Assessment tools predicting fitness to drive in older adults: a systematic review

Occupational therapy and driving and community mobility for older adults

This special issue of the American Journal of Occupational Therapy includes summaries from a systematic evidence-based literature review of occupational therapy and driving and community mobility for older adults. Since the previous review on this topic in 2008, the cohort of 78 million baby boomers began turning 65 in January 2011. As a group, this cohort is more likely to have longer life expectancy, stay in the workforce longer, and age in place in the community. Is the occupational therapy profession ready for the potential demand for driving rehabilitation services from this generation of older drivers who grew up with the automobile and are dependent on it for access to and participation in their communities?

Dropout during a driving simulator study: A survival analysis

INTRODUCTION

Simulator sickness is the occurrence of motion-sickness like symptoms that can occur during use of simulators and virtual reality technologies. This study investigated individual factors that contributed to simulator sickness and dropout while using a desktop driving simulator.

METHOD

Eighty-eight older adult drivers (mean age 72.82±5.42years) attempted a practice drive and two test drives. Participants also completed a battery of cognitive and visual assessments, provided information on their health and driving habits, and reported their experience of simulator sickness symptoms throughout the study.

RESULTS

Fifty-two participants dropped out before completing the driving tasks. A time-dependent Cox Proportional Hazards model showed that female gender (HR=2.02), prior motion sickness history (HR=2.22), and Mini-SSQ score (HR=1.55) were associated with dropout. There were no differences between dropouts and completers on any of the cognitive abilities tests.

CONCLUSIONS

Older adults are a high-risk group for simulator sickness. Within this group, female gender and prior motion sickness history are related to simulator dropout. Higher reported experience of symptoms of simulator sickness increased rates of dropout.

PRACTICAL APPLICATIONS

The results highlight the importance of screening and monitoring of participants in driving simulation studies. Older adults, females, and those with a prior history of motion sickness may be especially at risk.

Typical Brake Reaction Times Across the Life Span

This paper provides average brake reaction times for healthy community living adults from 16 to 90+ years of age, divided by gender. Using consistent directions and context, the RT-2S Simple Brake Reaction shows that average brake reactions for males is 0.50 seconds (median = 0.48, minimum = 0.25 maximum = 0.92) and for females is 0.53 seconds (median = 0.51 minimum = 0.30 maximum = 1.36). The use of a brake reaction timer to assess fitness to drive may be useful for clients recovering from orthopedic surgery, while use as a driving determinate of older adults should be done in conjunction with other tools.

Factors Influencing the Clinical Stratification of Suitability to Drive after Stroke: A Qualitative Study

While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a "maybe" group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive picture of the person. A mix of assessment approaches including standardized assessment but with increased emphasis on naturalistic observation of functional performance underpinned the clinical stratification process. This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum.

State of the journal, 2014

The outgoing editor-in-chief outlines the advances made during her 6-yr tenure and provides recommendations for AJOT’s future

Method for the systematic reviews on occupational therapy and driving and community mobility for older adults

Systematic reviews of literature relevant to driving and community mobility for older adults are important to the practice of occupational therapy. We describe the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy assessments and interventions for driving and community mobility for older adults. We include the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review, a summary of the themes of the results, the strengths and limitations of the findings, and the implications for practice, education, and research are presented.