Kathleen Golisz; Occupational Therapy Interventions to Improve Driving Performance in Older Adults: A Systematic Review. Am J Occup Ther 2014;68(6):662-669. doi: 10.5014/ajot.2014.011247.
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© 2019 American Occupational Therapy Association
This systematic review synthesizes the research on interventions used by occupational therapy practitioners to address cognitive and visual function, motor function, driving skills, self-regulation and self-awareness, and the role of passengers and family involvement in the driving ability, performance, and safety of older adults. After a comprehensive search of the research literature, 29 studies were reviewed and synthesized into five themes: (1) educational interventions including family education, (2) cognitive–perceptual training, (3) interventions addressing physical fitness, (4) simulator training, and (5) behind-the-wheel training. Outcome measures used in the studies included changes in knowledge through speed of processing, physical and cognitive skills predicted to reduce crash risk, simulated driving, and real-world driving. The studies demonstrated low to moderate positive effects for interventions used by occupational therapy practitioners to improve older driver performance.
Occupational therapy practitioners should consider the use of visual, cognitive, motor, and educational interventions when working with older drivers on community mobility issues.
Educational programs focused on awareness and self-regulatory behaviors are recommended. All occupational therapists should discuss driving with their clients and families along with strategies to reduce their risk of crashes or injuries.
Group- and individual-based physical fitness programs that simultaneously challenge cognitive–perceptual skills may prolong driving years and delay cessation. Fit and flexible drivers may be more able to visualize risks and respond quickly while driving. Supporting the health and wellness of older drivers can be incorporated into occupational therapy practice or community service projects.
Computer-based programs focused on increasing speed of processing are expanding and becoming more accessible to older adults. Occupational therapists need to be aware of the products and their potential usefulness in prolonging safe driving in older adults. Continued research is needed on the effectiveness of these new tools as they are developed.
Evidence is emerging that hazard perception training, whether done in a clinical setting, with a simulator, or during behind-the-wheel training, can help drivers learn to anticipate hazards and where to focus their attention while driving. Therapists should provide client-centered coaching and feedback.
Personalized feedback on driving performance using videotaped drives also holds promise. With the advances in technology, dash-mounted video cameras can be incorporated into behind-the-wheel training and reviewed with drivers after their session to offer feedback and suggestions for the next session. Coaching and feedback on performance, whether it be in a simulator or real-world on-road training, have strong evidence supporting their effectiveness.
Occupational therapy practitioners should support caregivers as they address issues of driving cessation with drivers with dementia by offering psychoeducational support groups, possibly in collaboration with colleagues in social work or psychology. The planning needed to maintain community participation post–driving cessation requires cognitive skills that may be challenged. Occupational therapy practitioners may need to change the approach from remediation to supporting active engagement by helping the driver with dementia and his or her family transition to alternative forms of transportation to foster community participation and preserve roles outside the home.
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