association's Older Driver Project yielded results important to supporting safe older adult mobility within the community. Results of the evidence-based review will be presented which examined the effectiveness of occupational therapy interventions for older adult driving and transportation issues.

As the population ages and field of driver rehabilitation and community mobility becomes more formalized, there is a need to substantiate the services conducted by occupational therapists. An evidence based literature review was conducted by the American Occupational Therapy Association to identify interventions that are effective in supporting participation in community mobility among older adults.

A comprehensive literature search and systematic literature review was conducted to answer the following questions:

  1. What is the evidence for the effect of intervention with the person on the participation of the older adult?
  2. What is the evidence for the effect of infrastructure on the participation of the older adult?
  3. What is the evidence for the effect of automobile-related modifications on the driving ability, performance and safety of the older adult?
  4. What is the evidence for the effect of policy and community mobility programs (e.g., alternative transportation, walkable communities, education, pedestrian programs) on the participation of the older adult?

A review of the evidence revealed there are numerous intervetions that can be employed to the person, the infrastructure, the car, policy and the community to support participation of the older adult.

Interventions with the person shown to be effective include medical interventions such as cataract surgery and medication management; and visual/cognitive/motor interventions such as exercise programs, vision training, and cognitive retraining; while educational interventions were less effective.

Modifications to vehicles such as heads up displays, navigation systems, water resistant and tinted windows appear to contribute to operation of the vehicle, however, the higher technology modifications can prove to be cognitively distracting for the older driver. The modifications do not enhance participation among older adults.

The physical infrastructure of driving environments including signage and intersection design can facilitate safe performance of driving by older adults. While signage and new roadway construction may accommodate the age-related deficits of older drivers these changes are cost prohibitive. The evidence did not specifically address enhanced participation.

Policy related changes such as required vision testing or in-person renewal revealed a decrease in automobile crashes but did not necessarily relate to supporting participation in older adults.

Community mobility interventions did support participation in older adults, but more significantly highlighted the interdependence among stakeholders and the need for interagency collaboration.

The evidence-based literature review exposed several intervention strategies to increase the driving, community mobility and participation among older adults. Based on the nature of many of the effective interventions, it is evident that occupational therapists must continue to participate in collaborative relationships with the disciplines and agencies that can support those interventions. The future of occupational therapists focused on supporting community mobility and participation among older adults will include partnerships with automobile manufacturers, municipal planning organizations, physicians, aging agencies, transit agencies, community business owners, state licensing entities and others.

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