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Older Drivers Phase III - DOC

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					             Live Well, Live Long: Steps to Better Health
      Health Promotion and Disease Prevention for Older Adults

                      Road Map to Driving Wellness

Chapter 3. Coordinating Prevention and Intervention Activities and
           Services

Table of Contents
     Introduction: Organizing Successful Programs Supporting Safe and
     Appropriate Driving Decisions
     Community Collaboration for the Spectrum of Driving Options
           Family, Partners and Friends
           Service Providers for Older Adults
               Working with Families, Partners and Caregivers
               Working with Older Drivers
               Reaching Older Drivers with Complex Driving Issues
                   Alzheimer’s Disease
                   Alcohol, Medications and Risky Drinking
           Materials to Help Older Drivers Plan for a Change in Mobility
           Law Enforcement
           Departments of Motor Vehicles
           Healthcare Providers
           Volunteer Organizations
           Faith-based Organizations
           Community Colleges and Universities
           Transportation and Safety Organizations
     Developing a Community Awareness and Action Program
               What do you want to accomplish?
               Who is the audience?
               What do you want to say to your audience and how often?
           Step 1. What? Content and Format
               What are some format options for program presentations? What
               formats might lend themselves best to this content?
               What formats have been successful for other programs and how can
               those be adapted to provide information about medications?




                                       1
                    What resources do you have to advertise and produce this program or
                    campaign?
                 Step 2. Where? Determining the Location
                    What safe and comfortable space near convenient transportation or
                    parking can you use for your program?
                 Step 3. Who? Identifying and Recruiting a Presenter
                    What groups or individuals in the community have expertise and
                    interest in the content?
                    Are your speakers appropriate for culturally diverse populations?
                         Is your speaker familiar with community resources?
                 Step 4. How? Publicizing the Program
                    Using word of mouth
                    Pitching the program in newsletters
                    Contacting the local media
                    Distributing flyers
                 Step 5. How? Coordinating the Program
                    Developing an action plan and timeline
                    Designing handouts
                    Determining what local resources are available
                 Step 6. How Well? Evaluation and Follow-up
                    How do you know you were successful?
                    Did you meet your projection for number of attendees?
                    Did the program gain adequate exposure?
                    Was the program effective in achieving your goals?
                    Did the program’s cost in time and resources provide enough benefit
                    to satisfy the community, funders and your organization?
                 Resources
                 References
                 Handouts

Introduction: Organizing Successful Programs Supporting Safe and
Appropriate Driving Decisions
The majority of older drivers think they will know when they should stop driving.1 And
most do regulate their driving behavior without the benefit of an objective external
assessment or specific self-assessment tool. While many older adults continue to drive
until they are very old, they very frequently reduce their risk by driving less, avoiding
driving in poor conditions, and reducing their exposure to high-risk situations. Their self-
regulating strategies become more complex until, for some, a triggering event (illness,
crash or injury) prompts them to stop driving altogether.



1
 Schatz, S., Stutts, J. and Wilkins, J. (1999B) “The Premature Reduction and Cessation of Driving: A
Preliminary Study of Women Who Choose Not to Drive or to Drive Infrequently.” Proceedings
Transportation Research Board 78. Transportation Research Record No. 1693.



                                                    2
Driving Mis-Decisions

While the majority of drivers self-monitor properly, others make inappropriate decisions.
Some drivers may stop prematurely, while others—unaware of their declining abilities,
unaware of options for coping with them, or lacking other transportation options—
operate cars beyond safe driving capacity. As many as 20 percent of older drivers
continue to drive even after they fail an assessment by the Department of Motor Vehicles
(DMV) and are advised to stop driving.2

Ideally, driving decisions consist of a spectrum of options for making the right choice at
the right time.

At one end sits the older person who has a lifetime of safe driving habits and has not yet
experienced some of the age- or disease-related declines known to negatively affect safe
driving performance.

At the other end is the unsafe driver who requires:

                Transportation from friends and family, or through public or private
                 services
                An environment that provides walkable access to basic services and social
                 supports, or offers delivery services such as groceries and medications




2
 Dobbs, B.M., and Dobbs, A.R. (1997). ―Delicensing: Mobility and related consequences for the patient
and family members.‖ Paper presented at Transportation Research Board 76 th Annual Meeting,
Washington, DC, Jan. 12–16, 1997.



                                                   3
                          Spectrum of Driving Decisions



Well Drivers with      Well Drivers with        Unsafe Drivers       Unsafe Drivers
No Chronic             Chronic                  with No Chronic      with Chronic
Conditions             Conditions               Conditions           Conditions
                                 Prevention Actions
 Periodically         Periodically       Look for                    Review aspects
  review the rules of   review the rules    undiagnosed                  of chronic
  the road              of the road and     conditions                   conditions that
 Conduct periodic      adequacy of         affecting driving            may be treatable
  driving               appropriate        Review                       or for which
  assessment to         adaptive            appropriate safe             accommodations
  determine baseline    strategies          driving strategies           may be made
  capabilities          currently used     Conduct both on-            Conduct both
 Conduct               for driving         and off-road                 on- and off-road
  assessment for       Provide exercises   assessments to               assessments to
  adaptive              to maintain rapid   help identify                help identify
  equipment to          reflexes, muscle    safe-driving                 safe-driving
  improve driving       strength, and       problems                     problems
 Provide exercises     flexibility        Follow up
  to maintain rapid    Review              assessment with
  reflexes, muscle      medication with     retraining
  strength, and         a pharmacist or    Provide exercises
  flexibility           doctor              to maintain rapid
 Review                                    reflexes, muscle
  medication with a                         strength, and
  pharmacist or                             flexibility
  doctor                                   Review
                                            medication with a
                                            pharmacist or
                                            doctor


Driving Discussions

Unfortunately, a crisis usually forces driving discussions with older adults, which may
focus on approaches to taking away the car keys. Few discussions are about driving
behavior and strategies that help avert problems with on-road safety. Not surprisingly,
initiating conversations with older adults about driving is difficult at best.




                                            4
As with the spectrum of driving decisions, planning for driving wellness and safety will
ideally engage a range of participants—community members, loved ones, and
professionals—to navigate between older adults’ needs and transportation options.

For many people, financial planning is central to retirement planning. Encourage older
adults to develop transportation strategies in combination with their financial plans.
Suggest considering, when moving to a home in later years:

              The availability of transportation in the surrounding area
              The proximity to needed services
              The availability of sidewalks and crime-free neighborhoods for walking to
               services

Having safety-promotion discussions before a crisis occurs encourages driving wellness
and safety. Early planning for an older person’s driving future may:

              Reduce stress by creating transportation alternatives for the older driver
               with diminished skills
              Avoid injuries or fatalities from crashes
              Reduce family and partner stress from struggling over car privileges
              Reduce costs for door-to-door public transportation (paratransit) by
               ensuring that capable drivers can remain on the road
              Support older adults in their efforts to stay connected and contribute to
               their community

This section will outline the possible roles that various segments of the community can
play in providing options and transitions for older drivers.

Community Collaboration for the Spectrum of Driving Options
Many community-based organizations—both public and nongovernmental—are well-
positioned to provide public information and education about options for older-driver
safety in their communities. Families and community groups rely on a variety of
organizations to answer questions about driving wellness.

Service providers for older adults can act as the focal point for driving-wellness activities
by coordinating communication and disseminating information within communities on
this issue. They can also identify unsafe drivers from those who attend programs and
receive services from their organizations.

Providing specific physical-activity programs that build strength and endurance, from
exercise to dancing, can enhance driving wellness for older adults.

Mobility managers—case managers who coordinate the transportation needs of older
people with available options—can unite the efforts of multiple community



                                              5
organizations. The wealth of local resources helps families and partners with the
complex process of determining safe driving choices.

Family, Partners and Friends
Research indicates that family and friends of older drivers see few benefits to discussions
with loved ones about driving. Although older adults and their families assert that they
should discuss the process of reducing and ceasing driving, in practice such a
conversation rarely takes place or goes poorly. Here are some possible reasons:
            A significant barrier to talking about driving is fear of the older person’s
               negative response
            Families and partners may find confronting older adults about unsafe
               driving disrespectful or meddling. It may also be accompanied by
               disapproval from others in the family or community
            The adult child may not want to deal with the question of what role he or
               she will have to play in meeting the parent’s transportation needs if
               driving is restricted
            If the loved one is the main driver in the household, isolation might
               increase for the nondriver
            Well-meaning older drivers may resist offers of rides from an adult child
               by simply responding, ―I don’t want to be a burden‖
            The discussion is postponed until a crisis occurs—a poor time for
               developing a transportation plan

On the other hand, receiving rides from family and friends can foster a sense of being
cared for and provide a positive social interaction that can reduce loneliness.3

Overwhelmingly, the personal automobile remains the transportation of choice for both
drivers and nondrivers. Nondrivers identified riding with a friend or family member as
the most preferred alternative to driving.4

Service Providers for Older Adults

Working with Families, Partners and Caregivers

Even when family members, friends and providers are willing to tackle these difficult
conversations, research indicates that they want more information with which to initiate a
discussion. Providers can assist in preparing families and partners for the discussion by
supplying:

3
 Glasgow, N. (2000) ―Older Americans’ Patterns of Driving and Using Other Transportation.‖ Rural
America 15(3):1–5. Retrieved from U.S. Dept. of Agriculture on the World Wide Web:
http://www.ers.usda.gov/epubs/pdf/ruralamerica/sep2000/sep2000f.pdf.
4
 Coughlin, J., and Straight, A. (2001) Transportation and Older Persons: Perceptions and Preferences—
A Report on Focus Groups. Retrieved from AARP on the World Wide Web:
http://research.aarp.org/il/2001_05_transport_1.html.


                                                  6
               A list of signs indicating driving impairment
               Tips on observing the older driver’s abilities
               An understanding of the meaning of driving from the loved one’s
                perspective
               Suggestions on opening the driving discussion
               Ideas on how best to talk about appropriate driving and travel choices
               Materials to help older drivers plan for a change in mobility
               A list of community resources for driving evaluation and remediation
               Strategies for driving reduction or retirement
               Local transportation alternatives for the older driver

Families often question service providers about the signs of driving impairment. This
opportunity allows providers an opening to talk about the spectrum of driving ability and
to make suggestions on how to approach discussions with older drivers.

Preparing for the Conversation

To prepare for useful discussions with the older driver, have the family and partner focus
on the older driver’s functional capacity, not age or disease. People age at different
rates and age-related problems known to affect driver performance do not occur in
all people at the same rate or to the same degree.5 The discussion should:

               Clarify for the family and partner the transportation needs of the older
                person
               Highlight steps that the older driver has taken to ensure safe driving, such
                as limiting driving at night, in poor weather conditions or during high-
                traffic times
               Develop strategies to improve driving
               Result in positive action to ensure safety

Preparation for the conversation begins with fact finding. Have families and partners
identify signs of driving problems. With concrete examples, you as a provider can help
them consider positive approaches such as focusing the conversation on remediation and
not on loss of keys. Provide families and partners with the following list of signs to
identify driving problems.




5
 Stressel, D.L. (2000) ―Driving Issues of the Older Adult.‖ OT Practice: AOTA Continuing Education
Article 1–9.



                                                  7
                                       Signs of Driving Problems 6, 7

                     Vehicle crashes
                     New dents or dings in the car
                     Observations by neighbors or friends of unsafe driving
                     Police visits
                     Two or more traffic tickets, warnings, collisions or ―near misses‖
                      within the last two years
                     Increases in car insurance premiums because of collisions
                     Getting lost when driving on familiar streets


To prepare for the conversation with the older driver, have the family member or partner
observe driving performance. Encourage the concerned family member or partner to ride
with the older driver. Remind the observer to look for the strengths of the older driver’s
performance. Then consider how to strengthen the weaker areas. The observer should
ride with the older driver two or three times at different times of the day and under
different conditions. Suggest that the rider just observe and not comment while in the
car.

After the ride, have the family member or partner consider factors that might have
interfered with driving performance. Provide some of the following suggestions:


                            Contributing Factors to Driving Problems

                 Inappropriate adjustment of the seat, steering wheel, mirrors, safety belt
                 Difficulty seeing
                 Problems with neck flexibility in turning to see traffic on the left or right
                 Difficulty hearing
                 Medications reactions
                 Alcohol misuse


Help the family and partner develop supportive strategies to respond to these challenges.



6
 Sterns, H.L., Sterns, R., Aizenberg, R. and Anapole, J. (2001) Family and Friends Concerned About an
Older Driver. National Highway and Safety Administration Research Report No. DOT HS 809 307.
Washington, DC: U.S. Department of Transportation. Also available on the World Wide Web:
www.nhtsa.dot.gov/people/injury/olddrive/FamilynFriends/faf_index.htm.
7
 LePore, P.R. (2000) When You Are Concerned—A Handbook for Families, Friends and Caregivers
Worried About the Safety of an Aging Driver. Albany, NY: New York State Office on Aging.


                                                  8
The second step involves the concerned family member or partner taking a ride with the
driver. Instruct the observer to keep the following questions in mind during the drive:

              Did the driver wear glasses or contact lenses if needed?
              Did the driver use a safety belt without taking a cue from the rider? Was
               the belt used properly (across the shoulder and secure over the lap—not
               under the arm)?
            Safe driving begins with seeing clearly and putting on a safety belt.

             Was the driver sitting at least 10 inches from the steering-wheel airbag?
            Being 10 inches or more from the airbag will likely prevent injury or death
            if the airbag activates.

              Could the driver see the road adequately? (Some drivers need to sit higher
               to see properly out the vehicle’s windows)
             Was the driver able to twist around or turn her head to see what was
               happening when backing up, or was she able to rely on the mirrors? Were
               the mirrors adjusted to decrease blind spots?
            Proper seating position and mirror settings are needed for safe
            maneuvering.

              Could the driver reach and satisfactorily operate the gas pedal, brake
               pedal, clutch pedal, steering wheel and directional signals? Did he or she
               select the proper transmission gear?
            Reaching and satisfactorily operating the vehicle’s controls are
            prerequisites for safe driving. 8

During the drive, the observer will watch the driver for the following signs of good
driving:

               Stops fully at all traffic signals or stop signs and looks both ways to check
                for cross-traffic
            Bringing the vehicle to a standstill for stop signs and red lights is automatic
            behavior for all drivers and especially those who have been driving most of
            their lives. When this behavior is absent or intermittent, the driver’s unsafe
            habits pose a high risk of injury to the driver and others sharing the
            highway.

               Easily merges onto highways, or turns onto busy streets

               Yields right of way



8
    Ibid.



                                              9
           Yielding the right of way, especially when merging, requires a driver to
           interact with changing traffic patterns rather than giving an automatic
           response. Repeated failure to yield right of way signals unsafe driving.

               Reacts appropriately (not too slowly or too suddenly, cutting off traffic) to
                sirens and flashing lights of emergency vehicles
               Avoids weaving, straddling lanes, drifting into other lanes or changing
                lanes without signaling
               Does not get lost or disoriented easily in familiar places
               Obeys traffic signs (no left turn, no turn on red)
               Drives fast enough not to impede the safe flow of traffic but not so
                aggressively that others are endangered
               Pays attention to other vehicles, bicycles, pedestrians and road hazards
               Drives decisively—avoids canceling directional signals, for example

Beginning the Discussion

Encourage the family to talk about the drive(s) and the observations made. Emphasize
that the discussion should provide helpful feedback for the driver, not punishment.
Counsel that productive conversations result when family and partners:

               Make the goal of the conversation preserving independence (not
                necessarily by driving)
               Ask the older driver how he or she felt about the drive
               Take responsibility for concern by sharing how they feel, not how they
                want the driver to respond
               Use words such as safe ―conditions,‖ not ―restrictions‖
               Listen with respect and sensitivity to feelings a person may have about
                the situation
               Open up options such as an outside assessment or taking a driver
                refresher course
               Prepare for negative reactions such as anger

If the family or partner can’t arrange to ride with the older driver, the above suggestions
can still act as an opener for discussion about driving. Emphasize giving the older driver
room to talk about perceived driving performance and feelings about driving.

Here are a few ways not to approach the subject:
            Make the goal of the conversation to ―get him/her off the road‖
            Make accusations of unsafe driving
            Have a big family discussion so the driver feels ―ambushed‖

In order for the observer to see the older driver at his or her best, encourage the rider to
make this a comfortable drive with little stress. The rider should just observe and not
comment while in the car.



                                              10
         If the driver did well, it is good news for both the older driver and concerned loved ones.
         But if the driver had some problems and knows it did not go well, he or she may not want
         to hear about it at that moment. Here are some tips on providing feedback:

                            Reinforce examples of competent driving as well as areas of concern
                            Base the timing of the discussion on knowledge of the older person’s
                             responses and receptivity to this sensitive issue. For some, there is no
                             good time to talk, while for others the discussion is a welcome chance to
                             express concerns about driving in today’s busy world. Ask the driver
                             when the best time to talk about the ride would be—right after the drive or
                             later in the day
                            Come to the discussion prepared with driving options and a knowledge of
                             resources to improve driving or to provide alternatives

         Coping with Reactions

         Reactions to the discussion can vary from acceptance to denial. Families may express to
         service providers concern over the older driver’s reactions to driving discussions.

