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                        North American Conference on Elderly Mobility (NACEM) Noteworthy Practices


            
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                Driver Education and Training
Florida's Aging Road User Strategic Safety Plan

Over 18 percent of the population in Florida is over age 65 and by the year 2030, this demographic is predicted to increase to 27 percent. To address the transportation safety challenges of the State's aging population, the Florida DOT and the Pepper Institute on Aging and Public Policy formed Florida's Safe Mobility for Life Coalition and together developed an *Aging Road User Strategic Safety Plan*.4 The Safe Mobility for Life Coalition is a statewide alliance of 28 member organizations that represent the fields of engineering, enforcement, safety, health, transportation, and aging. A central goal of the *Aging Road User Strategic Safety Plan* is to reduce the number of driving–related injuries and fatalities among older drivers in Florida. The plan also helps aging Floridians maintain their independence and remain active in the community even when driving is no longer feasible. To meet these goals, the plan includes 10 Emphasis Areas that balance the safety and mobility needs of Florida's aging population.

**Aging Road User Strategic Safety Plan Emphasis Areas:**

Advocacy and Policy
	Aging in Place
	Assessment, Remediation, and Rehabilitation
	Data Collection and Analysis
	Licensing and Enforcement
	Other Road Users
	Outreach and Education
	Prevention and Early Recognition
	Program Management, Evaluation, and Resources
	Transitioning from DrivingDuring the plan's development process, coalition members met four times between August 2010 and September 2011; the emphasis area teams met twice. During these meetings, members developed goals, objectives, performance measures, and strategies for implementing improvements in each emphasis area.

Some of the objectives identified in the plan include:

Increase the number of drivers who are proactive about staying safe on the road;
	Increase the number of livable communities in Florida;
	Increase communication opportunities with elected officials to promote policies that enhance safety, access, and mobility for aging road users;
	Increase the statewide capacity of driver rehabilitation specialists; and
	Identify and implement effective design elements and safety countermeasures to benefit aging vulnerable road users.In addition to the expertise offered by the Coalition, three focus groups were conducted to obtain stakeholder input on the plan. Finally, to identify the habits, needs, and concerns of Florida's aging road users, a survey was conducted with Florida residents age 50 and older. The results were used to establish a baseline for the strategic plan and further refine the plan's strategies. Survey respondents indicated that the availability of transportation options, planning for transitions away from driving, awareness of Coalition resources and safety events, and general safety concerns like distracted driving are critical issues for aging road users. In response, the strategic plan incorporates objectives and strategies to address these issues.

"Image shows the cover of Florida's Guide for Aging Drivers"**Figure 9.** Florida's Aging Road User Strategic Safety Plan
Source: Florida Department of Transportation

As the Coalition began implementing the plan, one of the first resources developed was *Florida's Guide for Aging Drivers* (Figure 9). This guide is designed to help older Floridians continue driving as long as safely possible and shares information to help them prepare for their transportation needs should they need to stop driving. Ultimately, the *Aging Road User Strategic Safety Plan* was aligned with the Florida DOT *Strategic Highway Safety Plan*5 and is included in the emphasis area that focuses on at–risk drivers.

For additional information:

Agency: Florida Department of Transportation
Contact: Gail Holley, Safe Mobility for Life Program Manager
Telephone: 850–410–5414
Email: gail.holley@dot.state.fl.us

Michigan's Guide for Aging Drivers and Their Families

Since 1997, the Michigan Senior Mobility Work Group, a statewide group of safety partners, has been addressing the challenges of the State's aging population. Organized under the direction of the Governor's Traffic Safety Advisory Commission, the goals of the Senior Mobility Work Group are to improve the safety and mobility of aging Michigan residents even when driving is no longer a safe option, and reduce serious injury and fatal crashes involving older drivers. To assist with meeting these goals, the Michigan DOT partnered with the Michigan Department of State, the Office of Highway Safety Planning, and AAA Michigan to publish and distribute *Michigan's Guide for Aging Drivers and their Families* (Figure 10).

"Image shows the cover of Michigan's Guide for Aging Drivers and Their Families"**Figure 10.** Michigan's Guide for Aging Drivers and Their Families

The guide is a resource for Michigan's aging drivers and their families and caregivers. It emphasizes the importance of understanding how aging and age–related changes affect the ability to drive safely. A portion of the guide includes information to help establish whether a person is safe to drive. Tools include a driving self–assessment, a list of behaviors that may affect safe driving, guidance on partnering with the medical community, and how to request a driver evaluation. The guide also includes strategies to improve the safety of older drivers such as:

Drive only during daylight;
	Avoid rush hour and heavy traffic;
	Make three right turns instead of a left turn or make left turns at traffic signals; and
	Map out safe routes that include well–lit streets, less traffic, left turns at traffic signals, and clear signs.The guide also reminds readers that not all road users are drivers; many people walk, ride bicycles, or motorcycles. Accordingly, the guide includes safety strategies for these more vulnerable users, as well as winter safety strategies.

