Question 1

In the Occupational Therapy Framework, driving is considered a(n):
A) Activity of daily living
B) Instrumental activity of daily living
C) Client factor
D) Role

Accepted Answer

Driving and community mobility as an instrumental activity of daily living (IADL) is recognized as critical to being able to participate in all other occupations (Dickerson, 2012), and as such, is considered an occupation enabler (Stav & Lieberman, 2008). Thus, older adults who cannot drive or who refrain from driving may have difficulty engaging in many of the fundamental activities for achieving productive aging.

Question 2

A fundamental reason why older adults value the ability to drive is:
A) Generational influence
B) Family values
C) Lack of good public transportation
D) No interest in ride sharing

Accepted Answer

The boomer generation grew up during a time when cars had just become readily available for most families. While only the wealthy had cars before World War II, in the 1950s and 1960s mass production made vehicles affordable, allowing families to move into the suburbs and expanding their social and physical environments. Every teenager counted the days to get their driver's license because the "car" was the social networking tool of this generation. In other words, the car was the equivalent to the smartphone today! Driving down the main street of any town in the "right" vehicle was comparable to posting the latest on Facebook or Twitter-making sure to connect with peers as well as seeing who everyone you were with or who had the best "wheels." Although telephones were available to communicate, they were often shared on "party lines," and teens had little privacy. The popular method of socialization was driving to local gathering places, whether it was a high school sports game, drugstore, diner, McDonald's eatery, concert, swimming pool, or the drive-in movie theater. With the expansion of the interstate highway system, families explored beyond their immediate communities, going on road trips (e.g., Route 66); taking vacations to the beach, mountains, or lake; traveling to extended family gatherings; or simply just enjoying Sunday drives. Thus, driving for the boomers is not just about community mobility (i.e., getting to where they want and need to go), but about the occupation of driving. Regardless of available alternative transportation, an older adult at risk of losing his or her ability to drive may not be just about losing just an option of community mobility. The older adult will be losing their highly valued occupation of driving "their car"-possibly equivalent to the younger person losing their phone privileges. Moreover, it is recognized that driving is crucial to engaging in other occupations, including work, education, play, leisure, and social participation, as well as most other IADLs (e.g., shopping, health management, money management, and caregiving) (Schold Davis, Dickerson, Dellinger, & Chodrow, 2016).

Question 3

Older adults tend be safe drivers due to which factor?
A) Generational influence
B) Family values
C) Avoidance of driving during high traffic times
D) Tendency to be cautious

Accepted Answer

It is important to recognize that older adults are generally safe drivers, overall having the lowest risk of collisions. Part of the reason for fewer crashes is the lower exposure to risk factors. Older adults tend to avoid driving during rush hour, at night, or on high-speed interstates. Additionally, research has clearly demonstrated that it is not "age" that leads to declines in driving, but the functional impairments associated with medical conditions that put older drivers at risk (Coughlin & D'Ambrosio, 2012; Dickerson et al., 2017).

Question 4

What aspect of older adult independence should be a legal right?
A) Driving one's own car
B) Community mobility
C) Ability to perform ADLs
D) A ramp to one's home for accessibility

Accepted Answer

Although driving is a privilege granted by the state, community mobility is a right for everyone. It is critical to understand that many of the ADLs and most of the IADLs are affected by whether someone is able to be mobile in their community. Table 13-1 outlines aspects of occupations, as identified by the Practice Framework (AOTA, 2014), that warrant consideration when addressing driving and community mobility of the client (Dickerson, 2016).

Question 5

Driving is a key IADL; however, some occupational therapy practitioners are hesitant to assess driving for which of the following reasons?
A) Public transportation is often convenient and available
B) Lack of confidence in making decisions about driving capability
C) Cost and time required for driving evaluations
D) Lack of assessment tools

Accepted Answer

When considering the IADL of driving, the identification process is not more complex, but it is more complicated. With driving, the potential risk is not just to the client and maybe the caregivers but also to the general public, as the negative result is a crash that often involves more than one person. While the fear of making a decision about driving is often the reason occupational therapy practitioners do not have the confidence to address driving (Dickerson, Schold Davis, & Chew, 2011), driving and community mobility is within the scope of occupational therapy practice and the ethical obligation of the practitioner to identify risk (Slater, 2012). Practitioners cannot make decisions about driving licensing, as only the state licensing agencies grant licenses. However, because occupational therapy practitioners observe functional performance and identify risk, they have been identified as the "go-to" profession for driver evaluation and rehabilitation (Society & Pomidor, 2016). Unless occupational therapy practitioners step up to address this IADL with all clients, it could be another practice area lost to other, less qualified service providers (who are without or have less medical training or education) who are already devising certificate programs that purport to be able to evaluate older adults effectively (Dickerson, 2012; Dickerson, 2014).