         In surveys conducted by the New York State Department on Aging, families, friends and
         caregivers reported the following range of responses from older drivers:

                                                                                      Sadness/          Disbelief and
   Acceptance                       Anger                 Embarrassment              Depression            Denial
 She agreed to the         At first, he was resentful    He does not want to     There has been    She said, ―How
  sale of her car            and sarcastic                  see anyone because       withdrawal and     could you do this
 He was resigned           She vehemently                 he feels the loss of     depression         to me! I don’t
  to not driving             protested, got angry,          his license labels                          believe you did
  again, and also            cried. She brings it up        him as unfit                                this to me!‖
  relieved                   with relatives and friends    It hurt her feelings                       He talked about
 He has reluctantly        She has gone to see           She was deeply                              his perfect driving
  accepted                   several doctors to try to      offended by the                             record for over 60
                             get them to permit her to      intervention                                years
                             drive                                                                     She said there was
                            She was negative,                                                          nothing wrong
                             sarcastic, and angry                                                       with her driving
                            There was pouting,                                                        She has ignored
                             resentment, hostility,                                                     me
                             vindictiveness
                            She was argumentative,
                             difficult
                            My mother has always
                             been a lady. When the
                             DMV took her license,
                             she was furious, she was
                             yelling foul language and
                             screaming. My father
                             couldn’t stand the abuse.
                             My sister and I had to



                                                               11
              help calm her down. It
              took four days!


Allow family members and partners to identify their emotions and those of the older
driver. Explain that reactions can be expected and may be unpleasant. Listen and
provide support without taking sides. You may want to respond with phrases such as:
            ―I understand that this reaction is upsetting‖
            ―You obviously care a great deal about your (partner, father, etc) and want
               to keep him safe.‖

You can help families and partners by sharing the following tips on coping with
reactions.




                                           12
                  Tips: Responding to the Hostile or Angry Driver

  Listen:                  Hear the person out. Allow him or her to express anger and
                            hostility
                           Do not become defensive
                           Answer concerns where appropriate
                           Acknowledge the older person’s feelings

  Use logic:               Where appropriate, go over the reasons and the evidence of
                            why driving is now dangerous
                           Where appropriate, review the ramifications of continuing
                            to drive. Explain how an injury could be much more
                            disruptive to one’s life than not driving. Ask how he or she
                            would feel if unsafe driving caused injury to or killed
                            another person. Ask what the implications would be to the
                            individual’s estate
                           Share information about similar situations in which a driver
                            refused to stop driving when it was time and then later
                            crashed or caused injury

 Suggest a second          Suggest an assessment from a certified driving specialist or
 opinion:                   a health professional

  Look at advantages:      When appropriate, point out that the stresses of driving
                            could be eliminated (―Mom, you won’t have to service the
                            car, worry about finding a parking space, or worry about
                            how other people drive‖). Point out the cost of driving,
                            including maintenance, gasoline, insurance and registration.
                            AARP estimates them to range between 50¢ and 75¢ per
                            mile
                           Point out that past concerns (perhaps about crashing or
                            getting lost) could also be eliminated

  Develop alternatives:      Affirm your desire to help with transportation if the
                              person has to stop driving

If the result of the discussion is recognition of diminished capacity for driving or
retirement from the wheel, family members and partners should be encouraged to check
in frequently and provide ongoing support for the elder. Developing a plan to meet the
mobility needs of the older person assists in keeping older adults connected to the
community.




                                          13
After the Discussion

Leaving the wheel is often a watershed event for an aging driver. It represents the end of
a unique form of individual freedom that the driver may have known and counted upon
for most of his or her life. Suddenly, that freedom and all it conveys disappears forever.
This passage can bring forth the strong emotions of any major loss. Driving cessation is
one of the greatest predictors of depression.9

Families and partners can help with the loss of driving by:

                Encouraging involvement with friends and continuation of usual activities
                 outside the home
                Listen and acknowledge the feelings of loss
                Help with transportation needs
                Arranging for a DMV nondriver identification card. Replacing a
                 surrendered license with a DMV nondriver photo ID card does more than
                 just continue the driver’s primary form of identification—the card can
                 create a feeling of connection to society
                Making plans for visitors either through family, friends or a friendly-
                 visiting program

Keep in mind that, especially in cultures where older family members are revered,
families may shy away from questioning the driving ability of the head of the family or
elder. The spouse may introduce the discussion, but, depending on gender and status of
the older motorist, the spouse may abandon the attempt after the motorist’s first ―No.‖

Working with Older Drivers

Staff members of community-based organizations can work with both families and older
drivers to help older motorists stay behind the wheel. By offering programs based on
driving longevity rather than driving cessation, the agency develops trusting relationships
with all parties. Community-based agencies can encourage and assist the older person to
continue driving safely by:

                Developing opportunities to assess the driving environment
                Creating or providing referrals to driving programs that assess capability
                 and provide on- and off-road training programs
                Providing assessments for driving function
                Distributing information on safe driving and self-assessment


9
  Marottoli, R.A., Mendes de Leon, C.F., Glass, T.A., Williams, C.S., Cooney, L.M., Jr., Berkman, L.F.,
and Tinetti, M.E. (1997) ―Driving Cessation and Increased Depressive Symptoms: Prospective Evidence
from the New Haven Established Populations for Epidemiologic Studies of the Elderly.‖ Journal of the
American Geriatric Society 45(2):202–06.




                                                   14
         Creating supportive options for older drivers who must reduce driving or
          retire from the wheel
         Collaborating with transportation and service providers to ensure that
          transportation options are available for drivers who reduce or stop driving

Developing Opportunities to Assess the Driving Environment

   Fitting the Car to the Driver

   Reducing or retiring from driving does not automatically mean giving up the car.
   The car may have great meaning to the older adult. Suggest that the car be used
   by others to transport the older person to the doctor or the store. Being able to
   offer the use of the car can help retain the sense of independence.

   Anecdotal evidence suggests that a surprisingly large number of older drivers do
   not know how to adjust steering wheels, car seats or safety belts to meet their
   needs. To improve driving safety and comfort, with the help of trained
   professionals older drivers can add devices (such as special equipment for
   steering and foot-pedal operation) to their cars. Having a car with an automatic
   transmission, power steering and power brakes can transform an uncomfortable
   vehicle into a more accommodating environment.

   Ask families or partners to consider supporting the older driver by ensuring that
   he or she drives under the best possible circumstances. Have loved ones
   investigate adaptive equipment. These can include:

         Safety-belt adapters to make belts easy to reach, improve fit, and make
          release buttons easier to operate with arthritic hands
         Special torso restraints to hold the driver upright
         Pedal extenders to better reach the brake and accelerator while keeping the
          seat back at a safe distance (11 inches) from the airbag in the steering
          wheel
         Full-view inside mirrors and side ―spot‖ mirrors to minimize blind spots
         Steering-wheel spinners, turning devices, and reduced-effort power
          steering (helpful for drivers who have use of one arm only)
         Directional-signal crossovers to shift operation of directionals to the other
          side or to the foot (to use the driver’s stronger arm or leg)
         Extra-loud turn-signal ―clickers‖ or relocated/brighter turn-signal
          indicators
         Left-foot accelerator for those with limited or no use of the right foot
         Touch pads or voice-scan activation systems for car controls and
          electronic joystick controls for steering, gas pedal and brake
         Scooter- and wheelchair-loading devices and transfer assists to help the
          person in and out of the vehicle
         Keyless ignition and doors that automatically lock and open



                                       15
   Caution that one does not simply buy and install the equipment. A professional
   assessment by an occupational therapist or a certified driving rehabilitation
   specialist determines that the equipment is necessary, in order to save money and
   ensure safety. Proper installation by trained staff ensures proper fit and safety.
   And finally, training by an occupational therapist or certified driving-
   rehabilitation specialist on the use of the new equipment increases the likelihood
   of safe vehicle operation.
   For more information on adaptive equipment, turn to ABLEDATA on the Web at
   http://www.abledata.com/. A federally funded project sponsored by the National
   Institute on Disability and Rehabilitation Research (NIDRR), which is part of the
   Office of Special Education and Rehabilitative Services (OSERS) of the U.S.
   Department of Education, the ABLEDATA database contains information on
   more than 30,000 assistive technology products.
   Community agency staff can invite occupational therapists, certified driving-
   rehabilitation specialists and professionals from rehabilitation facilities to assist
   with community education on proper car adjustments and adaptive equipment. As
   with any new activity, just providing the tools does not guarantee proper use or
   comfort. Training followed by practice leads to success. Community agencies
   can support such training programs.

   Older adults living on low incomes may not have extra money to buy and install
   adaptive equipment. Community-service providers could develop a referral list of
   low-cost programs, or initiate a campaign to develop resources for low-income
   elders to receive equipment. Consider making the information available in
   languages spoken in the local community.

Creating or Providing Referrals to Driving Fitness Programs

   Refreshing the Driver on the Rules of the Road

   The majority of mature drivers today never attended a formal driver-education
   class. They passed the tests by reading the DMV’s booklet and practicing with a
   family member in a parking lot or field. Automobiles, roads and driving have
   changed over the past 40 years, and drivers have had few opportunities to refresh
   their knowledge aside from on-the-job training.

   To help older drivers review safe driving practices, community agencies can
   sponsor a course called the AARP Driver Safety Program (formerly called 55
   Alive Mature Driving Program) at local public facilities. The AARP classroom
   program introduces the latest information about traffic laws, road signs and safe
   driving practices. Unlike most of the other approved accident-prevention courses,
   this eight-hour, two-session classroom program tailors the topics and presentation
   to seasoned drivers. Most states offer point and insurance-premium reductions to
   those completing the program.




                                        16
       Referrals to the AARP course and others sponsored by AAA (formerly known as
       the American Automobile Association) and the National Safety Council allow
       older drivers to stay current on today’s driving practices and laws.

       Encouraging Both Physical and Mental Fitness

       Driving a car requires strength to depress the brake and gas pedals, turn the
       steering wheel, shift gears, and even to enter and exit the vehicle. Flexibility is
       essential in looking over one’s shoulder to change lanes or looking left or right to
       check for traffic. Reaching for a safety belt requires a certain range of motion in
       the shoulders. The driver must also have the endurance to physically perform
       and remain alert. Any driver education program for older adults should include
       information on the physical and mental requirements of driving and referrals to
       local physical activity programs.

Example—Driving Physical Fitness

A Flexible Training Package for Improving Older-Driver Performance

Description: The AAA Foundation has created a brochure describing the importance of
flexibility and physical conditioning for driving. The brochure outlines a few simple
exercises and suggests that readers participate in structured exercise programs.

Contact: AAA Foundation for Traffic Safety
1440 New York Ave. NW, Suite 201
Washington, DC 20005
Website: www.aaafts.org


       Good nutrition and adequate water intake affect mind and body health needed for
       safe driving. Just consider water—every body system depends on water.
       Lack of water can lead to dehydration. Even mild dehydration of as little as 1
       percent to 2 percent loss of body weight can impair concentration and cause
       fatigue and headaches.
       Poor nutrition can affect proper blood circulation important for supplying cells
       with the ―building materials‖ they require for proper function. The decreased
       flow of blood in the brain results in slow starvation of brain cells and, in the
       extreme, blockage that causes stroke. Additionally, good nutrition provides the
       fuel to repair damage caused by stress-induced hormones.
       Maintaining mental agility as one ages is as important as maintaining physical
       dexterity. Intellectual stimulation promotes brain growth in animals and protects
       against cognitive decline in humans. Animal studies show brains can shrink if
       deprived of thought-provoking toys and enriched environments. These results




                                            17
       lead researchers to infer that, in humans, age-associated memory loss could be
       partly attributed to lack of mental stimulation.
       Some medications can affect alertness and vision. The more medications that are
       consumed, the greater the risk for side effects and interactions that affect the
       ability to focus on driving. Older adults as a group are more susceptible to
       adverse reactions to medications because of the number they take each day—
       more than any other age group—and because of physiological changes due to
       aging. Therefore, optimal management of medications becomes even more
       crucial for older drivers. Ideally, older adults should have medications reviewed
       annually by a healthcare provider. Community organizations can sponsor lectures
       and individual counseling on medication use and its effect on driving.

Example—Medications Management

Avoiding the Pitfalls and Perils of Medication Use in Older Adults
Description: In central Florida, a housing coordinator and a parish nurse advertise the
30-minute lecture by a pharmacist, followed by a one-to-one medications review.
Interested participants receive a brief medication-screening form to fill out and return to
the pharmacist one week prior to the program date. The pharmacist reviews the forms
and prepares a written medication-problem alert for the physician, if potential
medication-related problems arise.
Contact: Lori Daiello, PharmD, BCPP
Pharmacotherapy Solutions
E-mail: ldaiello@cfl.rr.com


       Community agency professionals can develop physical-activity programs—such
       as walking groups, stretching and resistance-training classes—to encourage
       strength, endurance and flexibility. Communities can sponsor worthwhile
       prevention programs, enhanced by information and counseling by professionals
       on medication use.

   Providing Assessments for Driving Function

   Taking a driving ―test‖ can stir anxiety in the bravest driver. Therefore, a driving
   assessment conducted by staff from a trusted organization can make the process more
   acceptable. Driving assessments are helpful to people who:

           1.   Want to confirm their level of driving fitness
           2.   Are able to drive safely but lack confidence
           3.   Seek a plan for the future when driving may no longer be possible
           4.   Could potentially endanger themselves and others




                                             18
Example—Driving Assessments

You Decide: Senior Driving Awareness Program

Description: Area Agencies on Aging sites in Michigan participate in the ―You Decide:
Senior Driving Awareness Program,‖ coordinated with state and local agencies, and
public transportation authorities.10 Sites vary and include the Traffic Improvement
Association Mature Driver Workshop, MedRehab (from the University of Michigan)
Drive-ability Program, and the William Beaumont Hospital Driver Rehabilitation
Program.

Coordinated activities include:
   1. Driver training using the Michigan Mature Driver Retraining Workshop, a four-
      hour session using AAA’s Safe Driving for Mature Operators course (see
      Transportation and Safety Organization section below) conducted by a AAA-
      certified instructor. Participation is voluntary and results are confidential.
   2. Physical and mental vitality tests to allow an individual to self-evaluate his or her
      abilities. The tests include visual acuity, depth perception and visual attention
      (Visual Attention Analyzer/Useful Field of View).
   3. An on-road evaluation given by a retired law-enforcement officer who is AAA-
      certified, on a course laid out by the University of Michigan Traffic Engineering
      Department. The instructor notes problems in driving behavior and offers
      suggestions for improvement. The on-road appraisal results are also confidential.

Evidence of accomplishment: Over 400 individuals are served each year.

Contact: Tina Abbate Marzoff
Michigan Area Agency on Aging 1B
29100 Northwestern Hwy., Suite 400
Southfield, MI 48034
Phone: (248) 213-0533, (248) 262-1293, or 262-9217


     Although lengthy (over 750 questions with helpful feedback comments), the Driving
     Decisions Workbook from the University of Michigan Transportation Research
     Institute is a useful tool for discussion purposes in a training group or for individuals
     to evaluate their own driving.11

     Ideally, driving assessment should be offered in languages spoken in the community.

10
   National Highway Traffic Safety Administration (April 1999) Safe Mobility for Older People: Notebook
3–29. U.S. Department of Transportation. No. DOT HS 808 853. Retrieved from NHTSA on the World
Wide Web: www.nhtsa.dot.gov/people/injury/olddrive/safe/01c03.htm
11
   Eby, D.W., Molnar, L.J., and Shope, J.T. (2000) Driving Decisions Workbook. . Ann Arbor, MI:
University of Michigan Transportation Research Institute. Available on the World Wide Web:
www.umtri.umich.edu/library/pdf/2000-14.pdf.
.


                                                  19
   Distributing Information on Safe Driving and Self-Assessment

       Promoting Safe Habits and Preparation for the Trip

       Community agency staff can promote safe habits and preparation for road trips or
       jaunts to the grocery store. Driving requires dividing one’s attention among
       multiple activities and being able to react quickly. The following table outlines
       some of the driving challenges that may come up for the older driver and the
       solutions that contribute to a safe journey.

