Feb 10, 2020
Driving is often the key to independence with many older adults and family members struggling to make the best decisions around this ability and resource. Terry Cassidy, Occupational Therapist, certified Driver Rehabilitation Specialist for Fitness to Drive and owner of Health Promotion Partners shares this discussion with Maile Gray, Executive Director of Drive Smart as they talk about signs that driving may be at risk, the evaluation processes they use and most importantly how to transition out of driving and yet keep on living.
Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Learn more at Pikes Peak Area Agency on Aging.
Transcript:
Today's episode is about transit and independence. My name is Michaela Nichols and I'm here with Terry Cassidy and Maile Grey. Terry is a licensed occupational therapist and a certified driver rehabilitation specialist at Health Promotion Partners. Miley is the Executive Director of Drive Smart Colorado.
Q - Can you both give a short introduction about what you do?
A – Sure. I'm the director like you said of a small community traffic safety education program. We’re a non-profit and we've been around since the 1980s. We have a series of programs, kind of from birth on up through you know teenage years, working with communities and we have a very, very, robust program geared toward the older driver. Our entire focus, our mission for the nonprofit, is to reduce crashes. Thus, reducing injuries and fatalities. So, our work with the older driver, is to focus on making sure that they drive as long as they can safely do so. So, we have some little tips we give presentations, we partner with Terry, and basically have a good time with the aging population.
Michaela - Thank you
Terry - I'm Terry and I'm the owner and operator of Health Promotion Partners. Our main program is the Fitness to Drive Program. And so, through that problem, we do driver evaluations. I really see our role as helping individuals and helping families to make decisions around driving. So, certainly when we’re talking about older drivers, really looking at skills related to driving, really helping people make decisions. Do they need to cut back, do they need to change some things, or maybe they need to find alternatives to driving in order to get around in the community?
Q - As people age, they can begin to experience decreased ability to safely drive. Can you talk about some of the signs that people may be losing the ability to drive safely?
Terry - Sure. You know there are definitely warning signs, and there's a list of them available, there are some good lists, we can give you some resources for those. but one piece I would like to mention, is it's not to me that ability or losing the ability drive, isn't related directly to age. so, there are factors like are physiologically that tend to be more common as people get older, but certainly when I’m looking at someone's ability to drive it's really about function more so then the date they were born. but in terms of the driving ability things that are commonly changing with age would be things like vision. the amount of light someone needs to have good vision. also, that reaction time, making quick decisions in the moment. sometimes some physical changes, neck range of motion can really impact safe driving in terms of being aware of what's going on around your vehicle. and even moving hand and foot movements can be issues there. I think in terms of warning signs that a family member would notice, or maybe someone drivers themselves, and things we ask families to keep an eye out for would be dents or scratches on car that there's maybe not an explanation for. certainly, somebody getting lost in a familiar environment is a warning sign the third should be a little more investigation done. and you know one that we mention a lot is if there's people in your life who are not wanting to ride with you. so that might be your child sometimes it could be a very good friend who is trying to help you out there so listening to people around you sometimes and
Maile - to tag on a little bit to Terry, oftentimes the family members don't necessarily notice the changes in mom or dad driving because say you go to visit them it's pretty typical for the younger, the adult child the adult family member, to actually take over the driving while they're visiting or such. and so sometimes you might say well yeah my mom or dad is just doing great, well when was last time you actually let them drive? you know so that might be something to keep in mind that periodically, you as a family member, let that person drive you around a little bit. and then you might have a better understanding of where they're at when it comes to their ability to safely drive. and like Terry said, I think I think most people can drive from their house to the grocery store, or their House or to the doctor's office, in the perfect world. but we don't live in a perfect world, and there are people out there who are who do things like run stop signs and run stoplights and are very distracted these days and for that reaction time to really be keen you know to be able to really slam on their brakes, or to be able to really maneuver out-of-the-way of somebody else. might not be your driving, but to be able to protect yourself and people in your car. That's kind of a tricky situation.
Q - Can you talk about the process of assessing someone's driving and the steps that you take?