The guide concludes with a section on the impact of age–related ability changes on driving. Driving presents particular challenges to older people because of changes in their vision, cognition, and physical function. To address these impacts, there is detailed information on the types of changes that occur with vision, hearing, medication, cognition, dementia, and physical condition and how these changes impact safe driving. There is also guidance for drivers who must limit or stop driving for their safety and the safety of others. The guide encourages aging drivers to develop a transportation plan that incorporates alternative transportation options such as walking, senior shuttles, and bus services for that time when they may no longer be able to drive.

For additional information:

Agency: Michigan Department of Transportation
Contact: Kimberly Lariviere, Strategic Highway Safety Engineer
Telephone: 517–373–3889
Email: larivierek@michigan.gov

CarFit

CarFit is an educational program created by the American Society on Aging and jointly developed by AAA, AARP, and the American Occupational Therapy Association. The program is designed to help older drivers find out how well they fit their vehicle, highlight actions they can take to improve their fit, and promote conversations about safety and mobility. It also provides information and materials on resources that can enhance their safety as drivers and increase their mobility in the community.

Older drivers may contend with physical changes that affect their driving. For example, a reduced range of motion can limit head rotation and visual impairments can delay recovery from glare. Older drivers are also more likely to be killed or seriously injured in a crash due to greater fragility.

While driver safety programs address cognitive abilities and skills, older drivers can also improve their safety by ensuring their vehicles are properly adjusted for them. At a CarFit event, a trained professional asks simple questions and completes a 12–point CarFit checklist. This list includes checking items such as the position of the vehicle's mirrors, the steering wheel tilt, and the driver's position to the brake pedal. The entire process takes 20 minutes and drivers leave with recommended car adjustments and adaptations as well as a list of resources in their area. By making individual adjustments to reach their best person–to–vehicle fit, drivers can better benefit from their vehicle's safety features and have better control behind the wheel. For example, good foot positioning on the gas and brake pedals is important. If the driver is reaching to press on the pedals, it can cause fatigue in the leg and slow reaction times. The top opportunities for a better fit include steering wheel tilt, head restraint position, and improved line of sight.

**A good car fit means:**

Clear line of sight over the steering wheel.
	Room (at least 10 inches) between the driver's chest and air bag in the steering wheel.
	Properly adjusted head restraint.
	Easy access to gas and brake pedals.
	A seat you fit in safely and comfortably.
	A seat belt that holds you in the proper position and remains comfortable while drivingCarFit was pilot tested in 2005 with more than 300 older drivers. Based on findings from the completed checklists and follow–up surveys with participants, the program is proving to be effective, with 37 percent of participants having identified at least one critical safety issue that needed to be addressed. Survey respondents indicate that as a result of their participation in CarFit, they have made a change to improve the fit to their vehicle, their use of safety features in their vehicle, and/or willingness to discuss their driving with family or health care providers.

There is no charge to participate in a CarFit event. A complete list of CarFit events scheduled throughout the country can be found by visiting www.car–fit.org.

"Diagram of the CarFit process"**Figure 11.** CarFit Process

For additional information:

Agency: AARP Driver Safety
Contact: Frank Carroll, Curriculum Development
Telephone: 202–434–3919
Email: fcarroll@aarp.org

Using Driving Rehab Specialists to Help Older Drivers Keep the Keys

By the year 2020, there will be more than 40 million licensed drivers 65 and older. It is essential for occupational therapy practitioners as well as driving rehab specialists (DRSs) to help older adults address community mobility. Personal mobility is critical to healthy aging, quality of life, and independence, therefore, it is important to explore the resources that are available to help aging adults "keep the keys."

Genesis Rehab Services (GRS) provides physical therapy, occupational therapy, speech therapy, respiratory therapy, and wellness services for the older adult population. GRS partners with nursing centers, assisted living facilities, independent living facilities, hospitals, home health companies, adult day care programs, and outpatient clinics to provide comprehensive therapy services. They employ over 18,000 therapists and assistants in approximately 1,500 rehabilitation gyms which operate in 46 States and the District of Columbia and that see 45,000 patients each day.

"Image shows driving rehab specialists conducting an in-vehicle evaluation"**Figure 12.** Driving Rehab Specialists Conduct an In–vehicle Evaluation
Courtesy of *Driving Rehabilitation by Genesis Rehab Services*

GRS employs DRSs who work with clients to help them gain the skills they need to stay safe, comfortable, and confident behind the wheel of their car, even as they experience age–related physical and mental changes. Their goal is to keep clients as mobile, independent, and safe as possible for as long as possible.

