By Karen Keller Capuciati
So Mom wants to drive again. She started talking about it some 4 months after her stroke, but it hasn’t been an easy fix.
Mom’s convinced that getting back behind the wheel of her car is a fundamental part of her returning to a normal life, and it’s hard to disagree with that idea. Not only does the lack of driving mean a loss of independence for her, but Mom doesn’t want to let the stroke become the dominant issue in her life.
The problem, though, is that, while not physically incapacitated, Mom’s stroke did leave her with certain aphasic difficulties that interfere with her ability to drive safely. Quick decision-making is one area that still gives her trouble, particularly in the face of multiple stimuli or any other area that requires prompt number and letter recognition (street signs, speed limits, etc.).
So we were faced with the question of how to proceed. We were referred by Mom’s physiatrist (a term for rehabilitation physician) to a driving program where we met Desiree Lanford, a caring and knowledgeable young woman who brings an especially effective combination of skills – as both a driving rehabilitation specialist and an occupational therapist – to this type of situation.
Here’s how it works:
The Evaluation: The first step is an overall evaluation of visual, physical and cognitive abilities pertinent to driving, followed by actual supervised drive time. Desiree tests vision skills that involve acuity, peripheral vision, depth perception, contrast sensitivity (the skill used to see at night and in low-light situations) and visual phoria (the ability of both eyes to work in concert). The cognitive tests examine Mom’s visual processing speed, divided and selective attention, comprehension and memory. The physical tests evaluated her strength, range of motion, and coordination. Desiree led Mom through an on-the-road test of her driving skills in the program’s equipped Buick Century with a training brake and special mirrors. They began in the parking lot so Desiree could familiarize Mom with the car and get comfortable. Then they proceeded to higher speed and traffic roadways. The road test lasted about 40 minutes. Mom received immediate feedback throughout the 3-hour process. (The evaluation cost $300 in this program.)
The Recommendation: At the end of the overall evaluation, you all may learn that (1) your parent did fine and is safe to drive independently; (2) he or she is not ready to drive alone but may improve with behind-the-wheel training; or (3) intervention will not help and your parent should retire from driving altogether.
Desiree said that Mom was having trouble with focus and concentration, and recommended they share more one-on-one driving sessions. Desiree’s goal is to help our mother understand exactly how the stroke has affected her ability to drive so that she can take precautions and learn strategies for driving safely on her own. We recommend finding a driving rehabilitation instructor who is also an occupational therapist because an OT is aware of how aging and/or an illness can specifically affect one’s ability to drive. (Private driving instruction in this program costs $60 for 30 minutes.)
Who Needs Driving Rehabilitation: People who have a physical and/or mental impairments or conditions that have resulted from illness, injury or normal aging may need to consider a driving rehabilitation program like this. It might be someone with a new physical disability, like the loss of a limb, or it could be someone who has suffered a brain injury or been diagnosed with a disorder that interferes with cognitive ability. Or it could simply be that the family is starting to see problems with an older driver, such as drifting into another lane, or any other kind of misjudgment that might precipitate an accident.
Why Is Driving Rehabilitation A Good Idea: So what’s preventing someone from just driving if he or she wants to? Nothing actually, except the good sense to recognize they may be a danger to others, and without some form of re-training, they could risk hurting people, getting sued or even losing their insurance coverage. The program teaches impaired drivers how to recognize their areas of concern and provides them with adapted strategies to keep them, and other people, safe behind the wheel. Just like with other rehabilitative therapies, the program continues until the therapist believes your parent will do well on his or her own.
How To Locate A Program: Desiree recommended two options to find a CDRS (certified driving rehab specialist) online:
- The Association For Driving Rehabilitation Specialists (select “state/province” in Field 1 and hit “continue” then select the state and hit “search”)
- The American Occupational Therapy Association’s website
With either site you can search by state, and if you do not find a program in the database, ask the occupational therapy department of a local rehab hospital.
Special Advice For Those With Alzheimer’s Or Any Dementia Diagnosis In The Family: Desiree gave us three valuable points on this topic:
- Read At The Crossroads: Family Conversations about Alzheimer’s Disease, Dementia and Driving, from The Hartford. This guidebook, as well as other safety information for older drivers, can be found on The Hartford website, and it is recommended that families read and discuss this book soon after a diagnosis of dementia. The guidebook offers suggestions on how to have a good conversation with your family about driving issues. It also lists warning signs for drivers with dementia, and helps you explore alternative transportation options.
- Get your parent in a driving program for a baseline evaluation. Come back every 6 months to a year for a check-up evaluation. This will allow your parent to learn where they are at each stage and how to maintain safe habits while they are still able to drive.
