A mature (over 50) lady gets pulled over for speeding and this drama unfolds:
Elderly Woman: Is there a problem, officer?
Officer: Ma'am, you were speeding.
Elderly Woman: Oh, I see.
Officer: Can I see your license, please?
Elderly Woman: I'd give it to you, but I don't have one.
Officer: Don't have one?
Elderly Woman: I lost it--four years ago for drunk driving.
Officer: Oh, I see....Can I see your vehicle registration papers, please?
Elderly Woman: I can't do that.
Officer: Why not?
Elderly Woman: I stole this car.
Officer: Stole it?
Elderly Woman: Yes, and I killed and hacked up the owner.
Officer: You what?
Elderly Woman: His body parts are in a plastic bag in the trunk if you want to see.
The officer looks at the woman and slowly backs away to his car and calls for backup. Within minutes, five police cars circle the elderly lady's car. A senior officer slowly approaches, clasping his half-drawn gun.
Officer 2: Ma'am, could you step out of the vehicle please?
The woman steps out of her vehicle.
Elderly Woman: Is there a problem sir?
Officer 2: One of my officers told me you have stolen this car and murdered the owner.
Elderly Woman: Murdered the owner?
Officer 2: Yes, could you open the trunk of your car please?
The woman opens the trunk, revealing that it's empty.
Officer 2: Is this your car ma'am?
Elderly Woman: Yes, here are the registration papers.
The officer is quite stunned.
Officer 2: One of my officers claims that you do not have a driver's license.
The woman digs into her handbag and pulls out a clutch purse containing her license and hands it to the officer. The officer examines the license. He looks quite puzzled.
Officer 2: Thank you ma'am. One of my officers told me you didn't have a license, you stole this car, and you murdered and hacked up the owner.
Elderly Woman: Bet the liar told you I was speeding, too.
-Anonymous
It is difficult to answer the question about whether or not it is better to use a driving simulator or behind the wheel (BTW) testing for elderly drivers. Both have their pros and cons.
As far as simulators are concerned, when used in conjunction with client/family interviews, visual and cognitive tests such as clock drawing, trail-making and the short blessed, they can yield enough information to determine a person should not be driving or at the very least should also have a BTW evaluation.
Drawbacks however, can include different types of simulators revealing different results (depending on simulator width, lighting and assessment data), training of the evaluator, driver unfamiliarity with computer simulators (which creates an unnatural feel), and the real presence of simulator sickness (nausea, dizziness, headaches) that stops some testing before completion.
BTW testing will help determine the client's driving abilities by testing visual-perceptual, cognitive, and motor skills necessary for driving. It is especially useful for judging attention to multiple stimuli at one time.
As noted in the article "Evaluating Driving as a Valued Instrumental Activity of Daily Living" (AOTA publication, Productive Aging, January, 2011), BTW testing can effectively reveal if a person with physical difficulties can drive safely with the necessary adaptations. Unfortunately, when it comes to cognitive changes with aging, BTW training is not as cut and dried.
Years of patterned behavior behind the wheel can mask many cognitive difficulties as the driver performs automatic procedures practiced for many years. Some of these include staying in lanes, stopping at red lights and operating the vehicle at proper speeds. Unless an unexpected event occurs, it may not be as easy to spot decline in judgment or reasoning, and creating BTW situations that would identify them may pose a danger to the driver and evaluator.
In the article "Evidence-Based and Occupational Perspective of Effective Interventions for Older Clients that Remediate of Support Improved Driving Performance" ( AOTA publication, Driving and Community Mobility, March, 2008) the authors note that "most individuals fail to recognize their decline in driving competence and adjust to lower levels of visual acuity, reduced reaction time, and reduced peripheral vision and cognitive function." Therefore, giving these drivers insight into their deficits would be the most valuable intervention practice.
Accordingly, aging drivers are less likely to accept the validity of simulated testing, regardless of the information presented. Therefore the best approach to driving evaluations is an extensive testing that includes interviews, cognitive testing, driving simulations and behind the wheel driving.
The OT community should embrace both options, and in treating the whole person, should provide an individualized assessment that directly addresses each client's unique needs. That is the goal of Older Driver Safety Awareness Week December 3-7, 2012. http://www.aota.org/olderdriverweek
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