By Amanda Mohler, OTD, OTR/L
Department of Occupational Therapy
Arkansas State University
Driving is a dynamic task requiring the active engagement of an individual’s sensory, perceptual, cognitive, and motor systems. However, as individuals age, the systems are at risk of declining, resulting in poorer accuracy of driving performance. Research shows the effects of aging on physiologic systems often result in decreased muscle strength, coordination, and motor control. The aging systems can result in a slowing of emergency maneuvers and increased breaking time (Karthaus & Falkenstein, 2016). Furthermore, age-related degeneration of the peripheral sensory receptors results in decreased postural control of the lower limbs and decreased force production for pedal reaction (Lacherez, Wood, Anstey, & Lord, 2014; Woolnough et al., 2013). Researchers found cognitive functions relevant for safe driving decline with age as well. Imperative executive function skills such as the ability to visually scan the driving field or shift attention decreases with age. The changes in executive function result in the decreased ability to monitor the environment, react appropriately, and manage multiple tasks, therefore, resulting in an increased risk of accidents or traffic violations (Karthaus & Falkenstein, 2016; Hahn, Wild-Wall, Falkenstein, 2011; Richardson & Marottoli, 2003).
There is a misconception that stricter driving rules and policies for aging adults would resolve the behind the wheel risks.. However, research shows increased monitoring, such as undergoing medical or vision tests to renew one’s license, does not result in increased safe driving or decreased fatal accidents (Karthaus & Falkenstein, 2016). Some proponents of harsher driving laws have even recommended retracting a drivers’ license after a specific age. However, decreased access to driving often encourages individuals to use less safe methods of mobility, such as walking or driving without a license. Therefore, regulating older adult drivers with harsher policies is not the answer. Rather, the solution lies in finding strategies to promote safe driving designed explicitly for the aging population.
To address the growing population of older adults still driving, students from the Department of Occupational Therapy at Arkansas State University (AState) partnered with community civic agencies to promote older adult safe driving using driving simulation technology. Driving simulation is an evolving technology consisting of computer-aided technology to mimic real-life driving scenarios. Trained professionals use driving simulation for assessment and intervention purposes. The simulation technology allows professionals the capacity to assess one’s ability to drive, including physical and cognitive factors. The driving simulation produces real-world and evidence-based results that professionals can review with clients via a report or video replay to provide education and training on their changing needs related to aging and driving.
Because of the flexibility of driving simulation technology, all individuals benefit from it no matter age, gender, disease, or injury. At AState, educated students and faculty use the technology to assess specific human functions related to driving, aging, and older adult diseases. Common assessments include, but are not limited to, physical ability to sustain driving, reaction time, hazardous perceptions, memory, planning, safety, attention, and vehicle control. Each of the driving skills are relevant in assessing and enhancing cognitive, sensory, and motor skills. Following each drive, the health professional reviews the results with clients and provides feedback and recommendations on maintaining safe driving. If clients require additional training, they have the option to participate in a driving program using the simulator. During the driving program, clients receive education on specific impairments and safe driving skills including basic vehicle control skills (e.g., steering wheel, or gas and brake pedal), progressive roadway and driving tasks (e.g., construction zone or metropolitan city), and advanced driving safety and performance skills (e.g., defensive driving or hazard detection).
Since the simulation occurs in a controlled environment, it offers many benefits. One benefit is the ability to provide safe, objective, reliable, and repeatable performance measures (Classen & Brooks, 2014; Be ́dard, Parkkari, Weaver, Riendeau, & Dahlquist, 2010). Second, professionals can present situations that would not otherwise be available or may be too risky for the client at the time of the assessment. The simulator operator can control the simulation settings, including external conditions (e.g., weather, traffic, road surface), exposure to hazards such as school zones or pedestrians, and control the driving situations (e.g., suburban or rural).
Driving is an everyday and automatic task. For many older adults, driving is a way to remain independent and mobile. Losing the ability to drive puts one at risk for depression, isolation, and decreased health. Therefore, restricting or revoking an older adults’ ability to drive has the potential to increase the national economic burden and decrease one’s overall quality of life. It is not a matter of changing policies or restricting one’s license. Instead, professionals and policymakers should focus on educating older adults on safe driving and addressing their changing skills associated with the natural age-related process.
Be ́dard, M., Parkkari, M., Weaver, B., Riendeau, J., & Dahlquist, M. (2010). Brief Report— Assessment of driving performance using a simulator protocol: Validity and reproducibility. American Journal of Occupational Therapy, 64, 336–340.
Classen, S. & Brooks, J. (2014). Driving Simulators for Occupational Therapy Screening, Assessment, and Intervention. Occupational Therapy in Health Care, 28(2), 154-162. doi: 10.3109/07380577.2014.901590
Hahn, M., Wild-Wall, N., & Falkenstein, M. (2011). Age-related differences in performance and stimulus processing in dual task situation. Brain Research, 1414, 66–76.
Lacherez, P., Wood, J.M., Anstey, K.J., & Lord, S. (2014). Sensorimotor and postural control factors associated with driving safety in a community-dwelling older driver population. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 69 (2), 240–244. Retrieved from http://dx.doi.org/10.1093/gerona/glt173
Richardson, E.D. & Marottoli, R.A. (2003). Visual attention and driving behaviors among community-living older persons. Journal of Gerontology: Series A, 58, M832–M836.
Woolnough, A., Salim, D., Marshall, S.C., Weegar, K., PorterM.M., Rapoport, M.J., Man Son-Hing, M.,…Vrkljan, B. (2013). Determining the validity of the AMA guide: A historical cohort analysis of the assessment of driving related skills and crash rate among older drivers. Accident Analysis & Prevention. 61, 311–316. Retrieved from: http://dx.doi.org/10.1016/j. aap.2013.03.020