         Driving Challenges                                  Solutions
Overwhelmed by proliferation of          Plan the trip route. Drive in familiar areas.
signs, road markings, pedestrians and
vehicles

Lacking confidence in handling the       Drive during the day. Avoid rush hours. Find
demands of high speeds and heavy         alternative routes with less traffic.
traffic

Challenged by judging gaps in traffic,       Drive during the day. Avoid rush hours.
making it more difficult:                     Find alternative routes with less traffic
    To turn left at intersections or
    To merge with traffic when              Remind yourself to look both ways when
       turning right                          approaching an intersection

                                             Find routes where left turns have green-
                                              arrow signals. Avoid left turns by taking
                                              routes that require right turns

                                             Avoid highways, where speed makes
                                              distance judgment more difficult




                                             20
Concerned about seeing and reacting          Scan far down the road continuously to
too slowly to cars coming out of              anticipate future problems and plan
driveways and side streets or cars            actions
ahead slowing down
                                             Ride with a passenger who acts as a
                                              ―second pair of eyes‖

                                             To keep a safe distance behind another
                                              car, find a marker (tree, sign, lamppost)
                                              and, as the car in front passes it, count:
                                              1001, 1002, 1003, 1004. Leave enough
                                              space to reach the same marker at the
                                              count of 1004

Troubled about seeing traffic and            Always wear glasses with current
street signs                                  prescription. Avoid eyewear with side
                                              pieces that block your vision

                                             Visit an eye doctor every year to check
                                              for cataracts, glaucoma, macular
                                              degeneration and diabetic retinopathy

                                             Avoid sunglasses or tinted lenses at night

                                             Avoid car windows that are darkened or
                                              tinted

Challenged to see lane lines and other       Always wear glasses with current
pavement markings, curbs, medians,            prescription
and other vehicles, especially at
dawn, dusk or at night                       Visit an eye doctor every year to check
                                              for cataracts, glaucoma, macular
                                              degeneration and diabetic retinopathy

                                             Avoid sunglasses or tinted lenses at night

                                             Avoid car windows that are darkened or
                                              tinted

                                             Keep windshield, mirrors, and headlights
                                              clean

                                             During car inspections, check for correct
                                              headlight aim



                                             21
                                                Turn the brightness up on the instrument
                                                 panel

Uncomfortable at night from glare of            Sit high enough in the seat to see the road
oncoming headlights                              for at least 10 feet in front of the car

                                                Look to the lower right side of the road
                                                 when there is oncoming traffic

                                                When choosing a car, look for rearview
                                                 mirrors that automatically filter out glare

Adapted from NHTSA, Driving Safely While Aging Gracefully.

        Using Safety Belts at All Times

        Safety-belt campaigns over the past 20 years have ingrained in most Americans
        the importance of buckling up. However, the functional limitations an aging
        person experiences creates barriers to complying with the safety-belt message. In
        particular:

               Restricted flexibility may lessen the driver’s ability to reach over the
                shoulder to grab the belt
               Reduced strength may inhibit ability to pull a safety belt over the chest to
                the latch on the seat
               Loss of dexterity due to arthritis may present difficulty in securing the belt
                buckle into the seat latch
               Compromised bone density can result in broken bones if the safety belt
                binds the chest during the sudden force of a crash

        Community agencies can encourage use of safety belts through adaptive
        equipment. For example:

               Safety-belt adapters make belts easier to reach
               Improving the belt’s fit and access makes release buttons easier to operate
                with arthritic hands
               Special torso restraints can hold the driver upright
               New styles of safety belts feed out more gradually and work with airbags
                to reduce bone injuries during crashes

        Promoting these devices will assist in making safety-belt use a habit.




                                                22
   Creating Supportive Options for Older Drivers Who Must Reduce Driving or
   Retire from the Wheel

   Just as people close to the older driver can assist in the emotional transition to
   alternative mobility, community-based organizations can take a prime role in
   developing supportive programs. These include:

              Helping to arrange transportation so the retiring driver can maintain
               involvement with friends and activities
              Arranging for a DMV nondriver identification card, or replacing a
               surrendered license with a DMV nondriver photo ID card
              Providing counseling. Lots of older persons stop driving voluntarily.
               Some assist in counseling others who have just given up the wheel
              Arranging for visitors either through family, friends or friendly-visiting
               programs (a community-organized service matching volunteer visitors to
               isolated older adults).

Example 1—Helping with Loss

Getting in Gear
Description: The Getting in Gear program in Tampa, Florida, provides case management
for adults who have ceased driving. Managers assist with driving assessment and
transportation needs, help develop opportunities for social interaction, and screen for
depression three months following the retirement from driving.

For those who choose to reduce driving, Getting in Gear suggests a retest after one year.
During that year, the Getting in Gear program staff work with semi-retired drivers in
exploring alternative transportation options.

For male drivers, older men such as retired law-enforcement officers are recruited for
driving counseling.

Evidence of accomplishment: Getting in Gear has provided 1,733 case-management
services with 228 Defensive Driving participants. Getting in Gear conducted 431 driving
assessments in 1999.

Setting: Senior centers, community centers

Contact: Susan Samson, Project Director
Getting in Gear
Area Agency on Aging
9455 Koger Blvd.
St. Petersburg, FL 33702
Phone: (727) 570-5151, ext. 234




                                             23
Example 2—Helping with Loss

Helping Our Own People (HOOP)
Description: In Sedgwick County, Kansas, the Helping Our Own People (HOOP)
program has assisted countless older adults and families with many difficulties that a
friendly ear from a peer counselor can ease. The Central Plains Area Agency on Aging
developed Older Drivers in Crisis: A Handbook for Peer Counselors to supplement the
training of counselors. The five goals of peer counseling for older drivers are:
   1. To show empathy, respect and genuine caring to help an older driver in crisis
   2. To help the older driver by listening to concerns and personal situations
   3. To use the counselor’s awareness of issues involved in retiring from driving and
      communicate understanding to the older driver
   4. To use the counselor’s knowledge of the aging process to counsel older adults
   5. To familiarize the counselor with local transportation resources and increase
      access to those resources for the older adults
Setting: Senior centers, mental health facilities

Contact: Valerhy Harmon
Sedgwick County Agency on Aging
510 N. Main, Suite 502
Wichita, KS 67203
Phone: (316) 660-5158
E-mail: vharmon@sedgwick.gov
Website: www.cpaaa.org


   Collaborating with Key Transportation and Service Coalitions for Positive
   Change

   Even with exceptional programs, educational campaigns and outreach, one
   organization cannot create the conditions for change in driving behavior. Older
   adults who need to change their driving habits must:

       1. Believe in the importance of change. They must feel:

                  There is a reason to change—to prevent harm to either self or others
                  There is a high personal risk
                  The benefits of the change are worthwhile
                  The pros outweigh the cons




                                            24
        2. Have confidence in their personal ability to make the change and cope with
           the difficult aspects.

        3. Be ready for change. They must:

                    Feel prepared to make the change
                    Decide when to make the change
                    Give it a priority

        Belief in the Change

        Collaborations among community organizations can influence older drivers by
        presenting a convincing public campaign based on function and ability, not age.
        Community organizations, such as healthcare providers, that directly influence the
        behavior of older adults can reinforce community messages about safe driving.

        Confidence in the Ability to Change

        Older-driver transportation expert Helen Kerschner from the Beverly Foundation
        (www.beverlyfoundation.org) believes that communities must work together to
        develop benefits for reducing or ceasing driving by providing alternatives that are:

               Available
               Acceptable
               Accessible
               Affordable
               Adaptable12

        The desirability of personal cars presents a challenge to the consideration of
        attractive alternatives. Our cars wait in the garage for us night and day; they are
        our most available source of transportation. Even older adults with physical
        limitations (e.g., difficulty climbing steps or walking to the bus stop) that restrict
        their ability to use public transportation find cars more accessible.

        To convince the older driver that he or she can maintain independence after
        reducing driving or retiring completely requires a collaboration of many
        professionals to create viable alternatives. See section on Transportation and
        Safety Organizations below.

        Readiness for Change




12
  Kerschner, H. (2003) ―Supplemental Transportation Programs for Seniors (STPs).” STPs Mobilizer
Project: White Paper Series. Retrieved from AAA Foundation for Traffic Safety on the World Wide Web:
http://www.seniordrivers.org/STPs/whitepaper1.cfm.


                                                 25
       For older drivers to make the right decision for their futures at the right time, a
       community of service providers, family member or partner, law-enforcement
       officers and healthcare professionals can help them plan for changes, look at
       options and reinforce the importance of their decisions.

       The probability that communities can become responsive to older members in
       their preparation for change increases when concerned organizations address the
       issue together. Who should meet? Transportation planners, highway engineers
       and car manufacturers can collaborate with government planners, private
       transportation research firms and transportation providers to help establish more
       responsive and creative mobility options while strengthening their advocacy of a
       system that works for everyone.

Example–Collaborations

Erie County (New York) Help Network

Description: The Help Network began as a problem-solving collaboration drawing
membership from aging-service organizations, law-enforcement agencies and
departments, medical and rehabilitation centers, driver-training programs, the DMV,
academic campuses, and community-service associations.

The network has created information services for families and caregivers of older drivers
and advocates for public policy changes. Member organizations provide volunteers
trained to field questions from families, partners, neighbors, or other community
members concerned about older adults who appear to be unsafe drivers.

Evidence of accomplishment: The network assisted in developing a court program for
older drivers. Bringing the issues of older-driver safety to healthcare, social-service, and
community organizations, the network hosted a conference called ―Are Your Parents Safe
for Driving?‖ Finding that some police officers were reluctant to follow up on calls
about older adults with poor driving habits, the network has worked with police
departments to discuss strategies for managing concerns about older drivers in their
jurisdictions.

Contact: Dorothy Levitt
Erie County Department of Senior Services
Edward A. Rath County Office Building
95 Franklin Street, 13th Floor
Buffalo, NY 14202
Phone: (716) 858-8081
E-mail: dlevitt@erie.gov
Website: www.erie.gov/driving




                                             26
Reaching Older Drivers with Complex Driving Issues

       Alzheimer’s Disease

       A diagnosis of Alzheimer’s does not mean a person should automatically be stripped
       of a driver’s license.13 But the diagnosis usually means close monitoring. Although
       there is evidence that some people in the early stages of the disease are able to drive
       safely even though they may not remember routes, countering evidence shows that
       people in early stages of the disease are more likely to become involved in crashes.14
       The unclear direction of these research results poses a dilemma in determining how to
       judge the driving ability of individuals with dementia.

       One solution involves conducting a clinical and driving evaluation to ascertain
       driving capability. Another recommendation is to begin a transition away from
       driving during the early stages of Alzheimer’s, while the person still understands the
       growing implications of the condition and the risk to self and others on the road. On
       the other hand, the person may reject the transition, still feeling capable of handling
       the wheel. If the older driver has moderate-to-severe dementia, there is never an easy
       method to regulate vehicle operation.15

       The Alzheimer’s Association recommends a series of steps:

               1. Acknowledge the loss
                  Be sensitive and reassuring. Try to involve the person in other aspects of
                  travel. Put the person in charge of the radio and temperature controls.
                  Ask for assistance in looking for important signs.
               2. Arrange for transportation
                  Reassure the person that a ride will be available when needed. Plan ahead.
               3. Solicit the support of others
                  Recruit a trusted authority such as a doctor to advise the person with
                  Alzheimer’s not to drive. Relatives and an insurance agent can reinforce
                  the message.
               4. Make the car less accessible
                  Have the caregiver keep the car keys. If the car is not often used, disable
                  it by removing the distributor cap or park it down the street.
               5. Take the test
                  Ask the DMV to retest the person. Remember that taking away a driver’s
                  license does not mean the person with dementia will stop driving.
               6. Be firm
                  Avoid arguments and long explanations. Focus on other activities the
                  person with dementia enjoys.

13
   Alzheimer’s Association (1995) ―Giving up the Car Keys.‖ Alzheimer’s Association National
Newsletter 15(3):1, 7.
14
   LePore, When You Are Concerned.
15
     Aging Alert (2003) ―Transportation.‖


                                                 27
   Alcohol, Medications and Risky Drinking

   Alcohol is the single most important factor in fatal crashes. Drivers of any age should
   never drink alcohol before getting behind the wheel. Alcohol misuse among older
   adults is especially lethal, because consumption of alcohol affects older adults
   differently:

              The physical effects of alcohol are intensified in older bodies
              As people age, they tend to increase their consumption of medications.
               Any amount of alcohol can intensify the actions of many medications,
               leading to increased sedation and disorientation, and increasing the risk of
               falls or car crashes

    Alcohol misuse among the population over 60 years old:

              May be difficult to detect. Diseases and conditions associated with aging
               can mask alcohol abuse or may be intensified by the abuse
              May be an invisible problem. Older adults may see an alcohol problem as
               a moral issue associated with feelings of shame and guilt. The feelings
               prompt denial of abuse and result in hidden drinking
              Results in as many hospitalizations as those for heart attacks

Materials to Help Older Drivers Plan for a Change in Mobility

Most older drivers self-monitor their abilities to operate a car. A number of organizations
have developed self-assessment tools.

   Driving Assessment
   Web Resources

       Administration on Aging
       www.aoa.dhhs.gov/aoa/pages/agepages/drivers.html
       This site links to a fact sheet covering age-related changes and how they affect
       driving, tips on self-assessment and information on alternatives to driving.

       AARP Caregiving: Driving and Transportation Concerns
       www.aarp.org/confacts/caregive/transportation.html
       Tips for caregivers about assessing older-adult driving and action alternatives to
       help the older driver stay on the road longer are important points of this AARP-
       sponsored site.

       American Medical Association
       Physician’s Guide to Assessing and Counseling Older Drivers
       www.ama-assn.org/ama/pub/category/10791.html#



                                            28
   This book is available online. The publication offers physicians a guide to
   assessing older drivers, recommendations for talking to patients who should cease
   driving and state laws about reporting.
   American Occupational Therapy Association
   Keeping Older Drivers Safe on the Road
   www.aota.org/featured/area6/links/link02aq.asp
   This brochure discusses how occupational therapists trained in driver evaluation
   and rehabilitation can evaluate an older adult’s ability to drive by testing his or
   her vision, reaction time, strength, judgment and endurance.

Books, Pamphlets and Programs

   AARP
   Older Driver Skill Assessment and Resource Guide (Creating Mobility Choices)
   This informative booklet includes many useful questions that help people assess
   their comfort with a variety of driving situations. The booklet also includes a
   number of important safety tips and reminders.
   Order number D14957
   Contact: AARP Fulfillment
   EE 01251
   601 E Street NW
   Washington, DC 20049

   The American Occupational Therapy Association
   Building Capacity to Meet the Needs of Older Drivers
   There is a shortage of occupational therapists trained to assess and provide
   rehabilitation to older drivers. The American Occupational Therapy Association
   provides continuing education to occupational therapists on older-driver issues,
   and seeks to integrate training curricula on older-driver assessments and
   rehabilitation into schools of occupational therapy.
   Contact: www.aota.org

   Older Driver Safe Mobility Program
   This is a pilot communications program designed to promote conversations about
   older-driver safety and explore ways in which communities can make it easier and
   safer for older adults to get around and make appropriate driving choices. The
   program is in the pilot-test phase and will be available to the general public in
   2004.

   The kit includes communications materials designed to reach older adults,
   policymakers and local media. It will also include a pretested survey to
   administer at a community site. The survey will help to measure the needs and
   attitudes of older drivers regarding their mobility choices.

   By distributing these materials, publicizing the survey results and holding local
   events, communities will be able to raise public awareness, stimulate conversation



                                       29
   about the issues, and build support for community actions that promote safe
   mobility for older adults.

   Contact: Michael Salamone
   Center for Social Marketing and Behavior Change
   Academy for Educational Development
   Phone: (202) 884-8083

Tips for Safe Driving
Web Resources

   AAA Foundation for Traffic Safety's Senior Driver Website
   www.seniordrivers.org/home/index.cfm?x=50&y=14#
   This website offers information on health and wellness, driving tips, fitting the car
   to the driver, and road emergencies.

   Lighthouse International
   Tips from Lighthouse International for Older Drivers with Vision Problems
   www.lighthouse.org/tips/old_people_driving.htm
   This brochure discusses vision changes associated with age and provides tips for a
   safe driving experience.




                                        30
    Tips from Lighthouse International for Older Drivers with Vision Problems
Everyone experiences some normal vision changes due to aging. They may have more
difficulty focusing on near tasks like reading or difficulty distinguishing colors and
contrast; they may need more light. But as Americans live longer, increasing numbers of
people are affected by more severe vision problems due to conditions such as macular
degeneration and glaucoma.
The ability to drive a car and get around independently is essential for millions of people.
While driving safely is a key concern for everyone, changes in the aging eye make it
especially relevant for older adults.
If you are 60 years of age or over, you are driving with only about one-third of the light
you had when you were 20 years old! This is due to changes within the eye (such as
yellowing of the lens and decreasing pupil size) that most people haven’t even realized
have occurred. Also, as an older driver, you cannot process and respond to visual
information as quickly and efficiently as you could when you were younger.
The following tips can make the driving experience much safer for the older driver:
      You should always have regular check-ups to maintain eye health and to ensure
       that your ability to drive safely is not compromised by undetected vision loss.

      Be aware that driving under the influence of some medications can dramatically
       diminish your ability to react to unexpected road hazards. Ask your doctor about
       the side effects of any medications you’re taking.

      Nighttime driving, which typically involves exposure to bright, fleeting glare,
       presents a particular challenge to older drivers. With this in mind, use extra
       caution in your decision to get behind a wheel at night.

      To minimize glare exposure when driving at night, do not look directly at the
       headlights of oncoming vehicles. Instead, direct your gaze down the road and
       toward the right side of your lane.

      Older drivers require more time to adjust to sudden changes in light level, such as
       when one enters a darkened tunnel from the bright afternoon sunlight. You can
       partially solve this problem with a pair of ―flip-up/down sunglasses.‖ View
       through the sunglasses for a few minutes while approaching a tunnel. Then flip
       them up and out of the way on entering the tunnel. You can also use ―wrap-
       around‖ sunglasses that fit over the top of your prescription eyeglasses, but can be
       removed easily upon entering a tunnel or other light-altering situation.




                                             31
       Cataracts can interfere seriously with driving performance, even though they only
        may produce a small decline in one’s ability to read a chart in the doctor’s office.
        If you’re developing cataracts, check with your eye doctor about whether or not
        it’s time to have them removed.

