Driving Capacity Consultation

Driving Capacity Clinic:

Introduction

The number of people who are 65 years of age or older in the United States is growing more rapidly than any other age group. By the year 2020, 17% of the population is expected to fall in this age range; estimates reach up to 50 millon elderly who will be licensed or driving.

Healthy aging brings remarkable changes in cardiorespiratory endurance, muscle strength, vision and hearing, neurologic function, immune response, and other areas of physiology. Chronic medical illness increases in prevalence with advancing age; more than 80% of those older than 65 years of age have at least one chronic disease and the majority of this group have two or more.

While elderly drivers account for a lower proportion of accidents and crashes than any other group, they have an increased risk on a per-mile basis for involvement in motor vehicle crashes. Older age has been linked to a higher risk involvement in motor vehicle accidents consequent to changes in sensory, motor and cognitive function as well as medical conditions and use of medications that can affect driving performance. In addition to greater involvement in crashes, elderly driver are more likely to die or suffer serious injuries in crashes; moreover, the elderly driver who survives a crash takes longer to recover in the hospital and is more likely to succumb to later secondary complications.

Complicating the relationship between age-related medical conditions and driving is dementia, a syndrome characterized by impairments in memory, judgment, abstract thought and other disturbances of higher cortical function and manifested in about 15% of persons over 65-years old. Based on neuropathologic studies, Alzheimer's disease, the most common cause, accounts for dementia in 50-70% of older patients and multiple infarct dementia in an additional 15-25% of patients.

Driving is without question one of the most complex behaviors that individuals perform because it requires the integration of a variety of physical, sensory, cognitive and emotional abilities. Moreover, the behavior of driving is performed within an ever-changing environment and context that is often too difficult to predict or anticipate. Yet in today's society there is little argument that the ability to drive an automobile is a critical component of an independent lifestyle. For individual aging or neurologically compromise this statement also hold true. However, these individuals are faced with potential impairments that may affect or limit and in some cases prohibit their ability to continue to remain on the road safely. Age alone doe snot stop a person fro driving. When family members, primary care physicians or even a person himself or herself are unsure of driving abilities, they are often referred to us for a comprehensive driving capacity assessment. Often after brain injury, stroke, or dementia, processing of information and reflexes are affected. This may result in the patient being unsafe to drive either temporarily, or in some cases, permanently. Potential benefit from driver training would be determined at the time of the assessment, or re-assessment may be recommended at a later date. Our clinical staff are knowledgeable about age-related changes that may affect driving ability. Through a comprehensive assessment, fitness to drive is determine.

Typically frequently impaired driving behavior in individuals neurologically compromised include:

Hesitating and stopping at green lights
Poor positioning of vehicle in relation to road and/or other cars
Consistently driving below the speed limit
Impulsivity and risk-taking behaviors
unsafe left turns
Changing lanes without awareness of surrounding vehicles
getting lost
Poor road sign recognition
Reduced awareness of other vehicles on the road
Lack of self-awareness
Poor judgment

Reasons for a Comprehensive Driving Evaluation

Research studies demonstrated that limitation for driving privileges should be based on demonstration of impaired driving competence, rather than on age itself or a clinical diagnosis such as dementia. Given the increasing number of older drivers, the incidence of dementia in the elderly and the crash risk for older drivers with dementia, it is necessary to establish procedures for identification of drivers at risk and assessment of driving competence skill for drivers with dementia.

Marin Neuropsychology Center is please to announced the incorporation of research-based Driving Capacity Assessment Clinic. We used evidenced-based instruments to assess the risk associated with driving on aging or neurologically compromised individuals.

Our program objectives are:

To provide patients, families and personal physician a comprehensive assessment of the patient's ability to drive
To provide recommendations regarding the patient's capacity t drive
To provide recommendation for treatment if needed to assist the individual in resuming driving

Comprehensive Driving Evaluation

Our evaluation consists in four distinctive phases:
1. Pre-Driving Evaluation

Gathering records including:

2. In-Clinic/Off-Road Evaluation

In depth Clinical interview and neuropsychological assessment.

3. Off-Road Driving simulation

This final in-clinic assessment in conjunction with prior information gathered helps to determine the readiness for a final phase, the on-road assessment.

4. On-Road Assessment

A behind the wheel examination of driving skills

Admission Criteria

Must meet California DMV standards for visual acuity/peripheral vision
Free of seizure activity in the last six months
Current drivers license or instructional permit must be present at the time of the on-road assessment

Outcome

Results of the assessment and driving ability will be discussed with the patient and a report sent to the referring physician. If deficits in driving skills do exist, our staff can offer the patient several options depending of the nature and extent of the impairment:

Assess rehabilitation potential for skill deficits
Recommend driving lessons to incorporate compensatory techniques for skill deficits
Provide the patient with education/training on alternate community mobility options
Make a referral to the Department of Motor Vehicles for a legal assessment of driving skills

Consulting Staff

Karen Smith, OTR/L, CDRS
Certified Driving Rehabilitation Specialist
46 Trinity Drive
Novato, CA 94947
Phone: 415-847-2098

To make an appointment

The Driving Capacity Evaluation is a self-pay program, although some health insurance plans may cover a portion of the evaluation. For more information about the cost of the program or to make an appointment, please call 415-457-3451.