Geriatric

Among all of the things a geriatrician deals with, driving is quite significant. In modern society, driving equates to freedom. Great efforts need to be made to keep individuals driving. Decisions involving this typically include the family physician, if still involved, the patient, the patient’s family, and any medical specialist the patient may be seeing.

 

The elderly can experience a number of conditions which lend themselves to driving fitness evaluation including macular degeneration, stroke, arthritis, diabetes, obesity, epilepsy, Alzheimer’s, Parkinson’s and other forms of dementia, end stage liver and renal disease, orthopaedic procedures, and other age-related issues.

 

Cognition, vision and motor skills are involved in the act of driving. There is no magic age when cognitive, vision and motor skills diminish. According to the Insurance Institute of Highway Safety, in 2007 motor vehicle crash deaths per capita among males and females began to increase markedly starting at ages 70-74. Across all age groups males had substantially higher death rates than females.

 

More vehicle crash deaths per 100,000 people by age and gender, 2007

Fatality Facts 2007, Insurance Institute for Highway Safety

 

Based on travel data collected between April 2001 and March 2002, the rate of passenger vehicle fatal crash involvements per 100 million miles traveled was higher for drivers 80 and older than for drivers of any other age group except teenagers. Drivers 85 and older had the highest rate of fatal crash involvement.

 

Passenger vehicle fatal crash involvements per 100 million miles traveled by driver age, April 2001 to March 2002

 

Fatality Facts 2007, Insurance Institute for Highway Safety

 

A geriatrician may be able to leverage a driving simulator in order to explore a range of sensory, cognitive and motor abilities including:

Unlike static individual component neuropsychological tests, the DriveSafety simulator is a dynamic functional performance test, which requires simultaneous processing of many different cognitive functions in an integrated manner.

 

The turn-key CDS™ clinical driving simulator is based on an actual car – a Ford Focus – giving all parties some face validation. The CDS Scenarios suite of virtual drives provide the OT and the patients a variety of driving situations including residential, suburban, urban, rural, industrial and freeway as well as various lighting (bright sunlight to dark nighttime) and weather conditions (clear, foggy, snowy). The virtual driving scenarios range from simple, adaptation drives and limited complexity to transitional drives that involved multiple real-world driving settings and various environmental factors. There are enough of them to avoid the clients from memorizing them. The driving scenarios are designed in accordance with AASHTO, MUTCD and ADED best practices for delivery of driver rehabilitation services.

 

The administrative interface is intuitive – the administrator can begin running virtual practice drives immediately. The administrator has the ability to play-back the patients’ practice drives, allowing the OT to point out to the patient the positive and negative behaviors and for the patient to learning and gain additional insight.

 

A suite of virtual drives involving a variety of common driving situations allows the therapists or clinicians to see their patients in a series of driving environments, from the simple to the complex.

 

A geriatric or senior clinic can benefit from a validated driving simulator. The simulator will enable the medical practice to help provide evaluations and assessments, treatment options, and driving practice. The system will provide added interest into the clinic by patients and their families, researchers, administrators, and the media. It is a new source of clinical revenue that can begin paying back immediately.