       Plan your travel to minimize the impact of any visual limitations. When possible,
        drive in familiar locations, and avoid driving at night, in bad weather and during
        busy rush hours.

       Consider speaking to an eyecare specialist, friend or family member about any
        concerns you may have related to driving.

       Familiarize yourself with the vision requirements for holding a driver’s license
        where you live; the regulations vary greatly from state to state.

       If you’re worried that a family member can no longer see well enough to drive,
        your first step should be to discuss the issue with the driver. In many instances,
        older drivers change their driving behaviors to compensate for vision changes—
        you may be relieved to learn that your family member is aware of the problem
        and taking steps to ensure his or her safety. If your relative doesn’t agree that
        there’s a problem, encourage a discussion with an eye doctor and, if it’s
        acceptable, go along to the appointment yourself. Often, when both family
        members and a doctor express concern, a patient will heed the warning.
These tips are based on an established body of research, and on original research conducted by the Arlene
R. Gordon Research Institute of Lighthouse International (updated 2003).



        National Highway and Traffic Safety Administration
        Driving Safely While Aging Gracefully
        www.nhtsa.dot.gov/people/injury/olddrive/Driving Safely Aging
        Web/index.html
        This online booklet outlines the physical changes associated with aging, as well as
        tips on coping with the changes to remain a safe driver.

    Special Transportation Needs and Equipment for Older Drivers
    Web Resources

        American Public Transportation Association
        www.APTA.com
        The Resource Guide for Seniors, found in the site’s research and
        statistics/resource guide section, identifies sources of information on the special
        transportation needs of older adults, and shows how public-transit systems are
        meeting the challenge of a graying America.

        Community Transportation Association


                                                   32
   www.ctaa.org/ntrc/is_senior.asp
   CTAA is partnering with the Beverly Foundation to showcase public-
   transportation innovations that meet the special needs of older adults.

   MIT Age Lab
   http://ford-
   mit.mit.edu:2001/Collaboration.nsf/626e6035eadbb4cd85256499006b15a6/82
   2a6a344c20b28685256bc20058bdc3/$FILE/Coughlin_500.4.pdf
   The site posts a newsletter that explores the various adaptive equipment options.

   United States Administration on Aging
   www.aoa.dhhs.gov/aoa/pages/agepages/drivers.html
   This site links to a fact sheet on age-related changes and how they affect driving,
   tips on self-assessment and information on alternatives to driving.

Books, Pamphlets and Programs

   AAA
   The series ―Straight Talk for Mature Drivers‖ includes:
       A Flexible Fitness Training Package for Improving Older Driver
         Performance
       Good Vision…Vital to Good Driving
       RX for Safe Driving
       Meeting the Challenge
   Contact: Local AAA organizations

   AARP
   Community Transportation Resource Worksheet
   This chart helps you make a list and keep track of what transportation options
   may be available in your community.
   Order number D16686

   Staying in Charge
   This pamphlet offers 25 useful tips to help older people remain independent in
   their homes and communities.
   Order number D15937
   Contact: AARP Fulfillment
   EE 01251
   601 E Street NW
   Washington, DC 20049

   Supplemental Transportation Programs (STPs)
   Communities throughout the country are filling transportation gaps by organizing
   community-based supplemental transportation programs for seniors (STPs). STPs
   provide many services that public transit and paratransportation cannot provide,



                                        33
   since many older adults who can no longer drive cannot access traditional
   transportation options.
   Several examples of the specialized services many STPs provide include ―door-
   through-door‖ service, the option of escorts, and travel across community
   boundaries.

   The Beverly Foundation in Pasadena, California, has surveyed many communities
   to identify how STPs are organized, what they do, who they serve, and how they
   actually provide transportation.
   Contact: Beverly Foundation
   Phone: (626) 792-2292
   Website: www.beverlyfoundation.org.

Community Resources on Driving Evaluation and Retraining
Web Resources

   Administration on Aging
   www.aoa.dhhs.gov
   The website and phone access inform readers about aging-service programs and
   area agency on aging locations throughout the United States.
   Phone: (800) 677-1116

   American Association of Motor Vehicle Administrators
   www.aamva.org
   The website assists in finding a DMV office in another state or province.

   American Occupational Therapy Association
   www.aota.org/featured/area6/links/link17.asp
   The association directory provides a list of occupational therapists by specialty.
   Search either under ―driving‖ or ―geriatrics.‖ Occupational therapists can provide
   a functional assessment and provide recommendations for improved mobility.

   Association for Driving Rehabilitation Specialists
   www.driver-ed.org
   The association provides a directory of certified driving-rehabilitation specialists
   who can assess and provide refresher courses for older drivers.
   Phone: (800) 290-2344

   Driving Schools of the Americas
   http://thedsaa.org/index.html
   This site provides locations of member driving schools throughout the United
   States and Canada.




                                        34
Law Enforcement
Older drivers want to drive safely and are not opposed to fair and unbiased evaluations.
The law-enforcement community can play an integral part in assessing older-driver
capability. It can collaborate with community organizations and government agencies by
providing materials, training, information programs and self-assessment techniques for
the older driver.

Law-enforcement officers analyze a steady flow of cues in any traffic encounter. Older
drivers ages 65 and older present a mix of operational mobility cues. A dialogue with the
person, as well as visual cues, will assist in determining if the person will require further
evaluation of driving mobility.

Screening
Example—Screening Cues for Driving Safety

In 1998, Florida state troopers in Pinellas County field-tested a set of cues to assist in
assessing the older drivers they encountered during traffic crash investigations and traffic
stops. These cues present a first-line screening to determine either poor driving judgment
or the capacity to operate a motor vehicle safely. They include:

Alertness
               Does the driver know the current time of day? Day of the week? Month
                of the year? Year?
               Does the driver recall where he or she is coming from? The destination?
               Does the driver have difficulty communicating? Stumble over words?
                Ramble in short, unattached, meaningless sentences or explanations of
                driving ability?

Appearance
          Is the driver’s clothing disheveled? Inappropriate for the season?
          Does the driver exhibit poor personal hygiene? (For example, stains or
           dried food on clothing, or in the motor vehicle. If the officer knows the
           driver, the officer may observe a change in personal habits)

Behavior
               Does the driver launch into accusations of perceived victimization?
               Does the driver appear confused or disoriented?
               Is the driver wearing an identification bracelet or necklace indicating
                dementia?
               Does the driver have difficulty finding and removing his or her driver’s
                license, motor vehicle registration, or insurance card from wallet/purse or
                producing other requested documents?
               If asked to step outside the motor vehicle, does he or she take a long time
                to walk a short distance, stumble/fall, shake excessively, or lack
                coordination when accomplishing simple tasks?


                                             35
               Does the driver have many prescription medicines, prescribed by different
                doctors, visible in the motor vehicle?



Interventions

Officers can effectively intervene as concerned representatives of the community because
many older citizens trust police officers. To help a driver steer clear of harm’s way on
the road, law-enforcement officers can offer the following:

With the older driver:

               Provide a referral to a local assistance agency that coaches and counsels
                older citizens on safe operational mobility or recommends other mobility
                options
               Recommend certain types of driving restrictions (nighttime, inclement
                weather, interstate driving)
               Encourage self-assessment
               Offer driver refresher courses
               Cite drivers who are violating traffic laws
               Follow up with a service provider to ensure that the older driver’s culture
                or language is considered

With the family, partner or friends:
            Act as a trusted authority in evaluating driving safety
            Support legal efforts to appropriately restrict or remove driving privileges
            Seek information and assistance on the health and mobility situation of the
              older driver

With other community agencies:
            Offer the assistance of the law-enforcement community in safe operational
              mobility-learning exercises

Departments of Motor Vehicles (DMV)
Many motor-vehicle departments take a proactive approach to assisting older drivers.
DMVs in some states:

               Provide a tiered driver-assessment program or assessment counseling
               Host driving-training programs
               Offer pamphlets or conduct information campaigns on safe driving
               Participate in transportation committees that assess drivability of roads
                and alternatives to driving




                                             36
Some states have changed the time span between renewal periods for a license based on
the driver’s age. Others issue restricted licenses based on individual capabilities (only
daytime driving, only driving a designated number of miles from home).

Tiered Approaches to Assessment

Example—Tiered Approaches

California DMV Three-tiered Assessment

California has initiated testing of a three-tiered model to make sure that drivers of all ages
do not get permission to drive more years or over greater distances than their skills
warrant. Instead of the traditional five-year renewal, some drivers will return to the
DMV every one or two years. Some drivers with certain impairments may receive
restricted licenses for distance-driving from home.

The California DMV measures visual acuity and contrast sensitivity, which are often
required in driver’s tests. The state has added a cognitive screening—asking for birth
date, Social Security number and answers to simple traffic questions. The screening
weeds out those who may be getting help from others. Pauses in responses of over a
minute may identify people struggling with memory loss. The screener also observes
applicants as they walk to the counter for signs of physical difficulty such as shaking,
excessive stiffness and the inability to make full use of hands and arms. Identified
difficulties move the applicant into tier-two evaluation.

In tier two, trained DMV employees screen for the applicant’s ability to identify objects
that flash on a computer monitor for as short a time as 16 milliseconds. The third tier is
medical assessment.

For more information on California’s pilot three-tiered program, contact David
Hennessey at dhennessey@dmv.ca.gov.




                                             37
Driver Training Programs

Example—Driver Training Programs

Keep Moving

The Massachusetts Registry of Motor Vehicles sponsors the ―Keep Moving‖ program, an
hour-long presentation on safe driving for older adults. Specific topics include how to
recognize the warning signs of unsafe driving, how to be the best driver possible, and
how to obtain a handicapped plate or placard. The free program is open to organizations
that guarantee a minimum of 20 attendees. Interested organizations can complete an
online form, which can be downloaded for faxing or mailing.

Contact: Michele Ellicks
Community Outreach Coordinator
Registry of Motor Vehicles
One Copley Place, 1st Floor
Boston, MA 02116
Phone: (617) 351-9959
Fax: (617) 351-9665
E-mail: mellicks@rmv.state.ma.us




                                          38
Pamphlets and Information Campaigns

Example—Pamphlets and Information Campaigns

At-Risk Public Education Consortium

Oregon has launched a statewide public education plan publicizing the ―Oregon’s Safe
Mobility Initiative—Shifting Gears in Later Years.‖ The initiative’s goals are to:

              Increase awareness about safe driving and encourage driver self-
               assessment, especially in light of vision, function, and cognitive
               impairment
              Provide information on resources for family members, partners, and
               caregivers of older adults who are considering driving retirement
              Address the information needs of physicians and other professionals
              Promote driver-improvement classes and alternative transportation
              Encourage state and regional planning to address safe mobility through
               technology, engineering, and public transportation

The At-Risk Driver Public Education office has created a toolkit designed for use by
professionals, agencies, and organizations, and is developing a series of public service
announcements and a website. The toolkit contains brochures and posters tailored to
older drivers, their families and partners, and medical personnel. The public service
announcements are spots for television and radio, and ready-to-use ads for the print
media. The website will have an online searchable database of transportation information
and community resources.

The initiative was created to help implement the state’s 1999 policy of fair licensing of
older drivers based on functional ability rather than age. The policy created new
reporting rules that, in addition to the American Medical Association’s work on assessing
and counseling older drivers, the DMV hopes will create more open conversations
between patient and doctor.

Contact: Claudia Grimm
Department of Motor Vehicles
1905 Lana Ave. NE
Salem, OR 97314
Phone: (503) 945-5282
E-mail: Claudia.E.Grimm@odot.state.or.us


Make information campaigns culturally and linguistically appropriate for local
community members. Having materials reviewed by ethnic communities provides
assurance that the messages will be accepted and more likely to reach the appropriate
audiences.



                                           39
Transportation Planning Committees

Example—Planning Committees

Maryland Older Driver Research and Development Consortium

The Maryland State Board of Physicians worked closely with state government and
community organizations to develop an active coalition that outlined these four major
areas of concern and set solutions in motion:

           1. To identify older drivers at risk of crashes based on functional ability.
           2. To provide remediation to drivers who fall into the unsafe category.
           3. To provide mobility options for older adults who must reduce or cease
              driving.
           4. To educate the public at large about issues of driving safety in later years.

Identification
Identification began with a study by the medical board to systematically evaluate the
vision, function and cognition of 2,000 older drivers over a five-year period; document
their driving records; provide helpful workshops for those experiencing driving difficulty;
and retest drivers, looking for improvement in safe driving behaviors. The computerized
version of an attention-switching test called Trails B proved most reliable in identifying
drivers at risk of crashing.

Remediation
Because the state does not have enough certified driving-rehabilitation specialists to
assist with driving remediation, the medical board and the DMV now offer three
workshops on the topics of low vision, adaptive equipment, and older-driver on-road
refresher courses. After receiving certification, instructors can receive referrals from the
medical board or the DMV.

Mobility Options
Work is still in progress to develop transportation information, counseling and services.

Public Education
Maryland is closely watching the American Association of Motor Vehicle
Administrators’ public information campaign, GrandDriver. The campaign urges the
public—particularly drivers over 65 and their adult children—to learn more about the
effects of aging on the ability to drive. In addition, the campaign urges aging drivers and
their families to talk about these issues before they become critical. GrandDriver uses
public relations, advertising, a website (http://www.granddriver.info/), a toll-free number,
brochures and a speakers’ bureau to raise awareness of this public-health issue.

Contact: Bob Rawley, MD
Maryland Older Driver Research and Development Consortium
E-mail: rocker1288@aol.com


                                             40
Healthcare Providers
Doctors

The safety of older drivers has long been a concern of the American Medical Association
(AMA) and the Academy of Family Physicians. As associations representing and
speaking to doctors, each has developed manuals and information pages to assist medical
colleagues in counseling older drivers.

The doctor’s role in older-driver safety covers three areas:

                Public Health and Safety
                Medical
                Legal/Ethical16

     Public Health and Safety

     Older drivers are the fastest growing population behind the wheel and suffer
     disproportionately from a high rate of traffic fatalities. From a public-health
     perspective, doctors can:

                Provide preventive care for potential impairments
                Assess individuals for medical fitness to drive
                Refer patients for functional evaluation and rehabilitation
                Counsel patients on driving safety

     Some states have mandated that physicians report patients to the DMV they suspect
     should not remain behind the wheel.

     Medical

     Doctors also play a medical role in the older adult’s ability to drive. Doctors conduct
     an assessment to evaluate the capabilities of the older driver to successfully function
     behind the wheel in terms of vision, cognition, alertness, and physical ability to
     operate the vehicle’s steering, speed, and safety mechanisms.

     Assessment of medical fitness to drive begins with a review of medical history. The
     doctor searches for these red flags:

                Medical conditions that may lead to impaired driving (dementia, arthritis,
                 foot abnormalities, cataracts)


16
  Schwartzberg, J. G. (Mar. 13, 2003) ―The Physician’s Role in Older Driver Safety.‖ Presented at the
Joint Conference of the American Society on Aging and the National Council on Aging.


                                                   41
           Medications that can affect alertness and response time (antihistamines,
            decongestants, sleep medications, cough medicines, antidepressants,
            tranquilizers, narcotic painkillers)
           Recent health events (surgery, stroke, heart attack)

During the assessment, the doctor informally observes the appearance and behavior of
the person, looking for:

       1.   Level of personal hygiene and grooming
       2.   Ability to walk and get in and out of chairs
       3.   Ability to accomplish visual tasks
       4.   Sharpness of attention, memory and understanding
       5.   Concerns of the patient and family or partner about driving capability

The second step is to determine any needed medical intervention and, if required, the
course of medical treatment. The doctor will identify the cause and treat the
condition or make referrals to vision specialists, driving-rehabilitation specialists, or
physical or occupational therapists.

If the patient appears functionally fit, the doctor can advise the driver about health
behaviors that can maintain fitness. Finally, if the patient is not able to safely operate
a car despite medical intervention and driving rehabilitation, the next step is
counseling the patient on driving retirement.

Legal/Ethical Aspects

The AMA’s policy is that physicians counsel the patient regarding medical evidence
for substantial driving impairment that threatens the patient’s and the public’s safety.
Counseling can include providing prevention and safety information, and advising the
patient to cut back on driving. As a last resort, the doctor may recommend driving
retirement. If the advice to discontinue driving is ignored by the patient, the AMA
considers notifying the DMV both desirable and ethical.

Even with the endorsement of the AMA, doctors may feel reluctant to report unsafe
drivers, fearing it will harm the trust between the doctor and patient or, at worst, will
bring about legal actions. Some states provide immunity for doctors who report
unsafe drivers to state regulatory agencies. The healthcare provider has the
responsibility of knowing and following the reporting laws of a state.

If there are no legal requirements, then ethically the doctor should ensure that the
unsafe driver remains off the road. Their doctor’s position as an authority figure can
influence many older drivers. Healthcare professionals who develop partnerships
with other providers or with family members may find a team approach more
effective in maintaining the special doctor-patient relationship and avoiding a
potentially dangerous situation for the older driver and the community.




                                          42
Nurses

Nurses in general can disseminate information about health and safe driving to older
patients, make appropriate referrals, and keep doctors apprised of family and patient
concerns about safe vehicle operation.