Question 6

Who can decide that an older adult no longer can retain a license to drive?
A) Occupational therapist
B) Physician
C) State licensing agency
D) Nurse practitioner

Accepted Answer

When considering the IADL of driving, the identification process is not more complex, but it is more complicated. With driving, the potential risk is not just to the client and maybe the caregivers but also the general public, as the negative result is a crash that often involves more than one person. While the fear of making a decision about driving is often the reason occupational therapy practitioners do not have the confidence to address driving (Dickerson, Schold Davis, & Chew, 2011), driving and community mobility is within the scope of occupational therapy practice and the ethical obligation of the practitioner to identify risk (Slater, 2012). Practitioners cannot make decisions about driving licensing, as only the state licensing agencies grant licenses. However, because occupational therapy practitioners observe functional performance and identify risk, they have been identified as the "go-to" profession for driver evaluation and rehabilitation (Society & Pomidor, 2016). Unless occupational therapy practitioners step up to address this IADL with all clients, it could be another practice area lost to other, less qualified service providers (who are without or have less medical training or education) who are already devising certificate programs that purport to be able to evaluate older adults effectively (Dickerson, 2012; Dickerson, 2014).

Question 7

Which group provides the evidence for making decisions about fitness to drive, particularly when related to screening and assessment?
A) State licensing authorities
B) Researchers
C) Practitioners
D) Consumers

Accepted Answer

Researchers provide the evidence for making decisions about fitness to drive, particularly when related to screening and assessment. With provided evidence concerning the validity and reliability of assessment tools, researchers assist in the establishment of appropriate constraints, limitations, and potential "cutoff" scores to be used by practitioners and/or licensing authorities. In best practice, researchers translate the research outcomes into practical criteria for an objective decision about fitness to drive. Researchers may be psychologists, occupational therapists, physicians, or other professionals with research degrees.

Question 8

Driving rehabilitation is a form of therapy that plans, develops, and implements services for individuals with disabilities in order for the individual to drive, typically following what rehabilitative approach?
A) Proactive
B) Maintenance
C) Remediation
D) Compensatory

Accepted Answer

Driving rehabilitation is a form of therapy-traditionally compensatory-that plans, develops, and implements services for individuals with disabilities in order for the individual to drive. Driver rehabilitation specialist (DRS) is a general term that encompasses a diverse group of providers. The requirements for the certification and education of a DRS are not based on being a member of a specific medical profession, nor is there is consistency between states. Providers who use the initials DRS have diverse backgrounds, including engineers, driving instructors, and health- care professionals.

Question 9

A typical outcome of a driving evaluation is which of the following?
A) Compensation through training
B) Use of a driving simulator
C) Road assessment
D) A report to state licensing authorities

Accepted Answer

Once completed, the outcomes of the evaluation may include one or a combination of the following implementation plans:
• Rehabilitation of underlying human components (e.g., increasing scanning abilities through specifically designed intervention)
• Compensation through training (e.g., driving simulator training, avoiding left turns),
• Compensation through adaptation of the vehicle (e.g., using hand controls or a steering knob for one-handed turning)
• Cessation of driving counseling and planning.

Question 10

Hand controls are an example of which type of driving rehabilitation intervention?
A) Rehabilitation of underlying human components
B) Compensation through training
C) Compensation through adaptation
D) Cessation of driving counseling and planning

Accepted Answer

Once completed, the outcomes of the evaluation may include one or a combination of the following implementation plans:
• Rehabilitation of underlying human components (e.g., increasing scanning abilities through specifically designed intervention)
• Compensation through training (e.g., driving simulator training, avoiding left turns),
• Compensation through adaptation of the vehicle (e.g., using hand controls or a steering knob for one-handed turning)
• Cessation of driving counseling and planning.

Question 11

In the process of addressing driving and community mobility, obtaining and reviewing data to determine the needs for evaluation is known as:
A) Screening
B) A driving simulator
C) A driving evaluation
D) An occupational profile

Accepted Answer

In the process of addressing driving and community mobility, it is critical to differentiate screening versus evaluation. Screening is the process of obtaining and reviewing data to determine the need for evaluation, while evaluation is obtaining and interpreting data to document results, inform, and, if appropriate, formulate a treatment plan (TRB, 2016). In the case of driving and community mobility, the process of screening might be done by trained, skilled, or highly skilled individuals, while evaluations are done by highly trained/skilled professionals.

