LifeSavers Conference

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What Can I Do About My Parents' Driving?
LifeSavers Conference April 14, 2008 Linda Hunt,
Ph.D. OTR/L lhunt_at_pacificu.edu
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State of Oregon Reporting Philosophy

• Preserves the independence, dignity, self-esteem
  from providing one's own mobility without risk to
  oneself or others.
• Supports relationship between primary care
  provider and patient.
• Does not target people solely on age, medical
  diagnosis/condition.

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Evolution of Oregon Law

• 1983
• All persons authorized by the State of Oregon
  to diagnose and treat disorders of the nervous
  system shall report immediately to the DOT every
  person over 14 years of age diagnosed having a
  disorder characterized by momentary or prolonged
  lapses of consciousness or control that is, or
  may become chronic.

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Continued

• 1999
• DMV convened a committee, the Older Driver
  Advisory Committee

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Continued

• August 4, 2001
• 80 year-old male driver
• 2001
• Oregon Legislature passed a bill requiring
  mandatory reporting of potentially impaired
  drivers by their physicians.

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• 2003
• Requires reporting of "severe and uncontrollable
  impairments."
• If a designated physician or health care
  provider does not make a report, that person
  shall be immune form civil liability that might
  otherwise result from not making the report.
  2003 Ore. Laws Ch. 462 (H.B. 2986)

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Non-Mandatory Reporting

• Includes early stages of AD and PD
• Vision, knowledge, drive test
• Retest 60 days
• 10 reports from family/friends

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Mandatory Reporting

• Severe and uncontrollable conditions
• Suspend license immediately
• Physicians report diagnosis
• Must provide functional description

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Continued

• Physicians immune from civil liability whether
  they report or not
• Medical Review Board may
• recommend that someone is too impaired for
  State of Oregon to test

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2005 Data Oregonian Drivers

• Over 2,955,484 individuals with Oregon drivers
  licenses
• 291,725 are age 70 or older
• 40,278 are age 85 or older

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Medically At-Risk Received Mandatory Reports

• (6/1/03 12/31/06) 5590 reports received
• Age of person reported ranged from 15 95.
• 56 of those reported were 70 or older
• 67 of those reported were 60 or older

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Continued

• 71 of reports received resulted in suspension
• 68 suspensions involved drivers age 70
• 61 mandatory program suspensions involved
  cognitive impairments
• Judgment, reaction time, memory, and attention
• 76 suspensions for cognitive impairments
  involved drivers age 70

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Continued

• 13 of suspensions involved vision only
• 74 of suspensions for vision only involved
  drivers 70 and older

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All Drivers

• Below 13 of individuals suspended under
  mandatory reporting program regain driving
  privileges by
• passing all DMV required tests (vision, knowledge
  and drive) or
• prevailing in an administrative law hearing.

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Family Members Assessment

• Reports incident of being lost.
• Restricts providing transportation for
  grandchildren.
• Voices concern.
• Provides cueing while driving.
• Observes hesitation at intersections/drives
  through inappropriately.

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Continued

• Reports near misses.
• Reports accident in last six months.
• Reports being stopped by police.
• Observes agitation while driving.

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Continued

• Observes weaving in and out of the driving lane.
• Observes missing traffic signs, lights or
  symbols.
• Observes drivers honking.

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Continued

• Notices other drivers taking evasive actions to
  avoid crashes.
• Observes turns at intersections without regard
  for oncoming traffic.
• Reports driving below the speed limit.

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Caregiver Insights as Assessment

• He is cautious.
• He does not drive often and only six blocks from
  home.
• It keeps her active, self-reliant, and able to
  drive in an emergency.

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Continued

• He wants to drive.
• Acknowledges concern with their loved one
  driving.
• Hunt LA, Morris, J.C, Edwards, DF,
  Wilson, B. (1993). Driving performance in
  persons with mild senile dementia of the
  Alzheimer type. Journal of the American
  Geriatrics Society, 41,747-753.

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Occupational Therapy Driver Evaluation

• Client Insight
• Visual/Sensation Performance
• Motor Performance
• Cognitive Performance
• Road Test

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(No Transcript)
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Hunt, L.
A., Murphy, C. F., Carr, D., Duchek. J. M.,
Buckles, V., Morris,

J. C. (1997). Environmental cueing
may effect performance on a road

test for drivers with
dementia of the Alzheimer type. Alzheimer Disease


Associated Disorders, II (Suppl. 1), 12-26.
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Research Results

• Currently Driving Results
• pass fail
• Yes (n37) 22 15
• No (n37) 13 24

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• Drive Study Ratings by Dementia Rating
• CDR 0 0.5
  1.0
• Safe 45 24 12
• (78) (67)
  (12)
• Unsafe 13 12 17
• (22) (33)
  (58)
• Hunt, L., Morris, J. C., Edwards, D.,
  Wilson, B. S. (1993). Driving performance in
  persons with mild senile dementia of the
  Alzheimer type. Journal of the American
  Geriatrics Society, 41, 747-753.

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Next Step Referrals and Partnerships

• Social Services
• What is available?
• Occupational Therapist/Psychologist
• Assessing feelings about self with respect to
  problem
• Enlisting help of someone who cares
• Rewarding self or being rewarded by others for
  not driving
• Acknowledging that change is part of the life
  cycle

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Continued

• Community Services
• Alzheimers Centers/Association
• Agency on Aging
• AARP
• Physician
• Monitor depression
• Monitor medication
• Monitor progression

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Follow-up

• Is the plan for transportation working?
• Ask about depression
• Is the client still driving?
• What happened with the licensing agency?
• Has the client been re-evaluated by the
  physician?

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Conclusions

• Understand State reporting laws
• Dialogue about cessation early
• Refer to OT appropriately

• Recognize empathy, conflict, resolution
• Locate resources
• Acknowledge difficulty and loss when driving no
  longer possible