Occupational Therapists

Some occupational therapists have taken advanced training to conduct both on- and off-
road driving-fitness assessments and interventions and can recommend alternative
solutions. Some occupational therapists are also certified driving-rehabilitation
specialists.

Driver-Rehabilitation Specialists

The Association of Driver Rehabilitation Specialists offers training and certification to
professionals who work to maintain and improve driving safety. The American
Occupational Therapy Association also offers training and continuing education to
practitioners.

Driver-rehabilitation specialists may:

              Provide clinical driving assessments
              Conduct on-road evaluations
              Follow up with training in safe driving techniques
              Recommend adaptive devices and educate older drivers on their use

Most certified rehabilitation specialists are occupational therapists whose services are
paid by health insurance companies. Medicare does not reimburse for assessment and
retraining courses. A listing of driving rehabilitation specialists certified by ADED is
available on the World Wide Web at www.aded.net.




                                            43
         The assessments that a certified rehabilitation specialist might use include:

Vision         Near and            Contrast              Color              Depth               Visual field
               distant             sensitivity           Ability to         perception          scanning
               Ability to see      Ability to see        distinguish        Ability to judge    Ability to pick out
               distant road        gray cars on a        color of traffic   adequate            objects by
               signs or nearby     dark road, on a       signal lights      distance for        glancing around
               car gauges          cloudy day                               merging or
                                                                            parking
Physical       Pain                Strength              Endurance          Joint range of
               Ability to move     Ability to move       Ability to         motion
               leg from gas to     legs                  drive 1 hour       Ability to reach
               brake pedal, or                                              safety belt or to
               hold the                                                     turn head and
               steering wheel                                               neck to check
                                                                            traffic

Visual         Useful Field of     Trailsmaking          Trailsmaking
Processing     Vision              A                     B
               Ability to see      Requires              Requires
               and attend to       maintaining           drawing a line
               images in side      attention in          between
               vision              sequencing            sequential
               (peripheral         written numbers       numbers and
               vision)—                                  letters that are
               especially          Ability to            scattered on a
               important at        maintain attention    page
               intersections       and focus
                                                         Ability to
                                                         switch
                                                         attention from
                                                         one focus to
                                                         another




                                                        44
Cognition     Traffic Symbol       Short Blessed
              Recognition          Test
              Ability to           Requires
              interpret the        remembering
              meaning of           current dates,
              traffic signs        sentences and
                                   counting
                                   backwards

                                   Ability to recall
                                   memories, take
                                   new directions
                                   and make
                                   judgments

       (Adapted from Hunt, L. (June 20, 2003) ―Driving Assessments.‖ American Society on Aging Web
       Seminar.)

       Hospital Rehabilitation Professionals

       Some hospital rehabilitation centers can conduct a driving assessment based on a doctor’s
       order. The assessment may include evaluation of:

                    Strength
                    Coordination
                    Vision (night vision and depth perception)
                    Divided attention
                    Brake reaction
                    Understanding of road signs
       Sometimes the center conducts an on-road driving test. Costs for hospital assessments
       vary, but are commonly $200–$600.

       Volunteer Organizations
       Volunteer organizations play a significant role in providing driver education and
       transportation alternatives. AARP was one of the first organizations to use volunteers as
       peer instructors for driving-refresher courses. Instructors of the ―55 Alive‖ course have
       trained thousands of experienced drivers over the past 20 years.

       Volunteer drivers hold down the costs of transportation programs, such as the Passport
       Program developed by the Beverly Foundation (www.beverlyfoundation.org).




                                                       45
Faith-based Organizations
Faith communities often help the older adult who has restricted or ceased driving by
providing rides to church services, social events, medical appointments or spiritual
activities. Some faith-based organizations have developed supplemental transportation
programs, adding to alternative-transportation options in a community.

Example—Faith-based Organizations

Gold Country Telecare

Description: Gold Country Telecare provides paratransit to rural communities in the California
Sierra Nevada mountains, using paid staff and volunteers. Telecare was established in 1974 by
Grace Lutheran Church of Grass Valley as a volunteer meal service, which soon expanded to
providing transportation to medical appointments. As a church program, Telecare began with
a solid footing in the community.

Evidence of accomplishment: The scope of services grew beyond the means of the faith
community’s volunteer effort, resulting in nonprofit incorporation. The grassroots nature
of the organization has led to local and regional support. In 2000, Telecare served 1,267
riders with 28,236 rides in a range of different vehicles. The program provides door-to-
door service seven days a week. The Beverly Foundation and the AAA Foundation gave
Gold Country Telecare a Six-STAR (Senior Transportation Action Response) Award as a
model of excellence.

Contact: Gold Care
P.O. Box 2161
Grass Valley, CA 95945
Phone: (530) 274-8264


Community Colleges and Universities
A number of community colleges and universities sponsor older-adult education
opportunities either through special classes for the older learner or courses open to all
ages that anyone can take without receiving graduation credits. Many educational
institutions want to be responsive to the local community and welcome involvement in
creating courses or offering special seminars for older adults, such as the Elderhostel
program (www.elderhostel.org).

Some community colleges have sponsored courses that touch on the topic of physical and
psychological changes as we age. Such a course could incorporate the topic of driving in
discussions about adaptation and function. Other schools have specifically sponsored
driving-refresher courses.




                                              46
Example—Community Colleges and Universities

Grand Rapids Community College Older Learner Center

Description: The Older Learner Center of Grand Rapids Community College
provides a range of services for older adults, including a television series on
successful aging. Broadcast on cable stations throughout Michigan, the series
offers information about remaining independent in later years. Specific episodes
address the subject of maintaining and improving health and mobility.

Evidence of accomplishment: The ―Successful Aging‖ video/television series
reaches 26 cable outlets and 3 million cable television subscribers. The program
has won three Tellys, a national award recognizing outstanding non-network and
cable TV productions.

Contact: Michael Faber, Director
143 Bostwick Ave. NE
Grand Rapids MI 49503
Phone: (616) 234-3483
E-mail: mfarber@grcc.edu
Website: http://web.grcc.edu/olc



Transportation and Safety Organizations
National Safety Council

The National Safety Council (NSC) and local branches operating under its umbrella are
sources for information about the NSC-approved motor-vehicle accident-prevention
courses.

The AAA has several local offices that support the Safe Driving for Mature Operators
Driving Improvement Programs. Participants receive valuable tips on safety involving
good visual habits, road communication (signs, turn signals and horn use), speed
adjustment that match road conditions, response to driving emergencies, and car
maintenance. Many insurance companies provide discounts to their clients who
participate in the driver refresher course.

Local Driving Schools

In some states, driving schools hire state-certified instructors experienced with older or
disabled people to provide an impartial behind-the-wheel evaluation. Instructors do not
automatically recommend loss of license if the driver performs unacceptably. A certified
instructor creates a written report (sometimes even a videotape) detailing the


                                            47
performance. The report documents the need for remedial instruction or recommends
driving retirement. However, driving-school instructors and driver educators often lack
the medical knowledge that driving-rehabilitation specialists bring to the evaluation.

Driving Alternatives

While this module focuses on the older-adult driver and whether he or she should remain
on the road, it is impossible to address this topic adequately without considering the
transportation options available in the community and whether those options meet the
needs of the older population.


   ―Transportation is a tie that binds the community to seniors and seniors to the
   community with respect to quality and quantity of life. At the same time
   transportation systems and services cannot expect to help accomplish this agenda if it
   does not make services
           available,
           acceptable,
           accessible,
           affordable
           adaptable.‖
                                                   Helen Kerschner, Beverly Foundation


Communities may opt to adapt existing transportation equipment and programs to meet
the needs of older adults. Examples include:

              Altering or modifying routes to make them more convenient for older
               adults
              Adding pickup and delivery locations and times (such as evening
               transportation)
              Linking with volunteer groups
              Providing financial incentives
              Recognizing the importance of nonessential as well as essential rides
              Distributing information that is culturally and linguistically appropriate for
               all local community members

There are also innovations in public-transit vehicles that make them more accessible for
older riders. Some community transportation providers have purchased buses that kneel,
lowering steps to the curb.

Some paratransit programs, also called dial-up programs, provide door-to-door (in
addition to curb-to-curb) service, helping with packages or even assisting with
wheelchairs.




                                            48
Taxi-voucher programs and public-transit organizations have developed driver-
sensitivity–training programs to improve the relationship between paid drivers and older
adults.17

Developing a Community Awareness and Action Program
This tool provides you with a step-by-step outline on developing educational events and
building community awareness and capacity. Consider five key questions:

                  1.   How do you begin the planning process?
                  2.   Who is the audience?
                  3.   What do you want to accomplish?
                  4.   What do you want to say to your audience and how often?
                  5.   How do I get from plan to program?

How do you begin the planning process?

Begin your program planning or campaign development by involving a planning team.
Teams can help either develop a single class or activity or a full campaign that uses
various programs and activities in a sustained manner. You may find that resources and
funding limit the scope of your efforts and restrict you to a single program.

A campaign, on the other hand, using various public-education tools and media channels
sustained over a longer time, has a far greater chance of successfully affecting your
community and its older drivers. Creating awareness of older-driver safety begins the
process of both changing behavior and changing the environment of a community to
encourage safer mobility. A campaign can take the next step in prompting the
community to take action and continue the plan. Using community members and key
organizational partners further increases your chances for success.

Who is the audience?

Once you develop goals, begin your planning process by identifying the intended
audience. Will the audience be your usual clients—or can the topic, goals and content
level appeal to a broader audience? Or will you develop materials for a more targeted
audience, perhaps people affected by a specific condition, or their caregivers? Will your
audience speak a different language, come from a different culture, or live on a low
income? Your intended audience will determine your selection of advertising, location
and speakers.




17
     Kerschner.


                                                  49
In defining your audience, consider the action you’d like them to take as a result of your
campaign.

              What do they believe now?
              What benefit will they receive from listening to your program?
              How can you make it easy for the audience to become involved and take
               action in your campaign?
How you answer these questions, and the nature of your audience, will determine your
selection of messages to deliver and advertising, location and speakers.

What do you want to accomplish?

Have your planning team determine four to six goals. These goals will help you focus
the program and evaluate its success. Ask yourself, ―Are the goals clearly stated and
measurable so that I will know if I have achieved them?‖

In addition to your own goals, consider the needs of your organization, your clients and
possible partners. Even if a presenter comes to you with a great idea for a program,
established goals will assure that your efforts stay aligned. If you have more than one
target audience, develop strategies to address your overall goals with each group.

What do you want to say to your audience and how often?

The next step is creating sustained, frequent and consistent messages for your defined
target audience. When developing goals for the program or campaign, create a one-
sentence message that conveys the information or action you want the audience to take
home. Think of a few phrases that have stuck in the public mind: ―Buckle up for safety‖;
―Eat five fruits and vegetables a day‖; ―Don’t drink and drive.‖ Try to limit your
campaign to no more than three messages.

Current marketing wisdom says that it takes seven exposures for someone to become
aware of a product or information. (How many times have you seen the ―Got Milk‖
commercial?) Plan for your message to reach the audience frequently. Use it on all your
promotional materials, letterhead, handouts, prizes or giveaways. Your message becomes
a ―household word‖ only if you sustain the campaign over time.

How do I get from plan to program?

Next, follow the basic steps for program development adapted from those outlined in the
Blueprint for Better Health module:

           1.   Reviewing program material (content and format)
           2.   Finding a location
           3.   Identifying and recruiting a presenter
           4.   Publicizing the program
           5.   Coordinating the program


                                            50
           6. Developing a referral list of community resources
           7. Creating handouts or packets
           8. Planning the evaluation and follow-up

Once you have completed these eight steps, you are ready to implement the program.

Step 1. What? Content and Format
Ask yourself:

               What are some format options for program presentations?
               What content is best conveyed in any one type of format?
               How does my audience best learn or accept the material that we present?
               How does the audience’s learning style dictate the format?

Lecture followed by a one-to-one session

The lecture format, usually followed by a one-to-one session with participants, emerges
as the most successful national model for programs on older-driver safety and wellness.
It can be adapted to a wide variety of settings and audiences and, by providing both
general information and personalized counseling, can achieve the goals of your
presentation.

               Large-group (more than 30 people) lecture
                This format works for topics that do not rely on discussion, or as an
                introductory lecture to a series of programs on a topic. The lecture serves
                as a foundation for awareness building, which is reinforced by interaction
                with the audience. A general theme might be Myths and Facts About
                Older Drivers, Secrets to Coping with Traffic, or Adaptive Equipment for
                Driving Comfort and Safety. The examples below include lectures
                followed by questions and answers or lectures followed by opportunities
                for one-to-one interaction.




                                             51
Example—Lecture/Large-Group Format

Cooperative Extension

Description: Based on her book Driving in Later Life, author Vicki Schmall developed a
comprehensive course for families of older adults either concerned about driving fitness
or looking for guidance on ―when to become concerned.‖ The program provides ways to
address the issue with an older family member based on ability, not age, and with an
understanding of the significance of driving to older drivers. The Oregon Cooperative
Extension produced ―Driving in Later Life‖ in 1998 with Dr. Schmall conducting a
number of extension-sponsored workshops. She has also presented the information to
community-service providers—social workers, agency directors, faith leaders, healthcare
providers, and retirement community staff—locally and nationally in workshops and
conferences.

Session length can vary from 45 minutes to three hours.

Evidence of accomplishment: Satisfaction surveys distributed at the close of the
presentation indicate a growing understanding of what driving means to older adults and
the loss it can represent if a person must give it up. The class had a positive effect on the
way family, partners, and agency staff stated they would approach discussions about
driving.

Contact: Vicki Schmall
835 Marylhurst Circle
West Linn, OR 97068
Phone: (503) 636-7989
E-mail: vschmall@attbi.com

The publication Driving Decisions in Later Life (Pub. No. PNW 510) is available for
$2.00 from:
Publication Orders
Extension & Station Communications
Oregon State University
422 Kerr Administration
Corvallis, OR 97331-2119
Fax: (541) 737-0817


              Small-group interaction
               This format is ideal for topics of interest to a small select audience—for
               instance, people who have recently retired from driving, caregivers, or
               drivers who have recently experienced a serious medical illness. Consider
               the potential for privacy issues in a small-group setting, when participants
               may share information about their health and/or therapy.


                                             52
Example—Small-Group Format

You Decide: Senior Driving Awareness Program (SDAP)

Description: Established in Michigan in 1997, groups meet monthly in eight
locations in urban, suburban, and rural areas. SDAP bases its structure on Driving
Decisions for Seniors (DDS), a Eugene, Oregon, model developed by Ethel
Villeneuve. The Oregon DDS support group meets twice a month at a local senior
center to talk about issues related to driving and to find solutions for mobility and
independence dilemmas. The DDS program also provides a phone number for
elders and family members to talk about their driving problems, ask
transportation-related questions, and receive support and encouragement. Since
the loss of car keys can trigger feelings of helplessness, the peer support and
opportunity to help others empowers older adults to maintain their sense of
competence and effectiveness.

The SDAP in Michigan also features an expert speaker each meeting, followed by a peer-
support and problem-solving group discussion. One-to-one mobility counseling is also
available to older adults and their families by phone or through its website, which
provides referrals to mobility-related services that include alternative and public
transportation, defensive driving courses, and rehabilitation programs. The group and
individual counseling helps older people make appropriate and informed driving choices.
SDAP encourages older adults to plan for their future mobility needs in much the same
way that they plan for retirement.

Outcome: SDAP, currently funded by a grant from the Community Foundation of
Southeast Michigan (CFSEM), has served over 3,000 people since 1997. A March 2001
focus group evaluation of SDAP found that the program indeed meets the needs of the
individuals it serves. Specifically:

              52 percent of participants have changed their driving habits as a result of
               the program
              42 percent of attendees become involved in future mobility planning
              100 percent of participants believe the program should be replicated in
               other Michigan communities, allowing more individuals access to vital
               mobility information

Contact: AAA 1-B Central Office (Oakland County)
29100 Northwestern Highway, Suite 400
Southfield, MI 48034
Phone: (248) 357-2255 or (800) 852-7795
Fax: (248) 948-9691
E-mail: www.aaa1b.com




                                             53
             One-to-one sessions
              Although not designed to impact a large number of people, this type of
              program can achieve your goals and provide positive outcomes on an
              individual basis. The program may be funded through a grant sponsored
              by a potential partner. In discussing collaboration with potential partners,
              you may also find excellent speakers for lectures or other presentations.

Example—One-to-One Sessions

Keeping Your Car Keys

Description: ―Keeping Your Car Keys‖ is a collaborative venture between the Cramer
Reed Center, a practice-based research center located in the Kansas residential
community of Larksfield Place, and The Human Factors program at Wichita State
University. It is an evidence-based program that identifies the skills and abilities that
predict crash risk. Open to residents of Larksfield Place and private-pay clients, the
staff tests useful field of view and other physical, sensory, and cognitive abilities
necessary for safe driving, and then provides training to improve skills and abilities.
Private-pay costs begin at $25.

To assess whether driving behaviors have improved as a result of the training, a trained
and licensed driving instructor conducts an on-road driving evaluation. Additionally,
the project uses a car equipped with a computer-programmed course that simulates signs
and obstacles that a driver would encounter on a specified course. Small video cameras
record the responses of the driver—both foot actions and facial expressions. Trained
instructors evaluate the on-road simulation.