- A family member or friend should drive with your parent from time to time to check on their driving ability.
Whether it’s dementia or another reason that raises concern about driving safety, it can be a very complicated and emotionally charged issue. Share with us any stories or solutions that you have had in your family.
Tags: alzheimer's and driving, driving and AD, driving for seniors, driving rehabilitation, elderly driving, how to talk about driving, occupational therapy for driving, Stroke
My aunt was 85 when she broke her hip. She spent a few weeks in rehab, and her recovery went well, but she became hesitant in almost every aspect of her life. This was a good thing when it came to maneuvering her too-crowded apartment, but hesitancy can be deadly when it comes to driving.
Auntie had been living on her own in Florida since her husband of 50+ years died 6 years earlier. She had a wonderful circle of friends, and she was more active than some women half her age. She took classes at the local university, went on trips with friends and volunteered to raise money for the local orchestra. Life without a car was unimaginable.
The doctor warned my aunt not to drive for six weeks after her rehab ended, but when I called one night two weeks after her discharge to check in, she was anxious to tell me about her lunch with friends on Siesta Key, where she’d lived for so many years. I asked her who had driven her to the Key, and she admitted that she’d driven herself. She told me I was being ridiculous, that she was fine. My visit a few weeks later proved otherwise.
Auntie was about 4′ 11″ until she broke her hip and lost at least an inch in height. When I arrived (I took a cab from the airport, refusing to give her my flight information), I offered to run to the store to pick up some groceries. I went to her car and saw that she’d put two bed pillows on the driver’s seat, so that she could see above the windshield. The next day, she insisted on driving when we went to lunch. I thought it might be a good idea to see how she did, so I agreed. Twice, my aunt pulled out into oncoming traffic, then stopped, not sure she had enough time to get into her lane. Horns blared, but she was oblivious. She had trouble deciding which route to take, and slowed the car to 10 or 15 mph while she decided. I drove home from the restaurant.
I had “the talk” with my aunt that night. I told her she needed more time before driving. She listened patiently, but I left Florida with little confidence that she would listen. Had I read this story, had I known about these resources, I might have been able to have her evaluated, but even her doctor offered no real advice. She just agreed that “it’s very hard”.
My aunt passed away about six months later, and when I went through her papers, I found a letter agreement with a local man, who accepted $2000 as payment for the minor accident he’d been in with Auntie. She never told me, and more importantly, she never reported the accident to her insurance company. She knew that her insurance company would investigate and would probably drop her coverage, so, while the damage was minor – about $400, according to the letter – that was a small amount to pay for her freedom.
I realize we are very lucky that the accident wasn’t worse, that she hadn’t killed someone. I am passing this story on to one of her younger friends in Florida, in hopes that she will pass it on to families in similar situations. If just one family is successful in getting a parent or friend evaluated, it will be worth it.
Another brilliant article! with all the information anyone needs! Thanks.
We received an email from Desiree who thought the following information might also be helpful: Driving rehab therapists also teach individuals with physical disabilities to use adaptive equipment to be independent drivers. For instance, if someone has lost functional use of the right leg we may be able to train the person to use hand controls or a left foot accelerator. The potential to use adaptive vehicle equipment can be assessed during the driving evaluation.
This article made my jaw drop. Ten years ago my father-in-law had a cerebral hemmorrhage that required emergency brain surgery and some weeks of rehabilitation. Remarkably, he made almost a full recovery surprising all of his surgeons and specialists. In fact, despite the fact that my father-in-law was then 76 years old, his doctors said that he could resume all of his normal activities as long as he felt capable. The first activity he wanted to resume was driving. Although we all had concerns about his ability to make quick decisions while driving, his doctors assured us that as long as he felt comfortable driving there was no reason why he shouldn’t since they had given him the verbal assurrance of medical clearance.
Ten years later and my father-in-law is still driving; however, his awareness has become impaired. When he makes turns they are wide enough for him to drive over the corner of a sidewalk, and it’s obvious that at times he has trouble determining the color of the traffic light.
After reading this article the family has decided to intervene and talk about driving rehabilitation and encourage his doctors to advise him to have a driving evaluation. Thanks so much for the information! And thank you so much for this site. It’s been a valuable resource to me and my family.
This article about your mom wanting to drive again brought back memories of my mother insisting she was capable of driving and that her reflexes were just as good as my brother’s. She still insists she can drive and that taking her car away was like taking a part of her life. Thanks for reminding us this is something all our parents go through and that the right decision was made.