Development and Pilot Testing of the Driving Check-Up: Expanding the Continuum of Services Available to Assist Older Drivers

Abstract

Introduction

The Driving Check-Up is designed as part of a larger continuum of services available to assist older adults in their goal of remaining safe and active drivers. Based in driving schools, certified driving instructors trained to conduct the assessments provide older adults with objective feedback aimed at improving safety and maximizing driving longevity through a 60-90 minute evaluation of key driving skills and abilities. An essential component of the Driving Check-Up is the relationship between the driving school and occupational therapy/driving rehabilitation specialist ensuring that drivers identified with health-related concerns can be directed to the appropriate medically based driver rehabilitation services. The Driving Check-Up, however, is not an evaluation of driver fitness.

Methods

Development of the Driving Check-Up

Several activities were carried out to provide input to the development of the Driving Check-Up program. These include the formation of and consultation with an Advisory Committee to provide guidance and assistance, a review of the published literature with a focus on on-road evaluations of older drivers, a survey to gather information about the current state of driving school-based evaluation programs, and interviews with a sample of program providers.

Pilot Testing of the Driving Check-Up

The objective of the pilot testing was to evaluate the initial developed program, materials, and training for the Driving Check-Up, and inform the revision of the program. An iterative process was planned by staggering implementation across six pilot sites. Each of the six sites was asked to recruit at least two driving instructors and 10 older drivers, with the goal of a total of 12 driving instructors and 60 older drivers offering feedback on the Driving Check-Up.

Results

Components of the Driving Check-Up

• Scheduling helps to ensure that the Check-Up is appropriate for the client, in addition to ensuring that the client understands the nature and requirements (e.g., license and vision) of the service.
• The Pre-Drive Interview gathers information on the older adult’s driving history, licensure, health issues, reason for seeking a Check-Up, and emergency contact.
• Screening Tests assess vision, motor, and cognitive processes in order to determine if the older adults has an impairment that might affect his or her driving ability or safety, and to justify the decision to proceed on road versus referral to an appropriate healthcare provider.
• In the On Road Drive, the driving instructor observes the older adult’s performance on potentially risky maneuvers for older drivers as well as any unsafe habits, traffic violations, and/or critical errors.
• The Post Drive Discussion summarizes the outcome of the Check-Up and offers helpful information and resources regarding maintaining driving fitness, planning for transition to other transportation options, and/or referral to an appropriate specialist.

Key Features of the Driving Check-Up

• Referral
  The program is designed to assist relatively healthy older adults in maintaining or improving their driving skills and knowledge; therefore, it is critical to have a process to address those older adults for whom the program is not appropriate. Thus, an essential component of the Driving Check-Up is the collaborative relationship between the driving school and a local occupational therapy/driving rehabilitation specialist.
• Liability
  Driving schools must have the appropriate liability insurance to cover their vehicles, which is a primary reason the Driving Check-Up is designed for the older adult to be assessed in the driving instructor’s vehicle. Also, given the education and training of the typical driving instructor, the screening tools, form for release of information, and referral process are designed to help protect the driving instructor and school and ensure that older drivers with medical impairments are detected and appropriately referred.
• Training
  Driving instructor training for the Driving Check-Up is essential for appropriate implementation. The training highlights the differences between instructing novice drivers and assessing experienced older drivers, ensures the Check-Up is performed according to its objectives, and provides information and tools to help recognize and refer medically at-risk drivers. It also includes practice implementing the Check-Up and using the tools and forms while the trainers observe and provide feedback.

Key Findings from the Pilot Testing

• 92% of participating driving instructors indicated they were somewhat or extremely likely to offer Driving Check-Ups in the future.
• The majority of driving instructors indicated they felt the screening tools were very or extremely useful.
• 83% of older adult participants indicated they would be somewhat or extremely likely to recommend the Driving Check-Up to a friend or family member.
• Older adult participants’ descriptions of the Check-Up were overwhelmingly positive: 89% described it as worthwhile; 83% valuable; and 81% informative.