Evidence of accomplishment: Instead of avoiding the issue of driving fitness, residents
of Larksfield Place are engaged and positive about the evaluation and training. Initial
evidence indicates improved attention skills for at least 17 months. Preliminary
evidence suggests that the training programs have improved the performance of older
drivers. Program graduates are more likely to detect hazards and respond more quickly
to stimuli.

Contact: Alex Chaparro
Associate Professor of Psychology
Wichita State University
Phone: (316) 978-3038
E-mail: alex.chaparro@wichita.edu
or
The Fitness Center at Parkfield Place
Phone: (316) 636-1000




                                           54
              Extended series of educational sessions
               A series of presentations on driving safety by single or diverse speakers
               can attract a large audience, especially if there are incentives such as
               discounts on insurance or reduced costs for special events or programs.

Example—Extended Series

Transportation Improvement Association

Description: In addition to SDAP, a successful program in a small-group format, the
Area Agency on Aging 1B in southern Michigan works with the Transportation
Improvement Association (TIA) to provide a three-day series of classroom presentations,
practice with self-testing equipment, and an on-road evaluation for $25. The Area
Agency on Aging helped organize the purchase of testing equipment to measure useful
field of view, brake-reaction time, and glare recovery. Older adults can self-test if they
choose and all information about their performance remains confidential. The outcomes
give the older driver more tools to make appropriate and safe driving decisions.

Outcome: In combination with peer meetings and telephone consultations, the Area
Agency on Aging has generated over 100 hours in casework over the year; 51 percent of
the older participants now self-restrict their driving.

Contact: Tina Abbate Marzolf
AAA 1-B Central Office (Oakland County)
29100 Northwestern Highway, Suite 400
Southfield, MI 48034
Phone: (248) 357-2255
Fax: (248) 948-9691
E-mail: tabbatemarzolf@aaa1b.com
Website: www.aaa1b.com


              Community programs for caregivers
               Certain topics, such as Alzheimer’s disease, fear of disclosing driving
               abilities or discomfort in contradicting family member’s desires may be
               more appropriate for caregivers than for patients. Support groups for
               caregivers operated by other community organizations may include topics
               on safe driving.

               Since families may have deep concerns about driving and transportation
               issues, providing classes or support information may prove helpful.




                                            55
Example—Community Program for Caregivers

Older Driver Family Assistance Help Network: A Caregiver Health Initiative (The
Help Network)

Description: The Help Network felt that targeting the older driver can be fraught with
difficulty—fear of self-disclosure and loss of independence or lack of self-awareness
related to safe driving. With the message ―Caring people do address driving concerns,‖
the Help Network empowers families, community-service staff, and law-enforcement
personnel reluctant to talk with an older driver about safety and driving wellness.
Caregivers or community service providers can call the Help Network’s trained member
volunteers. Using a directory of information with associated services, they search for
solutions to each case of unsafe driving, including adverse reactions to medications or
cataracts. The volunteers also provide accurate information, especially about the
DMV’s procedures and accommodations.

The Help Network reaches caregivers through posters, websites, speaking engagements,
and local television, radio, and newspapers. Additionally, the Network contacts
apartment managers, physicians, discharge planners, and church groups about its
services.

Partners in the Help Network include DMVs, local and state police, driver-rehabilitation
programs, the State Office on Aging, the medical community, pharmacists, senior
centers, housing sites, AARP, the Traffic Safety Board, transportation providers, health
departments, the Alzheimer’s Association, the local university, elected officials, judges,
professional case managers, adult protective services, and parish nurses.

Evidence of accomplishment: Besides positive comments voluntarily reported by
caregivers who have used the program, the Erie County Help Network was given one of
the 2002 Best Practices in Health Promotion Awards by the National Council on the
Aging. The Help Network assisted in establishing a court program for older drivers and
a conference for healthcare and social-service providers.

Contact: Dorothy Levitt
Erie County Department of Senior Services
Edward A. Rath County Office Building
95 Franklin Street, 13th Floor
Buffalo, NY 14202
Phone: (716) 858-8081
E-mail: dlevitt@erie.gov
Website: www.erie.gov/driving




                                           56
What formats have been successful for other programs and how can those be adapted to
provide information about driving?

You may want to review evaluations of previous programs to find the most successful
formats. A structured evaluation determines the effectiveness of a program and the
lessons learned. Check the evaluation format as well as the content. See Step 6 for
more information on evaluation forms.

Step 2. Where? Determining the Location
Begin by determining the locations available in your community for public meetings and
programs.

              Are there free or low-cost meeting rooms?
              Are local businesses willing to provide space?
              Is the location convenient and acceptable to your intended audience?
                    o Are the rooms accessible and appropriate for older adults?
                    o Are microphones available to accommodate those with hearing
                        loss?
                    o Is childcare provided if the target audience has the childcare role in
                        the family, or if family members plan to attend?

Again, return to your goals and your intended audience to focus your location selection.
Your format will also help determine the best location: size and privacy considerations
for a lecture and small group, or sufficient accommodations for a larger health-fair-type
venue. In addition, think of possible partners for the program. They may be able to
provide a suitable venue, help with sustained publicity about the event and thereby
increase attendance.

What safe and comfortable space near convenient transportation or parking can you use
for your program?

Consider personal safety in your choice of locations. Older people may be fearful of
some high-crime areas, of young people who may frequent a site, or of their own inability
to navigate stairways or public transportation venues such as bus stops or subways.
Encourage people to arrive in groups or to carpool for safety. Avoid starting or ending
programs during rush hour. The time of day and day of the week that you hold your
program can affect participation. Older drivers may only be comfortable driving during
the day. However, evenings may be good times for families to drive older people to
events, especially if intergenerational participation is desired. Adult children of older
individuals may be informal caregivers, potentially responsible for their parents’ future
transportation or driving decisions.

Take into account religious observances during the week. For example, among some
denominations, Wednesday night is reserved for religious study or family services.



                                            57
Some location ideas for a driving-safety program:

              Senior centers
              Automobile clubs
              Continuing-care communities
                  o These often have community rooms and residents who are an ideal
                      audience for driving-wellness programs
              Other housing sites with a large older population
                  o Some urban centers have apartment complexes that cater to older
                      adults
              Civic groups
                  o These may include clubs that own facilities, such as Elks and
                      Moose lodges, Veterans of Foreign Wars (VFW) posts
                  o You may seek an invitation to meetings and present where
                      members congregate, such as restaurants or churches
              Pharmacies, especially if they cater to an older population
                  o Driving and medication-related impairments are of concern to
                      pharmacists too
              Community rooms in county buildings or libraries
              Community colleges
              Hospitals and clinics
                  o They may connote illness and frailty to some audiences but they
                      are respected sources of information for others
              Religious and spiritual institutions
                  o Certain religious institutions may be uncomfortable for some
                      cultural groups

Step 3. Who? Identifying and Recruiting a Presenter
What groups or individuals in the community have expertise and interest in the content?

Sometimes, several speakers from different disciplines can provide a comprehensive
perspective, depending on the specific topic, content, and format of the presentation. For
instance, a law-enforcement officer and a healthcare provider can complement each other
in delivering the material effectively.

Three key criteria for selecting speakers:

              Expertise with the content
              Ability to convey material in an interesting manner
              Willingness to participate and help in the promotion

Are your speakers appropriate for culturally diverse populations?




                                             58
Try to find speakers who are either from the targeted culture or who know the language.
At the least, they should have knowledge of or experience with the community.

Your insight as a community resource for each audience increases the presenter’s
understanding of traditions and beliefs. Ignorance of cultural and community differences
can negatively affect programs. In contrast, incorporating knowledge about the culture or
community into programs increases the potential for success.

Is your speaker familiar with community resources?

Speakers may be knowledgeable about laws, safety issues or healthcare but not about
services and access issues in your community. If your speaker is not knowledgeable in
these areas, you may want to team the presenter with social workers, case managers,
transportation providers, or information and referral specialists from your community.

Step 4. How? Publicizing the Program
What resources do you have to advertise and produce this program or campaign?

Here are some steps to consider:

              Develop a budget, including the costs of advertising, rentals, food,
               speaker(s) and other incidentals. Does your final proposed budget support
               your goals for the program?

              Advertise in the local newspapers. You may not have the budget for a
               full-page advertisement, but small-town newspapers often offer short
               announcements in the main section of the paper as a public service

              Contact the local newspaper and speak with a reporter. See if anyone is
               assigned to the ―age beat.‖ Try to increase his or her awareness of the
               issues surrounding older adults and driving. Speak to the reporter about
               writing a general- or human-interest story about the topic, highlighting
               your program. Have events included in community events or bulletin
               board sections. For more information about developing media
               connections, see the Blueprint module

              Contributing information to the local cable station can result in a posting
               on the station’s community bulletin board.

              Contact community cable and radio stations for inclusion on events
               announcements or for talk show or news interviews.

              Design one-page flyers and distribute them in locations frequented by your
               target audience. Consider local pharmacies, clinics, senior centers, adult



                                            59
               daycare centers, retirement homes, or continuing-care centers. You can
               also ask them to cosponsor your program or event

              When translating promotional material to another language, seek help
               from members of the representative community to make sure the flyer
               really says what you want it to say in another language

              Work with your partners to assist in the program promotion

              If the budget allows for a well-known speaker, plan a full lecture with
               media coverage

              To advertise your program, use the resources of other health- and aging-
               related agencies, such as area agencies on aging, health departments,
               hospitals and ethnic community-based organizations

If you plan to launch a media campaign, refer to the section on working with the mass
media in the Blueprint module.

You can execute a low-cost publicity effort to notify individuals and groups of
your program and intended audience. Five levels of promotion are:

              Using word-of-mouth (least costly)
              Pitching the program in newsletters
              Contacting the local media (more time-consuming but may be
               especially effective in ethnic communities)
              Distributing flyers (moderate cost and moderate time involvement)
              Posting information on your website, on partners’ websites or on
               listservs

Within ethnic communities, find a local leader who will introduce you to the community
and to other contacts key to publicizing the program.

Using Word-of-mouth

   1. Contact past participants in older-adult programs, such as:

              Health-promotion program attendees
              Nutrition-site participants and meals-on-wheels volunteers
              Arts and recreation class members
              Fitness class participants
              Tax-aid program participants

   2. Make announcements at all your organization’s events.

   3. Offer door prizes to participants who bring friends.


                                            60
Pitching the Program in Newsletters

   1. Identify relevant newsletter sources:
          Hospitals or HMOs
          Pharmacies
          Chiropractors
          Senior centers
          Civic organizations (e.g., Rotary Club, Kiwanis Club)
          Religious groups
          Health clubs
          Older-adult organizations, such as local chapters of the Older
              Women’s League or Gray Panthers
          Health advocacy and education groups (your local chapter of the
              Alzheimer’s Association, the American Stroke Association, the
              American Parkinson Disease Association, diabetes associations)
          Advocacy groups such as the NAACP, La Raza, lesbian, gay,
              bisexual and transgender (LGBT) advocacy or social groups

   2. Contact the organization’s leader, minister, priest, rabbi, or spiritual or
      religious education director to secure a commitment to include the
      information in one of their newsletters or bulletins.

   3. Create a brief news story of 150 to 200 words that newsletter editors can
      insert into their publication. Be sure to include the topic, speaker, place,
      time and contact information.

Contacting the Local Media
  1. Create a list of local print and broadcast media, using the telephone
      directory or other community listings as a starting point. Include the
      following information:

              Type of media
              Name of publication or broadcasting station
              Contact names, including the appropriate reporter or editor
               (obtained by calling each media outlet)
              Section of the paper (lifestyles, health or community section or a
               special older-adult insert)
              Addresses
              Phone/fax numbers
              E-mail addresses
              Website

   2. Develop strategies to sell the impact of the older-driver issue to media in
      your community, such as:


                                            61
              How does aging and mobility affect older adults in your
               community?
              How does it affect the health of your community?
              How are family members affected? Does that affect business and
               employers?
              What is the urgency for the reporter coming to this program now?

        Collect ―hard data‖ on the issue. Use reliable sources, such as National
        Highway Traffic Safety Administration or Centers for Disease Control and
        Prevention, and reference the information or statistics. Reliable sources
        and referencing boosts your credibility.

   3.    Create a brief news release.

   4. Mail or fax an announcement for the weekly calendar and a media advisory to the
      appropriate reporters/editors at the local radio, TV and cable stations, as well as
      newspapers, magazines and community organization newsletters.

   5. For ethnic media, especially print, provide the information in the proper language.
      In some cases, the radio or television stations will translate the announcement for
      you.

   6. Follow up with a phone call to confirm receipt of the notices and to encourage
      media outlets to broadcast or publish the information.

For more information on publicity, turn to Chapter 3 in the Blueprint module

Distributing Flyers
   1. Develop a flyer outlining the following:

              Location
              Time and date
              Presenter information
              Brief description of what will be covered
              Cost
              Sponsoring groups

   2. Determine the best locations to promote your program, by mail or hand
      delivery, such as:

              Local offices or chapters of national health organizations
               (e.g., the Alzheimer’s Association, the American Stroke
               Association)
              AARP chapters



                                            62
              AAA
              Local area agencies on aging
              Cooperative extension offices
              DMVs
              Hospitals and health clinics
              Senior centers, older-adult clubs, and retirement groups
              Libraries, schools, colleges, local bookstores
              Pharmacies
              Physician offices and clinics catering to older adults
              Churches, synagogues, mosques, temples
              Civic groups and local businesses such as barbershops
              Laundromats and grocery stores
              YMCAs
              Restaurants frequented by older adults
              Nutrition sites
              Housing sites

Step 5. How? Coordinating the Program
Developing an Action Plan and Timeline

Initial planning should include goal setting, budgeting and developing an action plan. An
action plan and timeline lists tasks, and identifies who is responsible to do what by
when. It is a good way to keep track of the multiple steps carried out by many people for
a successful program. Use the action plan and timeline at program meetings with your
organization, volunteers and partners to help run your meetings efficiently. Establishing
expectation helps to avoid misunderstandings. Meet with partners and advisory groups
regularly. If you can’t meet face to face, conference calls to report on program planning
can also be effective.

Follow the checklist in the Blueprint module of general tasks for coordinating a
successful program, and adapt it to your needs:

              Determine the location
              Confirm speaker(s)
              Determine speaker needs for audiovisual equipment and handouts
              Secure audiovisual equipment
              Obtain additional educational materials for distribution
              Make arrangements for refreshments (a critical element in minority
               communities)
              Locate wheelchair-accessible areas
              Plan room setups
              Check the heating and cooling and lighting systems




                                            63
Designing Handouts

Your program should include handouts with referral and resource information. Work
with your speakers to determine what handouts and resource material they may already
have and wish to distribute. Additionally, if you have contacted potential speakers who
are unable to participate, it may be worthwhile to ask them for ideas for resource
materials.

See the list of resources at the end of this section for possible sources for handouts.

Determining What Local Resources Are Available

Make a local resource list for participants. With transportation consistently listed
as the number-one need for older adults, program participants may appreciate
having a list of all transportation options in the local area. Contact the agencies
and individuals you plan to list in advance to confirm their availability.

Include the following basic information on the list:

              Name of facility/organization
              Contact person(s)
              Addresses and phone numbers
              Office hours or hours of operation
              Payment coverage or cost

You might also want to include the following:

              Exercise programs (local older-adult fitness programs in health
               clubs, YMCAs, or community centers)
              Dietitians (to evaluate nutritional levels and identify problems
               associated with memory or vision that might be related to food)
              Physical therapists (to provide advice and treatment for health
               issues related to physical mobility and strength)
              Occupational therapists (for functional evaluation and
               recommendations for adaptive equipment for the car and to help
               with mobility planning if one needs to cut back on or stop driving)
              Optometrists (for vision services)
              Local community-health clinics serving culturally diverse
               populations or people living on low incomes

Step 6. How Well? Evaluation and Follow-up
How do you know you were successful?




                                             64
The goals you developed at the beginning of the planning process become your
measuring stick for success. To know if you have successfully reached these objectives,
set benchmarks indicating satisfactory levels of accomplishment. To ascertain when the
program has reached these levels, you must measure your progress. Design your
evaluation forms in concert with your goals.




                                           65
To determine whether you were successful, divide your evaluation into three
measurement areas:

               Exposure
               Effectiveness
               Cost effectiveness

Exposure

Did you meet your projection for number of attendees?

Did the program gain adequate exposure?

There are two aspects to exposure: before and after.

   1. Before: informing the community
      Your evaluation should answer questions such as:

               How many news stories, articles, radio announcements, television spots,
                posters and flyers were distributed?
               Where were the announcements placed?
               Where did participants hear about the program?
               Did families and partners respond to the publicity?
               How many personal contacts were made?

   2. After: reporting on the events
      Your evaluation should answer questions such as:

               Did the media distribute information about safe driving in the older
                population after the event?
               Did reporters attend?
               Were there follow-up stories?
               Were there follow-up responses from older adults and/or caregivers?

Effectiveness

Was the program effective in achieving your goals?

   1. You should test the level of knowledge about your program’s topic prior to
       conducting your program. You can follow up with a second test following the
       program. Consider asking participants, at the beginning of the program, what
       they want to know about the topic, and what they don’t understand. Then ask
       why they came. This information is useful to define their level of behavior
       change or motivational status. For more information on motivation for behavior
       change, turn to Chapter 1 of the Blueprint module.