Terry - Sure, so as you mentioned in the beginning my background is as an occupational therapist so really my evaluation all comes from that standpoint. but we're really looking at the skills related to driving. so, some of those warning signs or factors that I mentioned earlier we do a really thorough evaluation of vision. so not just the eye chart, but an interesting vision piece is contrast sensitivity, and something that's not measured very often, and that is a visual skill that does tend to decrease with age. There is actually more evidence linking contrast sensitivity to crashes than acuity. so it's just kind of interesting.
Maile - Can you explain Terry what contrast sensitivity is?
Terry - I can try, yes. so, I explain contrast sensitivity as really being able to tell foreground from background. so, I think of somebody driving, around here, I think of seeing a deer at dawn. like you're going down the street, if your vision is crisp and you're awake, you'll notice it- but it would be easy to drive by and not even notice that there was a deer on the side of the road, or somebody in a dark sweatshirt in the evening. so really pertains to low light conditions and so that's just one piece of what I could look at. So, what I would look at but a lot of times somebody would decrease contrast sensitivity in my recommendation might be that may not drive at night, for example.
Maile - so, it does not necessarily mean you can't drive at all it just means you might need to self-limit or have some serious suggestions made to you about where you should drive and when you should drive
Terry - so aside from vision. I would look at strength and range of motion. some of those things I talked about. movement, being able to check your blind spots, or turning your head. and then I do have some equipment that looks at brake reaction time. so really just testing that motor speed of going from gas pedal to brake pedal, based on what that person is seeing the red or green lights there. I always do some sort of cognitive assessment. so, it's just a screening, but really looking at memory. working memory and cognition to some extent as part of it. really because it's driving involves so much brain work. We just, it's such an overlearned task we don't realize that we're working so hard when we're driving, but really there's a lot to it
Q - Can you talk about some of the small adjustments that can be made to help assist with safer driving?
Terry - yeah, I’m going to let Maile talk about car fit for little bit here
Maile - So, car fit. I actually was taught car fit by Terry, but she's been real busy doing all of our other things. For the most part I kind of have done a lot of car fit trainings and events in our community. Car fit is an international program that was developed in 2006 by AAA, the American Occupational Therapy Association, and AARP. So those folks got together and thought, can't we just do something that helps seniors, or really anybody, make sure that they fit in their car properly. That they can do things simply, like eliminate the blind spot, which really helps in the range of motion for your neck. If you eliminate blind spots out of your sideview mirrors, you don't have to careen your neck so far in order to see a car coming up on your side. That does a couple things, in these days of extreme distracted driving, the longer you take your eyes away from the windshield and from what's in front of you, even to look behind you to see who's coming up on the side of you, could mean the difference of a crash or not. So, the less time that you take your eyes away from the road the better. So, we have little tips. You know, simple, simple, things that all, and i really want to stress this, is really for all ages. When people buy a car these days, they're taught about Bluetooth, they’re taught about the little blinking lights for, you know in the side view mirrors, they're taught about all the info-tainment section, on maps. They're taught about all this stuff. But they're not reviewed on how they should sit, how far away should you sit from your steering wheel, which is really not just your steering wheel but it's where the airbag deploys. So, we remind people that they want to keep that 10-inch zone between their chest and the steering wheel, airbag deployment zone. You don't ever want to sit real close to the steering wheel, like you see a lot of people driving, sometimes more the older person. because perhaps they've shrunk a little bit, they're not quite as tall as they once were, so they are sitting closer to the steering wheel to see things. So, you know, those are very simple to show them and remind them how you tilt your steering wheel so that it's tilted down toward your chest and not your face, because you don't want the airbag coming up at your face. Most people do not realize that their seat belt up by their shoulder actually can slide up and down to accommodate a taller person or shorter person, so that you make sure that that seat belt is riding across your collarbone and not like across your neck or down low on your shoulder. You really need that seat belt to be sitting across your collarbone, and then the lap portion to be low on your hips below your tummy. Those little reminders can actually make the difference between life and death, or at least severe injury. So, this is a 12-point check, this car fit event, a 12-point little checklist that we go through. And I am telling you every single person that gets out of there has some kind ‘ah-ha!’ moment that they didn't realize. And so, anything that we can do for them, the more we can educate the public on how to make sure that their car actually fits them properly. We don't look at their driving. We don't evaluate their driving at all. We only wanna see how they sit in their driver seat, and it can even be used for the passenger as well, some of these little tips. So, it's just really important to remember that, when you get in the car, make sure your steering wheel is not tilted up towards your face, make sure your sideview mirrors and your rearview mirror are all adjusted properly. Make sure that that you're just ready to go, that it fits you and not your spouse who is 6 foot four and you’re 4 foot 11. You're not seeing things the same way, but oftentimes people don't make those personal adjustments every time they get in the car. So, these are all just super simple and it's a very, very, enjoyable free service. And you can find a car fit technician by going to car-fit.org and you can find a technician in your area.