Question 12

When addressing driving and community mobility, the occupational therapist should follow which process?
A) Screening prior to evaluation
B) Use of a driving simulator to assess driving skills
C) OTPF process
D) Development of an intervention plan for driving remediation

Accepted Answer

Occupational therapy evaluations begin with an occupational therapy profile to determine the client's desires and goals. In addition to other occupations, including ADLs and other IADLs, the occupational therapist explores if and how the client attains community mobility (i.e., self-driver, ride with family or friends, public transit). The profile would also include determining if driving is a goal. The next step is the observation of performance; the occupational therapist evaluates the client's visual, sensory, motor, and cognition function through the performance skills evaluation (AOTA, 2014). A common misperception is that addressing the IADL of driving and community mobility requires a different process. Although the comprehensive driving evaluation includes the on-road assessment, the broader IADL of driving and community mobility evaluation begins with the same client factors underlying performance (e.g., vision, motor, cognition). The outcome of this evaluation is the first step in the OT-DRIVE model; the "OT" represents the process of an occupational therapist determining whether driving is important to this client and whether driving will be a risk (Schold Davis & Dickerson, 2017).

Question 13

The step in the process of the OT-DRIVE model when the occupational therapist determines the intervention plan considering the client's impairments on their potential for driving is:
A) Readiness
B) Intervention
C) Verification
D) Evaluation

Accepted Answer

"R" is for readiness; the occupational therapist determines the intervention plan considering the client's impairments on their potential for driving. "I" is for intervention. For each of the risk areas (i.e., red, green, or yellow) guidance has been identified for specific interventions that address driving. "V" represents verification. Because driving is a complex IADL, verification with the client, family, primary care provider, and other team members is important. Finally, "E" is for evaluation. Does the client need the comprehensive driving evaluation? The key to a successful outcome is the timing and readiness of the client for the comprehensive driving evaluation.

Question 14

Ms. Lee, a 76-year-old female, is taking time to thoroughly plan a trip across the country in her recreational vehicle. Ms. Lee is demonstrating the ability to perform which level of driving behavior?
A) Strategic
B) Tactical
C) Operational
D) Readiness

Accepted Answer

The framework is based on Michon's three levels of driving behaviors: strategic, tactical, and operational (TRB, 2016). The highest and overarching level, the strategic level, is the decision-making process of planning trip goals, deciding on the mode of transport (e.g., vehicle, walking, biking), and following the directions to get to the destination. The driving behavior skill at the strategic level is also needed during the driving process-for example, when a driver comes upon an accident and has to decide how to find an alternative route. Unexpected route changes are often the cause of older adults with cognitive impairment getting lost in familiar areas, and this indicates that education in skills that improve problem-solving is needed (Dickerson, Stressel, Justice, & Luther-Krug, 2012).

Question 15

Andrea tells you, the occupational therapy practitioner, that her mother got lost driving to the grocery store, a route she has taken many times. She asks your advice for next steps. The best next step is:
A) Encourage her to report this to her mother's physician
B) Recommend her mother take the bus from now on
C) Inform her that her mother should no longer drive
D) Complete a clinical observation checklist followed by a referral to a DRS for a specialized driving evaluation if indicated

Accepted Answer

Describing the person factors needed for safe driving (i.e., physical/sensory, cognitive, emotional regulation, insight), Dickerson and Bédard (Dickerson & Bédard, 2014) link these factors under each of the three levels of driving behaviors (see Table 13-3). Then, using examples of clinical observation questions for each level of behavior (see Table 13-4), the practitioner can use the questions to complete the designed checklist (see Table 13-5). Using this decision tool to extrapolate from the client's performance of tasks identifying fitness to drive, the therapist can identify the risk and the degree of impairment (i.e., none, mild, moderate, severe). As this is a new tool, there is no research to identify how many "flags" warrant a recommendation, but the community practice occupational therapist can decide to:
• Perform a further or specified evaluation,
• Change intervention strategies to address the performance skills underlying driving and community mobility, and
• Make a referral to a DRS for a specialized evaluation.