                                            66
   2. Note whether participants ask for additional information or programs, and/or ask
      questions of the speaker.
   3. If the program follows a small-group and one-to-one format, how many
      participants take advantage of the one-to-one portion?
   4. Before you close, ask the same questions asked at the beginning of the session.
      See if knowledge has increased.
   5. Follow up at a later time with participants to determine how they used the
      information.

Cost Effectiveness

Did the program’s cost in time and resources provide enough benefit to satisfy the
community, funders and your organization?

An ideal benefit from the program would be a decrease in crashes involving older drivers,
which comes from earlier recognition of unsafe driving habits and their willingness to
change their driving habits. This sort of evaluation, involving in-depth, long-term
research, is expensive and remains outside the financial capabilities of most community-
based organizations, unless you have close ties with university research departments or
organizations funded to conduct this research. If so, they may be interested in helping
you measure the effectiveness of your programs.

Despite these evaluation challenges, documenting the cost-benefit outcomes of a program
results in better planning for the next project, and may in fact be required for continued
outside funding.

The following are examples of participant and program coordinator evaluations along
with a summary evaluation. These or similar forms should be completed and kept with
other program materials so they can be reviewed when future programs are planned.
When presenting to ethnic older adults, take into consideration health literacy and
language issues. Assisting the participants in completing the evaluation form may
guarantee better success.




                                           67
      Example—Evaluation Forms: Program Satisfaction

                            Program Satisfaction Evaluation
1. How did you hear about this program? ____________________________________________
Rate each speaker. Circle 1 if you agree and circle 5 if you disagree. If you neither agree nor
disagree, circle 3.
                                                                     Agree               Disagree
2. The speaker was well informed about the subject.                  1       2      3     4       5
3. The speaker used easy-to-understand examples.                     1       2      3     4       5
4. The speaker was interesting.                                      1       2      3      4      5
5. The speaker was organized.                                        1       2      3     4       5
6. There was time allowed for questions.                             1       2      3     4       5
7. I learned new information.                                        1       2      3      4      5
8. I plan to use the information when I return home.                 1       2      3     4       5
What else would you like to know about this topic?
____________________________________________________________________________
Other comments (What was most helpful? Least helpful? Would you like to see more programs
of this type in the future?)
_____________________________________________________________________________
_____________________________________________________________________________




                                                  68
      Example—Evaluation Forms: Program Monitor

                                   Program Monitor Evaluation
Name:                                     Date:
Presenter:

1. How many people attended the program at the beginning of the session? _______
   How many people remained until the end? ______

                                                              Very      Somewhat   Not at All

2. How knowledgeable was the speaker on this topic?             1           2           3

3. How well did the speaker communicate to the audience?        1           2           3

4. If the speaker used audiovisual equipment, how effective
   was its presentation?                                        1           2           3

5. If the speaker used handouts, how helpful were they in
   conveying the health messages to the audience?               1           2           3

6. Did the audience participate?     Yes          No

7. Comments or suggestions on improving this presentation as a whole:




                                                  69
Example—Evaluation Forms: Exposure

                            Exposure Evaluation
   Number of news releases _______
   Areas of distribution_____________________________________________

   ______________________________________________________________

   Most Effective Promotion Areas
    Newsletters (which)___________________________________________

     ___________________________________________________________

     Radio (which stations)_________________________________________

     Newspapers (which)___________________________________________

     ___________________________________________________________

     Flyers (what areas) ___________________________________________

     Word of mouth (original sources/agency) _________________________

   What increases from normal intake in volume or attendance occurred? ____

   _________________________________________________________________




                                       70
     Example—Final Evaluation Worksheet


Program/Campaign____________________________________________________

Date Began____________________                 Date Completed_________________

CONTENT:
Strengths:


Areas for Improvement:


PROMOTION:
Successful Exposure Areas:

Least Successful:

Areas for Improvement:


TARGET AUDIENCE:
Who was the target audience?


Who participated in the program?


What changes in the participants were observed?


What changes were planned for, but did not occur?


What area(s) in the program or campaign can be changed to address these issues?


What sources should be consulted to facilitate this change?




                                          71
Resources
AAA Foundation for Traffic Safety
  www.seniordrivers.org
  The website provides information, videos, and quizzes to help older drivers stay
  safely behind the wheel for as many years as possible. It also offers a Mature
  Operators driver-education program.

AARP
  www.aarp.org/55alive
  The AARP Driver Safety Program is the nation's first and largest classroom driving-
  refresher course especially designed for motorists age 50 and older.

American Association of Motor Vehicle Administrators (AAMVA)
  www.granddriver.info
  The GrandDriver website helps older adults, as well as their friends, family, and
  caregivers, learn about the effects of aging on driving. It provides tips for assessing
  driving skills, information on ways to keep driving safely as long as possible, and
  suggestions for children and caregivers.

Alzheimer’s Association
   www.alz.org/FamCare/DaytoDay/Driving.htm
   This fact sheet discusses unsafe driving.

American Medical Association
  www.ama-assn.org
  Through its public-health programs, the AMA is developing a guide for physicians to
  counsel older drivers and their loved ones.

American Traffic Safety Services Association
  www.atssa.com
  The website houses a number of articles in its library about roadway designs that
  contribute to safety for older drivers.

Association for Driver Rehabilitation Specialists (ADRS)
   www.driver-ed.org
   Find fact sheets and a directory of driver-rehabilitation specialists. A driver-
   rehabilitation specialist can provide a comprehensive evaluation and make
   recommendations regarding driving.
   Phone: (800) 290-4175

Centers for Disease Control and Prevention
   The Center for Injury Prevention
   www.cdc.gov/ncipc/factsheets/older.htm
   This website contains several pages with statistical information on public-health
   issues related to driving among older adults.


                                             72
   National Center for Chronic Disease Prevention and Health Promotion
   Healthy Aging Branch
   www.cdc.gov/aging
   The CDC’s aging site provides information on healthy aging and recommendations
   for health-promotion activities.

Insurance Institute for Highway Safety
   www.hwysafety.org
   Check out this website for extensive vehicle safety and crash data information.
   Phone: (703) 247-1500

   www.hwysafety.org/safety_facts/state_laws/older_drivers.htm
   This section of the site provides licensing renewal information by state.

   www.hwysafety.org/srpdfs/sr3608.pdf
   The institute’s newsletter ran a special issue on September 8, 2001, on older drivers
   (available in PDF format).

National Highway Traffic Safety Administration (NHTSA)
   www.nhtsa.dot.gov
   The NHTSA website offers in-depth information about aging and driving through its
   brochure, Driving Safely While Aging Gracefully, research reports, traffic-safety fact
   sheets and other materials. Printed brochures are also available.

   Also search the NHTSA home page for a wealth of information on injury statistics,
   special safety programs in various regions of the United States, and research and
   safety pamphlets and reports.

   NHTSA Fatality Analysis Reporting System (FARS)
   www-nrd.nhtsa.dot.gov/departments/nrd-01/summaries/fars_98.html
   This NHTSA database contains fatal crash data from every region of the United State.

University of Michigan Transportation Research Institute
   www.umtri.umich.edu/library/pdf/2000-14.pdf
   This site contains an extensive (47-page) self-assessment guide called Driving
   Decisions Workbook. The reader responds to an interesting set of questions and
   receives immediate feedback on the answers.

U.S. Administration on Aging
   www.aoa.dhhs.gov
   The AOA provides information and resources on a broad range of aging issues.

   www.eldercare.gov or 1-800-677-1116
   The Eldercare Locator provides information and resources for older adults.




                                            73
References
Aging Alert (2003) ―Transportation.‖

Alzheimer’s Association (1995) ―Giving up the Car Keys.‖ Alzheimer’s Association
National Newsletter 15(3):1, 7.

Coughlin, J., and Straight, A. (2001) Transportation and Older Persons: Perceptions
and Preferences—A Report on Focus Groups. Retrieved from AARP on the World
Wide Web: http://research.aarp.org/il/2001_05_transport_1.html.

Dobbs, B.M., and Dobbs, A.R. (1997). ―De-licensing: Mobility and related consequences
for the patient and family members.‖ Paper presented at Transportation Research Board
76th Annual Meeting, Washington, DC, January 12–16, 1997.

Eby, D.W., Molnar, L.J., and Shope, J.T. (2000) Driving Decisions Workbook. Ann
Arbor, MI: University of Michigan Transportation Research Institute.

Glasgow, N. (2000) ―Older Americans’ Patterns of Driving and Using Other
Transportation.‖ Rural America 15(3):1–5. Retrieved from U.S. Dept. of Agriculture on
the World Wide Web:
http://www.ers.usda.gov/epubs/pdf/ruralamerica/sep2000/sep2000f.pdf.

How to Help an Older Driver: A Guide for Planning Safe Transportation. Brochure.
Washington, DC: AAA Foundation for Traffic Safety.

Kerschner, H. (2003) ―Supplemental Transportation Programs for Seniors (STPs).‖ STPs
Mobilizer Project: White Paper Series. Retrieved from AAA Foundation for Traffic
Safety on the World Wide Web:
http://www.seniordrivers.org/STPs/whitepaper1.cfm.

LePore, P.R. (2000) When You Are Concerned—A Handbook for Families, Friends
and Caregivers Worried About the Safety of an Aging Driver. Albany, NY: New York
State Office on Aging.

Marottoli, R.A., Mendes de Leon, C.F., Glass, T.A., Williams, C.S., Cooney, L.M., Jr.,
Berkman, L.F., and Tinetti, M.E. (1997) ―Driving Cessation and Increased Depressive
Symptoms: Prospective Evidence from the New Haven Established Populations for
Epidemiologic Studies of the Elderly.‖ Journal of the American Geriatric Society
45(2):202–06.

National Highway Traffic Safety Administration (April 1999) Safe Mobility for Older
People: Notebook 3–29. U.S. Department of Transportation. No. DOT HS 808 853.
Retrieved from NHTSA on the World Wide Web:
www.nhtsa.dot.gov/people/injury/olddrive/safe/01c03.htm



                                           74
Schatz, S., Stutts, J. and Wilkins, J. (1999B) “The Premature Reduction and Cessation of
Driving: A Preliminary Study of Women Who Choose Not to Drive or to Drive
Infrequently.” Proceedings Transportation Research Board 78. Transportation Research
Record No. 1693.

Schwartzberg, J. G. (Mar. 13, 2003) ―The Physician’s Role in Older Driver Safety.‖
Presented at the Joint Conference of the American Society on Aging and the National
Council on Aging, Chicago, IL. .

Sterns, H.L., Sterns, R., Aizenberg, R. and Anapole, J. (2001) Family and Friends
Concerned About an Older Driver. National Highway and Safety Administration
Research Report No. DOT HS 809 307. Washington, DC: U.S. Department of
Transportation. Also available on the World Wide Web:
http://www.nhtsa.dot.gov/people/injury/olddrive/FamilynFriends/faf_index.htm.

Stressel, D.L. (2000) ―Driving Issues of the Older Adult.‖ OT Practice: AOTA
Continuing Education Article 1–9.

Handouts
           1.   Older-Driver Fact Sheet: Get Around Safe & Sound
           2.   Older-Driver Fact Sheet: The Effects of Age on Driving
           3.   Older-Driver Fact Sheet: Follow-up Media Contact Sheet
           4.   Older-Driver Fact Sheet: Test Your Older Adult I.Q.
           5.   Older-Driver Fact Sheet: Realities About Older Drivers
           6.   Older-Driver Fact Sheet: Older Drivers
           7.   Older-Driver Fact Sheet: Safe Driving for Older Adults: Self Assessment




                                            75
Handout

DRIVING OVER 65?
Get Around Safe & Sound … As Long As Possible
While the natural process of aging may ultimately affect the skills required to be a safe
driver, the changes usually happen over time. During the course of 10, 20 or more years,
older adults may modify their driving several times. As changes in vision, hearing, or
other health conditions impair driving skills, older drivers need to know how to adjust
their habits to maintain safe mobility and community connections.


Know the Fundamentals
These basic rules for safe driving apply to any age group:
            Always wear corrective lenses as required
            Be rested. Don’t drive when you are physically exhausted or sleep-
               deprived
            Don’t wear sunglasses in dim or dark conditions
            Avoid alcohol before and while driving
            Ask your doctor or pharmacist how your medications affect driving
            Always, always wear a safety belt

Avoid Risky Drive Times
Minimize or prevent high-stress situations by avoiding difficult traffic situations. Older
drivers may continue to drive safely for many years by adjusting their habits as follows:
           Drive during daylight
           Drive in good weather
           Avoid rush-hour traffic
           Limit fast-paced highway driving

Find a Safe Way
Consider driving with a friend, or map out and practice the safest ways to routine
destinations: grocery stores, churches, doctor’s offices, shopping centers, etc. Look for:
            Well-lit streets
            Left turns at controlled intersections with left-turn arrows
            Clear signs and well-marked lanes
            Easy parking

Go Back to School
A driving course just for older adults can update drivers on traffic laws and suggest
useful ways to adapt driving habits to accommodate aging. Some courses even qualify
older drivers for a reduction in auto insurance costs. Courses may be offered locally, or
through national organizations such as:



                                            76
                AAA
                AARP
                National Safety Council

Drive a Safe Car
Look beyond the conventional safety features on a car. Like all drivers, older drivers
should make sure their cars offer a comfortable fit, maximum visibility, and minimal
physical strain. Consider these features:
             Height-adjustable seats
             Tilt/telescoping steering wheel
             Height-adjustable safety-belt anchors
             Good visibility
             Legible instruments
             Big, glare-proof mirrors
             Push-button controls
             Power windows and door locks
             Power steering
             Equipment such as pedal extenders and hand controls (for drivers with
                special needs)

Get Physical
Strength, flexibility and overall wellness contribute to the ability of an older driver to
remain a safe driver. After the age of 65 (if not sooner), drivers should:
             Receive regular medical and eye exams to identify physical conditions that
                may affect driving
             Consult with a doctor about exercising to maintain the flexibility and
                strength needed for safe driving

Plan for Gradual Retirement from the Wheel
The time may come when an older driver retires from driving. But retiring from driving
doesn’t mean retiring from life. Plan ahead and learn about the options for getting around
when driving isn’t an option:
           Public transportation, such as bus and subway services
           Senior shuttles
           Community driving services
           Friends and family
           Taxi services

This fact sheet is adapted from “How to Help an Older Driver: A Guide for Planning Safe
Transportation,” published by AAA Foundation for Traffic Safety, Washington, D.C.
(www.seniordrivers.org).




                                                  77
Handout

DRIVING OVER 65?
The Effects of Age on Driving … Know the Signs
The aging process can eventually affect a driver’s ability to sense, decide and act—
critical skills for safe driving. Knowing the early signs of driving difficulty—both
physical and cognitive—allows older drivers and their loved ones to discuss the situation
and take appropriate action to maintain their safety and the safety of their community.


Physical Changes

Seeing: As we age, we lose our ability to distinguish details and our field of vision
narrows. Declining eyesight affects critical driving functions, such as reading signs and
judging the speed of other vehicles.

Acting: Some older adults respond more slowly in a crisis, partially because of reduced
flexibility, weaker muscles and limited range of motion.

Cognitive Changes

Decision Making: Older drivers may process information and react more slowly than
younger people. As a result, older drivers may drive more slowly to compensate.

Attention: As they age, drivers may feel overwhelmed by the level of activity on the
road, especially busy highways or congested intersections. They may also have trouble
remaining attentive and may become easily distracted.

Perception: Older adults have more of their crashes at intersections than younger
drivers. The collisions are the result of failure to yield the right of way,
misunderstanding signs and signals, and inaccurately judging speed.




                                              78
        How to Help                          Talk Now, Plan for Later
                                             The key to getting around safe and sound now and in the
It’s not easy to think about                 future is to understand and evaluate the role driving plays
growing old, much less to talk               in an older person’s life. Yet few older adults discuss and
about it. Bringing up the                    plan how to meet transportation needs as life conditions
subject of safe driving may be               change. Some guidelines:
awkward, but if you can talk
now, you and your family can                 Take an individual approach
have a plan for the coming                   Some people can continue to drive well into old age;
years. Here are some tips for                others can’t. Consider each situation and address specific
making conversation easier:                  needs and wants as you address driving and
                                             transportation issues.
   Recognize that an older
    driver is not necessarily an             Communicate openly and respectfully
    unsafe driver. Decisions                 Older drivers think of themselves as safe drivers. We get
    will be made based on the                defensive or deny a problem if we feel attacked or
    specific needs of the                    accused. Adult children and other friends or caregivers
    person and the situation.                should be positive and supportive while explaining
                                             concerns. Older individuals need to honestly
   Acknowledge that giving                  communicate their perspective, while remaining open to
    up (or even limiting)                    change. Together, talk about ways to adapt driving habits
    driving is a big deal—                   and plan for future transportation needs.
    symbolically and
    practically—for older                    Plan early
    drivers.                                 The earlier you discuss the inevitable consequences of
                                             aging, the better you can make provisions for the future.
   Emphasize that safety is                 At the same time you are planning with your parents, it is
    most important.                          also a good time to talk with your spouse, partner and/or
                                             children to begin planning for yourself. Include
   Review specific                          discussions about transportation needs as your family
    transportation needs and                 plans for retirement—just as you would address finances,
    develop a way to                         medical care, and housing.
    accommodate them.
                                             Assess
Agree together on a plan of                  It’s helpful to gain an objective assessment of driving
action. It may begin with                    abilities rather than relying on personal assumptions or
avoiding risky driving                       misperceptions. Older adults can get feedback on their
situations; proceed to seeking               driving skills from a certified driver-rehabilitation
education, rehabilitation, or                specialist. You can find one through www.driver-ed.org.
adaptive equipment; and                      Or, look into AARP’s Driver Safety or AAA's Mature
eventually lead to giving up                 Operators driver education programs.
the keys.