Terry - and if I could just add to that, car fit is really fun and great program. as I said it's not an evaluation of driving, it's really, I think of it as how well someone is using the safety features of their vehicle. For a lot of individuals, safety features have changed quite a bit since they started driving so there's..
Maile – Well there ARE safety features
Terry -..to me, I would say along the lines of small adjustments. In terms of helping your driving ability, to me, really goes along with healthy habits for life. Things like exercise, getting your eyes checked, taking your medications, walking keeping your brain active. You know, the kind of things that I think are good for our bodies and our brains throughout our lives. Those things are going to impact your driving as well.
Maile - To tag on to that. I was chatting with a woman one day at the Senior Center, and so she was a little bit elderly, but she's just walking along, and she just did a car fit with me. I said ‘well you did great’, she said ‘I learned so much’ and she goes ‘you know, I didn't drive for two years because I couldn't move my neck and everything, now I've been taking an exercise class and I'm back in the driver seat’. She goes, it made all the difference for her to get physically active again. So like Terry said, it is really important to maintain that physical fitness, along with everything else, your hearing, your eyes and what not because that is just going to help maintain your health as long as possible so that you can remain as active as possible.
Q - Driving is often seen as a way to stay independent. how would you help convince someone who may no longer be a safe driver to stop driving or limit their driving?
Maile - I do have this conversation with individuals that I see, I wish..
Terry - Its terribly difficult
Maile - ..that I didn’t ever have to have this conversation, because nobody wants to. Often, I'm coming at it from the perspective of, I want to keep somebody, when I look at independence. I’m looking at, are you able to do the things you want to do in your community? So often, we think independence has to mean alone, like I got there by myself. But to me it's very independent if you were able to do the things you need to do. If you're able to get to church, if you're able to get groceries, if you're able to socialize with your friends. And if we can emphasize more on the outcome in that perspective and less on that, (more on) things like did you independently schedule your ride with Silver Key or with Envida or with… you know there's a lot of ways to be independent and not drive yourself, but that's a shift in thinking
Terry - In our community, you know we're fortunate to live in a city of pretty good size. We’re a substantial sized city, we’re not as big as, you know, Los Angeles or even Denver, but we have over a half a million people living in this community. We’re fortunate that we have some programs out there. Transportation options for people. and it depends on your own ability, your own mobility, but you can take the bus, you could ride a cab, or a ride sharing program like Lyft or Uber. But there are, in the Colorado Springs Pikes Peak Area Council of Governments region. There are many open public transportation options that are pretty cost efficient and don't cost a lot of money, and you can find those by the mobility coordinating committee page on the Area Agency for Aging website. But, besides that, they often also rely on family members or friends. But it is the most difficult, probably, conversation that anybody has with a family member, for sure. Because I think that people do associate loss of driving, which they've been doing almost all their lives, with… well it can be very depressing to people. Our goal is to not let those people get to that point of depression by helping suggest other (options like) Silver Key or some of our other programs in our area. Now it is a little more tricky if you live in rural communities, where there are not as many options. And that's a very serious problem and there could be some innovative ridesharing. You know, if you're older and retired and you still have a car, perhaps you can offer your services to help drive somebody to their doctor's appointment, or to get their hair done. Something as simple as getting your hair done is one of the most important things that a lot of women do, and a lot of these transportation options take them to medical appointments, but not necessarily these other social engagements that are part of keeping you a whole person. So, we want to be able to suggest some other options to them so that they can maintain that feeling of being who they have been without driving. It’s really a tough it's a tough situation.