Question 16

Rearview cameras are an example of which type of evidence-based technology in prevention of car crashes?
A) Driverless car technology
B) Antilock braking system
C) Crash avoidance system
D) Advanced driver assistance systems

Accepted Answer

Great strides have been made in automating aspects of driving to improve driver safety and comfort. There are two general categories: crash avoidance systems (CAS) and Advanced Driver Assistance Systems (ADAS). A CAS provides warnings, such as lane departure warnings, forward collision warnings, and blind spot warnings, to prevent potential crashes. Current research has found that both blind spot-monitoring systems (Cicchino, August 2017a) and rearview cameras (Cicchino, October 2017b) are effective in preventing police-reported lane change crashes regardless of severity. For older adults, rear cameras are cutting crashes 40% for drivers 70 and older, compared to 15% for younger drivers (Cicchino, October 2017b).

Question 17

Older adults do not always adopt driving technologies that prevent motor vehicle accidents because they:
A) Drive older cars without the technology
B) Drive infrequently
C) Are unwilling to pay for these services
D) Lack trust in the technology

Accepted Answer

There are barriers to the adoption of the ADAS technology by older adults (Trubswetter & Bengler, 2013). First, older adults do not necessarily perceive the systems as useful and thus demonstrate a lack of trust. This is likely because older drivers do not fully understand the operations of the technology and may incorrectly use the assistance (Dickerson et al., 2017). For example, they may incorrectly attribute collision prevention features to the adaptive cruise control. Additionally, when training older adults on use of the in-vehicle information systems (e.g., hands- free commands), the workload of the driver was moderate to high, and practice did not eliminate interference with driving (Strayer, Cooper Turrill, Coleman, Ortiz, & Hopman, 2015). Other barriers include the undesired system feedback, risk of inattentiveness/distraction because of the feedback, functional limitations of the systems, and cost of the systems. Therefore, more research is needed to understand older adults' use of the technology, including their unique needs and learning styles and what are the behavioral adaptations (e.g., less use of turn signals with blind spot detection), as well as the real-world safety benefits, and, most importantly, the effect on situational awareness or the ability to take over when using automation (e.g., adaptive cruise control) (Dickerson et al., 2017).

Question 18

Occupational therapists should encourage which type of technology for wayfinding?
A) Driverless car technology
B) Global Positioning System
C) Crash avoidance system
D) Advanced driver assistance systems

Accepted Answer

One potential option to improve safety is an electronic navigational system, or what is commonly known as a Global Positioning System (GPS) device. A recent study comparing the performance of drivers familiar and unfamiliar with GPS examined whether GPS units improved older drivers' safety on unfamiliar routes by comparing performance between drivers who were familiar and unfamiliar with GPS and whether training with GPS devices had an impact on performance for those who were unfamiliar (Thomas et al., 2018). Results demonstrated that when traveling in unfamiliar areas, all drivers made fewer driving errors when using GPS units compared to using written paper directions, and those familiar with the system did better. Results also showed that drivers in their 60s exhibited safer behaviors than those in their 70s. In terms of programming a GPS unit, drivers who were familiar with a GPS did much better than those unfamiliar with it. These findings, supporting previous studies results (Dickerson et al., 20179), suggest that age is an important factor in using GPS systems to drive safely.

Quiz 13: Driving and Community Mobility Introduction

In the Occupational Therapy Framework, driving is considered a(n) :

A fundamental reason why older adults value the ability to drive is:

Older adults tend be safe drivers due to which factor?

What aspect of older adult independence should be a legal right?

Driving is a key IADL; however, some occupational therapy practitioners are hesitant to assess driving for which of the following reasons?

Who can decide that an older adult no longer can retain a license to drive?

Which group provides the evidence for making decisions about fitness to drive, particularly when related to screening and assessment?

Driving rehabilitation is a form of therapy that plans, develops, and implements services for individuals with disabilities in order for the individual to drive, typically following what rehabilitative approach?

A typical outcome of a driving evaluation is which of the following?

Hand controls are an example of which type of driving rehabilitation intervention?

In the process of addressing driving and community mobility, obtaining and reviewing data to determine the needs for evaluation is known as:

When addressing driving and community mobility, the occupational therapist should follow which process?

The step in the process of the OT-DRIVE model when the occupational therapist determines the intervention plan considering the client's impairments on their potential for driving is:

Ms. Lee, a 76-year-old female, is taking time to thoroughly plan a trip across the country in her recreational vehicle. Ms. Lee is demonstrating the ability to perform which level of driving behavior?

Andrea tells you, the occupational therapy practitioner, that her mother got lost driving to the grocery store, a route she has taken many times. She asks your advice for next steps. The best next step is:

Rearview cameras are an example of which type of evidence-based technology in prevention of car crashes?

Older adults do not always adopt driving technologies that prevent motor vehicle accidents because they:

Occupational therapists should encourage which type of technology for wayfinding?