This fact sheet is adapted from “How to Help an Older Driver: A Guide for Planning Safe Transportation,” published
by AAA Foundation for Traffic Safety, Washington, D.C. (www.seniordrivers.org).




                                                        79
                  Follow-up Media Contact Worksheet

Media   Contact            Received     Talking Points   Commitment/   Send
                           materials                     Response      Media
                           When?                                       Kit
Print                                   1.
Radio                                   2.
TV.                                     3.
Cable
Web
Print                                   1.
Radio                                   2.
TV.                                     3.
Cable
Web

Print                                   1.
Radio                                   2.
TV.                                     3.
Cable
Web

Print                                   1.
Radio                                   2.
TV.                                     3.
Cable
Web

Print                                   1.
Radio                                   2.
TV.                                     3.
Cable
Web




                                       80
                         Test Your Older Driver I.Q.
The following statements are designed to test your knowledge about older drivers
and older driver safety. Circle ―T‖ if you believe the statement is true; circle ―F‖ if
you believe the statement is false. Answers will be discussed as a group.

T    F     1. Public safety is significantly improved by getting older drivers off the
              road.

T    F     2. Most older drivers restrict or cease driving when they experience changes
              in their ability to drive.

T    F     3. Aging is associated with inevitable functional declines that make most
              older adults high-risk drivers.

T    F     4. Most older drivers who make the decision to quit driving do so because
              they think their driving is unsafe for themselves and others.

T    F     5. Most physicians know how to identify and counsel older patients who are
              likely to experience driving difficulties.

T    F     6. When older people come in for a license renewal, the DMV can readily
              identify those individuals whose driving ability is compromised.

T    F     7. It’s hard to justify improvements to highways that would make them
              friendlier to older drivers because it’s prohibitively expensive and would
              serve only a small segment of the population.

T    F     8. Public transportation is an effective transportation alternative for most
              older adults who no longer drive.

T    F     9. Reeducation or driver refresher courses are sufficient to help most older
              adults with functional deficits to drive safer longer.




                                            81
                      Realities About Older Drivers

1. FALSE: Although it is essential to do a better job of detecting older drivers whose
   age-related functional impairments place them at risk for crashes, most older drivers
   are safe.

   Older drivers are much less likely to drink and drive. Older drivers involved in fatal
   crashes in 2002 had the lowest proportion of intoxication of all adult drivers.
   (NHTSA, 2002)

2. TRUE: Most older drivers appropriately self-regulate. Some don’t. Certain
   problems, such as declining central vision, may be quite obvious. Cognitive changes,
   however, may be subtle and reduce a driver’s ability to detect loss of function.
   Whether changes in cognitive ability are caused by dementia (such as Alzheimer’s
   disease) or by normal age-related cognitive slowing, some people are not aware that
   they lack cognitive abilities for safe driving. Objective assessment is needed.

3. FALSE: While specific abilities needed to drive safely—such as vision, memory,
   physical strength, reaction time, and flexibility—may decline as we age, the rate of
   change varies greatly among older adults. Many older drivers do not differ
   significantly in their driving skills from middle-aged drivers, who statistically are the
   safest group on the road.

4. TRUE: In addition, some elders who are functionally intact and could be safe drivers
   lose the confidence to drive; they no longer feel comfortable or secure traveling at
   certain times or under certain conditions. In particular, older women who drive
   infrequently may lose key driving skills or confidence in them. When their driving is
   assessed, they often demonstrate that they can drive safely.

5. FALSE: Physicians commonly state that they know little about the effects of specific
   functional losses on driving safety, and they prefer that the state DMVs deal with the
   issue. Some physicians feel that they violate a patient’s trust if they take actions that
   could result in a patient’s loss of driving privileges. Others have concerns about
   losing the person as a patient or facing possible legal action. However, increasingly
   more physicians recognize their ethical obligation to discuss the dangers of driving
   with patients whose health and medical conditions could compromise both patient
   and public safety.

6. FALSE: Many states do not require in-person renewal of driver licenses. Where
   required, intervals between DMV visits may be as long as 12 years. Also, in states
   with in-person renewal, DMV staff is frequently not trained to recognize signs of risk.
   Road tests are rarely given and are not designed to identify the common safety
   problems of older drivers.




                                             82
7. FALSE: Quite often, it costs no more to build roads the right way, from a driver-
   needs perspective, than the wrong way. Many engineering improvements, if made
   when constructing new facilities or planning reconstruction projects, could be done at
   little or no added cost. Improvements that make highways safer and easier for elders
   also make them safer and friendlier for all drivers and pedestrians.

8. FALSE: Many older adults do not use public transportation because it is not available,
   not accessible, or doesn’t go where they want to go or when they want to go. Improved
   routes and scheduling would make public transportation more attractive. Current forms
   of public transportation are difficult or impossible for elders with diminished
   capabilities, such as Alzheimer’s disease or physical disabilities. Paratransit, enacted
   under the Americans with Disabilities Act, seeks to address this barrier.

9. FALSE: Less than 5 percent of eligible older adults complete such courses, which
   may be accomplished by merely attending classes. The benefits of classroom
   instruction that also does not include time behind the wheel are widely disputed.
   Driver refresher courses may offer some useful information to functionally intact
   elders, but individuals with functional deficits need more than classes to maintain safe
   mobility.




                                            83
                                  Older Drivers
Almost any adult with a driver’s license can remember that first trip alone in the family
car, feeling completely free and independent. For some older adults driving is not fun
any more. Some people may not drive at night because they have trouble seeing. Others
might avoid driving on high-speed interstate highways. For many older drivers, these are
the first signs that driving is becoming a problem.
But, driving is necessary for many. Getting around is a problem for the millions of older
people who live in the suburbs or rural areas. In cities there may be plenty of taxis and
public transportation like buses and subways. However, buses and subways may be hard
for someone suffering from arthritis or using a cane. Taxis may cost too much.
As a group older drivers are some of the country’s safest drivers. Fewer speed or drive
after drinking alcohol than at any other age. However, compared to young and middle-
age adults, people over 70 are more likely to be involved in a crash while driving and
more likely to die if in a crash. There are many reasons for this––some can be changed,
but others cannot.

How Does Age Affect Driving?
As we grow older, we do not turn into bad drivers. Some of us stay good drivers. Others
simply experience changes in their ability to handle a car safely. These include:

              Changes in our bodies
              Changes in the way we think
              Health problems
              Medications effects

Changes in your bodies––With age, joints may stiffen, and muscles weaken. Turning the
head to look back or steering and braking the car may become hard to do. Movements
are slower and may not be as accurate. Senses of smell, hearing, sight, touch, and taste
might grow weaker.

Vision—the ability to see—is a vital part of driving, but age brings changes in the lens of
the eye. Eyes need more light in order to see and are more sensitive to glare. One’s
ability to see things on the edge of the viewing area, peripheral vision, narrows. Vision
problems include cataracts, macular degeneration, and glaucoma.
              In cataracts the lens of the eye becomes cloudy, causing problems with the
                 ability to see.
              Macular degeneration is a breakdown of material inside the eye that leads
                 to a loss of vision in the central part of the viewing area.
              The rise in pressure inside the eye that develops in glaucoma may limit the
                 ability to see things on the edge of the viewing area.




                                            84
Changes in the way you think––The way your mind works also changes with age. Older
drivers may have trouble keeping attention fixed on one situation or have a hard time
doing two things at once––abilities needed to drive safely. When driving, you take in
new information from many sources and then react. Some older drivers react more
slowly in a new situation.

These are all normal changes in how the brain works with age. There are, however, two
forms of mental problems that can also affect the ability to drive.

      Depression, being ―down in the dumps‖ for a long time, may happen to many
       older people, but it is not normal. It can, and should, be treated. The attention
       and sleep problems depressed people of any age sometimes suffer can interfere
       with safe driving. So can the medicines used to treat depression.

      Dementia causes serious memory, personality, and behavioral problems that the
       affected person cannot recognize. People with dementia may at first remember
       how to operate an automobile and how to travel to familiar places. However, as
       the disease progresses, their driving abilities do become impaired. Unfortunately,
       people with dementia often cannot recognize when they should no longer drive.

Health problems––Other illnesses common among older people can affect the ability to
drive safely such as arthritis, Parkinson’s disease, or stroke. Sleep problems or fainting
make you less alert at an age when you may already have a hard time focusing your
attention. If you have an automatic defibrillator or pacemaker, your doctor might suggest
that you stop driving because there is a chance that the device might cause an irregular
heartbeat or dizziness. Diabetes may cause nerve damage in your hands, legs, or eyes.
The eye damage from diabetes is known as diabetic retinopathy. If you also have trouble
controlling your blood sugar level and might be in danger of losing consciousness, you
should think about giving up your license.

Medications––Older Americans take more prescription medicines than any other age
group. They often have one or more long-term illnesses such as arthritis, diabetes, high
blood pressure, and heart disease and may be taking several different drugs. Also, herbal
remedies are becoming popular as cost of medicines increase, more people seek solutions
to chronic conditions. An estimated 40 percent of the older-adult population use or have
tried herbal remedies. Multiple prescription medications, combined with over-the-
counter drugs and herbal medications may result in a complex medication interactions.

With age, older adult bodies may be more sensitive to the effects of medicine. The older
body may not use up a drug as quickly as a younger body does, so the drug can be active
for a longer time. Sometimes a combination of medicines increases the effects of each
drug on the body.




                                            85
Drugs that might interfere with your driving include sleep aids, medicine to treat
depression, antihistamines for allergies and colds, strong painkillers, and diabetes
medications. If you are taking one or more of them, talk to your doctor. Perhaps he or
she could change your prescription, or help you decide if the medicine—prescription,
over-the-counter, or herbal remedy—is affecting your driving.

Can I Be a Better Driver?
Many older people avoid difficult driving situations such as operating a vehicle at night,
on highways, during rush hour or in bad weather. Some limit trips to shopping and visits
to the doctor. This lowers the chance of having an accident. Older drivers are most at
risk while yielding right of way, turning, especially left turns, lane changing, passing, and
using expressway ramps. Pay extra attention at those times. If there is no left-turn light,
look for alternate routes that do provide such lights.

Plan your trips ahead of time. Stick to streets you know. Don’t drive under stress. Keep
distractions such as the fan, radio, or talking, to a minimum. Leave a big space between
your car and the one in front of you. Don’t drive when you are tired.

Think about taking a driving refresher class. Some car insurance companies reduce your
payment if you pass such a class. The AARP sponsors the ―Driver Safety Program.‖ Call
1-888-227-7669 (1-888-AARP NOW) for details about courses in your area. The AAA
(formerly known as the American Automobile Association) has a similar class called
―Safe Driving for Mature Operators.‖ Contact your local AAA office for class
information. These are 8-hour classroom courses that talk about the aging process and
help drivers adjust. You might want to take such a review every few years.

Certain features on a car can make driving easier. Power steering, power brakes,
automatic transmission, and larger mirrors are all helpful. Keep the headlights clean,
aligned and on at all times. Having a light-colored car will help other drivers see you.
Check the windshield wiper blades often use the rear-window defroster to keep the back
window clear at all times.

If in a crash, older occupants are more likely to suffer injuries than younger occupants.
Because older bones and blood vessels may be less flexible, they might break more
easily. People of any age should sit at least 12 inches from the steering wheel. Everyone
in the car should always wear a safety belt.

Should I Cut Back on Driving?
What if all of these suggestions are followed for safe driving and you are still concerned
about control the car in all situations? There are questions to ask yourself:

              Do other drivers often honk at you, and when?
              Have you had some accidents, even ―fender benders‖?
              Are you getting lost, even on well-known roads?
              Do cars or pedestrians seem to appear out of nowhere?



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              Have family, friends, or your doctor said they were worried about your
               driving?
              Do you drive less because you are not as confident about your ability?
              Have you been stopped by police for your driving?

If you answered yes to any of these, you probably should think seriously about whether
or not you are still a safe driver in all situations.

Resources to help make the driving reduction or retirement decision include:

              Free AARP guide, ―The Older Driver Skill Assessment and Resource
               Guide: Creating Mobility Choices.‖ Write to AARP Fulfillment, 601 E
               Street, NW, Washington, DC 20049, and asking for publication D14957

              The AAA Foundation for Traffic Safety free booklet, ―Drivers 55-Plus:
               Test Your Own Performance,‖ may be viewed and ordered on their
               website http://www.aaafoundation.org

              Free brochures on driving safety are available from the National Highway
               Traffic Safety Administration and may be downloaded from their website
               www.nhtsa.dot.gov/people/injury/olddrive/ or ordered by phone (888)
               327-4236 or fax(202) 366-7078

              The Hartford (insurance company) offers ―At The Crossroads: A Guide to
               Alzheimer's Disease, Dementia & Driving.‖ Download from their website
               http://www.thehartford.com/alzheimers/brochure.html or contact the John
               Hartford Foundation, At the Crossroads, 200 Executive Boulevard,
               Southington, CT 06489

How Will I Get Around?
When planning for retirement, you should think about how you’d get around if you were
not able to drive. Some communities provide low-cost bus or taxi service for older
people. Some offer carpools or transportation on request. Religious groups sometimes
have volunteers who take older adults where they need to go.

If such services are not available in your community, taxis may seem too expensive to
use often. Remember that you won’t have a car to maintain any longer. In fact, the AAA
estimates that the cost of owning and running the average car is over $6,500 a year. By
giving up your car, you might have as much as $125 a week that could be used for taxis,
public transportation, or buying gas for friends and relatives who can drive you places.

You can find your local agency on aging to learn about transportation services available
in your area through the Eldercare Locator: 1-800-677-1116
http://www.eldercare.gov.




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                        Safe Driving for Older Adults
                                  Self-Assessment
Some of the changes you experience as you get older can affect your ability to drive
safely.
The good news is that people who keep track of changes in their eyesight, physical fitness
and reflexes may be able to adjust their driving habits so they stay safe on the road.
The following questions will help you decide if physical changes have affected your
driving skills. Helpful tips about coping with these changes are also provided so that you
can remain a safe driver for as long as possible.
How is your eyesight?
Do you have trouble…
      Reading signs easily?
      Recognizing someone you know from across the street?
      Seeing street markings, other cars, and people walking—especially at dawn, at
       dusk and at night?
      Handling headlight glare at night?

If you said ―Yes‖ to any of these questions, you should…
      Make sure you always wear your glasses and that the prescription is current.
      Keep your windshield, mirrors and headlights clean.
      Make sure that your headlights are working and aimed correctly.
      Sit high enough in your seat so you can see the road for at least 10 feet in front of
       your vehicle.
      If you are 60 or older, see an eye doctor every year.
Do you have control of your vehicle?
Loss of strength, coordination and flexibility can make it hard to control your
vehicle. Do you have trouble…
      Looking over your shoulder to change lanes?
      Moving your foot from the gas to the brake pedal?
      Turning the steering wheel?
      Walking a block a day?
      Going up or down stairs because you have pain in your knees, legs or ankles?



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If you said ―Yes‖ to any of these questions, you should…
      Check with your doctor about physical therapy, medicine, stretching exercises, or
       a walking or fitness program.
      Know that an automatic transmission, power steering and brakes, and other
       special equipment can make it easier for you to drive your vehicle and use the
       foot pedals.
      Reduce your driver’s side blind spot by moving your mirrors.
      Watch for flashing lights of emergency vehicles.
      Listen for sounds outside your vehicle.
Does driving make you feel nervous, scared or overwhelmed?
Do you…
      Feel confused by traffic signs, and people and cars in traffic?
      Take medicine that makes you sleepy?
      Get dizzy, or have seizures or loss of consciousness?
      React slowly to normal driving situations?

If you said ―Yes‖ to any of these questions, you should…
      Ask your doctor if your health or side effects from your medicine can affect your
       driving.
      Take routes that you know.
      Try to drive during the day (avoid rush hour).
      Keep a safe distance between you and the car ahead of you.
      Always scan the road while you are driving so that you are ready for any
       problems and can plan your actions.
Are loved ones concerned?
Sometimes other people notice things about your driving that you might have
missed. Have people who you know and trust said they were concerned about your
driving?
If you said ―Yes,‖ you should…
      Talk with your doctor. Ask him or her to check the side effects of any medicines
       you are taking.
      Think about taking a mature driving class. The AAA, AARP and driving schools
       offer these classes.



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      Try walking, carpooling, public transit, and other forms of transportation.
For additional information about traffic safety for older road users, and safety belts and
child safety seats, please visit the NHTSA website at www.nhtsa.dot.gov. DOT’s Auto
Safety Hotline (1-888-327-4236) can also answer your questions and provide free traffic-
safety information.




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