GRS provides a variety of services for older adult drivers, including driving wellness consultations, specialized in–vehicle evaluations, client education and support, and training and specialized adaptive driving equipment. In the case of a client needing to cease driving, either temporarily or permanently, GRS will help them transition from driver to passenger. DRSs are highly–skilled occupational therapists with advanced training in driving rehabilitation. Their role is to guide and support clients through the driving evaluation, training, and if necessary the transition process to non–driver. They also work with clients to set reasonable goals for driving. GRS works with licensed, older adult drivers with a wide range of medical conditions, including:

Cataracts
	Congestive heart failure
	Dementia
	Diabetes
	Diabetic retinopathy
	Glaucoma
	Heart attack
	Knee replacement
	Left foot drop
	Mild cognitive impairment
	Mini stroke
	Multiple sclerosis
	Neuropathy
	Parkinson's disease
	Pulmonary disease
	Recent falls
	Sleep apnea
	Stroke
	Syncope
	Traumatic brain injuryCurrently, GRS has trained 10 DRSs and educated staff at approximately 100 facilities on the occupational therapist role in driving and community mobility. The GRS Driving Program is dedicated to raising general awareness of issues that face older adult drivers, which is the first step in making this movement successful and helping seniors keep their keys.

For additional information:

Agency: Genesis Rehab Services
Contact: Susan Touchinsky, Director of Driving Rehabilitation
Telephone: 484–650–2280
Email: susan.touchinsky@genesishcc.com

"Step by step process to get started with driving rehabilitation"**Figure 13.** Process to Get Started with Driving Rehabilitation
Courtesy of *Driving Rehabilitation by Genesis Rehab Services*

New and Improved AARP Smart DriverTM Course

In 1979, AARP initiated "55 Alive" to help keep older drivers safe while on the road. In 2014, AARP Driver Safety launched a new and improved refresher course called AARP Smart DriverTM, available nationwide in a classroom or online setting. The curriculum is based on new research in adult learning, consumer interest, and behind–the–wheel data gathered through driving simulators. The new course teaches safety strategies and defensive driving methods using adult learning principles. Participants learn about new traffic laws and rules of the road, how to safely navigate adverse weather conditions, and information on automobile technology. The course also provides guidance on driving techniques such as the safest way to change lanes and make turns at intersections, maintaining a safe driving distance, the effects of medication on driving, and reducing distractions such as cell phone use.

AARP Smart DriverTM Course can help to:

Update driving skills and knowledge of road rules and road hazards.
	Maintain proper following distance.
		Safely change lanes and make turns at intersections.
	Learn about normal age–related physical changes and how to adjust driving habits to compensate.
	Reduce chances of receiving a traffic violation, being involved in a traffic crash, or becoming injured.
	Bring awareness of the effects of medications on driving and driver distractions such as eating, smoking, and cell phone use.The process used by AARP Driver Safety to develop the course curriculum can be applied by other organizations. When developing the course curriculum, AARP Driver Safety collaborated with experts in mobility, aging, technology, and vehicle and driver safety. Data–based research led to changes in the course content to focus more on areas where older drivers can benefit from additional training. These areas include roundabouts, pavement markings, stop sign compliance, red light running, and driver behavior (such as seat belt use and speeding). AARP Driver Safety also conducted focus groups and incorporated participant feedback into the course revision. The course was field tested prior to its official launch and a simulator study validated its effectiveness at reducing driver errors.

The end result, a course designed with the participant in mind, is different in many ways from its predecessors. For example, course materials are in a new format that features reader–friendly print types and full–color pages. Products developed as part of the new course include a participant guidebook, instructor manual, course video, PowerPoint presentation, an instructor self–preparation and review guide, and an online Driving Resource Center at www.aarp.org/drc. Surveys conducted by AARP since launching the new course indicate that the updated curriculum is effective and drivers are changing their behavior.

Participants can take the course online at www.aarpdriversafety.org or find a classroom course at http://www.aarp.org/findacourse.

For additional information:

Agency: AARP Driver Safety
Contact: Frank Carroll, Curriculum Development
Telephone: 202–434–3919
Email: fcarroll@aarp.org

References

4Aging Road User Strategic Safety Plan. Accessed December 29, 2014. https://www.fdot.gov/traffic/trafficservices/safemobilityforlife.shtm.

5Florida Strategic Highway Safety Plan. Accessed December 29, 2014. https://www.fdot.gov/docs/default-source/safety/shsp2016/FDOT_2016SHSP_Final.pdf
      
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