Maile - And I will add a little bit here just my belief that as a society where we're going to have to shift to having this conversation more often. Honestly, because people are living longer if you look at generations, in the past it was not as big of a topic as it is now. And the research (shows that) men will outlive their ability to drive by 6 years, women by 10 years. And I often share that with clients, just to know that they're not alone in this, and they're not really being singled out by their family for some reason. This is something that as a society we need to find solutions to. And I think if we get closer to that, then it may not be as difficult of a transition. Because ‘Oh my neighbor down the hall says this service’ and ‘my neighbor here’, you know as more people are doing it my hope is that it's normalized.
Terry -absolutely
Q - It sounds like you already talked about alternate transportation options, but what do you see in the future of transportation in this area and the surrounding area?
Terry - I think the new buzzword is like autonomous vehicles right and that would just be amazing. Just dial up an autonomous car and they come and pick you up, and off you go to wherever you want (and) whenever you want. That is a ways off. The way people talk about it these days, is they really think this is going to happen within the next five years (for) that type of independence. They are testing them for sure, but when you think of an autonomous car, they do operate on a lot of things, for sure technology, but even as simple as infrastructure the road condition. If we think right now about the roads that we drive on, and the potholes, and the broken lines, because oftentimes they guide themselves on lines and on guardrails and what not. And there's just still a lot of that that needs to be fixed, so that's gonna take a little while. But I think at some point we will be, that will be a reality. I’m not exactly positive when that's going to happen, when it does it's going to be amazing. So that's one thing that we hear a lot about these days, ‘oh autonomous cars, driverless vehicles’, it's just going to be a little while. In the meanwhile, we need to do these other things that we've been talking about.
Maile - And I think too, finding ways, I think really turned courage community members to be involved in these discussions. With vehicles, or things along those lines, there's a lot of different ways it could look. And so, there's an ideal way, where there's coordination so that there's not just duplication of services (where you would have) 10 cars on the road for every one car you have right now (and) half of them are empty. You know there's a lot of pieces to that, but I think if it can be coordinated with public input. And I think a really important piece is to look at all the stakeholder. So, is there access for somebody in a wheelchair into an autonomous vehicle or a bus system, whatever that is. Is it appropriate for people, maybe who have low vision or even? So, looking at aging and disability and whatever the future for transit in this area is, I think is an important piece and then really looking at collaboration so there is not duplication.
Terry - And you know (as) we are here talking, we're sitting in the Area Agency on Aging, but honestly the services that like, for example I'm the chair of the mobility coordinating committee through this organization. And a lot of that deals with the disabled. So, it's not you know, we're talking about ability for everyone to be able to get where they want to go, when they want to get there, safely. Not just the older folk, who sometimes are also a little bit disabled in various ways, but it could be someone who's young but has some type of disability, who has a difficult time navigating this situation too. We want everyone to be able to get wherever they want to go safely and efficiently.
Q - Do you have anything else you'd like to share
Maile - If you have any questions about driver evaluation services, I’d be happy to talk to you/ go ahead and give us a call health promotion partners number 719-231-6657 or website is www.healthpromotion partners.com
Terry - and Drive Smart Colorado can be found up at 719-444-7534 and our website is drivesmartcolorado.com, even though we're a non-profit, I don’t even know if .org was around when we started, we've been around so long. But it is drive smartcolorado.com. I do want to guide people to the older driver page on that website because it has a lot of good information. It also has a copy that you can download of the Colorado’s guide for aging drivers and their families. This is about a 60 page guide, that is we can also send hard copies if you want, but it talks about everything from how to drive a roundabout, what did some of the bike lanes mean and how do you navigate them, because that's confusing to a lot of people. It also talks about Colorado's laws on how you get, how you renew your driver’s license and that sort of thing. It also goes through some tips on car fit (like) how to make your mirror adjustments. We also have a planning table. Let's say you want to reduce your driving amount of time, so maybe each week you sit down and you write ‘OK Sunday I'm going to go to the grocery store into church and Monday I'm gonna do this’ I mean it's a planning table to kind of help you guide your decisions in your week of driving as well. So, there's a lot of good information in there, so it's Colorado’s guide for aging drivers and their families
Michaela - thank you so much Terry and Maile for joining me on this episode of aging with altitude for those interested in learning more about what the Pikes Peak Area Agency on Aging offers you can go to ppacg.org or call 719-471-2096. Thank you.