Date Presented 03/26/20
This descriptive, cross-sectional study aims to characterize current need and utilization of driver rehabilitation services among a nationally representative sample of community-dwelling older adults. Overall findings suggest that the need for driver rehabilitation services is unmet within this population. Results from this study provide empirical evidence to support future OT practice and policy recommendations to improve older adult community mobility and participation.
Primary Author and Speaker: Elizabeth Marfeo
Contributing Authors: Amelia Coffey, Nathan Ward
PURPOSE: Access to reliable transportation is an important factor for independent living and community participation among older adults, with driving being the most common mode of transportation for many older adults (Jones et. al. 2016). Occupational therapists have been identified as leading experts in the field of driving rehabilitation (Mielenz et. al. 2017). The goal of this study is to determine the characteristics of community-dwelling older adults receiving driver rehabilitation services in order to identify opportunities for improved occupational therapy practice and development of policy recommendations related to older adult community mobility and participation.
DESIGN: Descriptive, cross-sectional study using data from the 2016 wave of the National Health & Aging Trends Study. Participants in the NHATS study are nationally representative of US Medicare beneficiaries ages 65 and older. Data were collected via annual in-person interviews. Participants in this study were included if they reported as community dwelling (N=5930) and receiving any rehabilitation services in the past year.
METHOD: Frequencies, percentages, cross tabulations, and graphical displays were used to complete descriptive analysis to characterize need and use of driver rehabilitation services among a national sample of community dwelling older adults. Frequency distributions were calculated to describe sample characteristics; chi-square and t-tests were used to test associations between rehabilitation utilization and demographic, health, and contextual variables of interest.
RESULTS: Among the sample of older adults receiving rehabilitation services (N=1173), 63% of the sample reported driving as their primary mode of community mobility; 25.8% reported limitations in community participation due to transportation related reasons; and 9.2% reported rehabilitation services focusing on driving/transportation related goals. Among those in driver rehabilitation (n=107), the majority were female (60.7%), White (66.4%), ages 70-84 (67.3%), and living in a metropolitan area (83.2%). Musculoskeletal conditions were the most common reason for rehabilitation (53.0%). Overall most respondents reported improved function (72.9%) and goal attainment (57.0%) following the end of their rehabilitation services.
CONCLUSION: The results of this study indicate a discrepancy between utilization of driving rehabilitation services and self-reported need. A large proportion of older adults depend on driving and transportation to enable them to fully participate in their community and daily routine. Many older adults report limitations in community participation due to transportation related reasons--yet driver rehabilitation represents only a small proportion of rehabilitation services used among this population.
IMPACT STATEMENT: As experts in driver rehabilitation and accommodation strategies, occupational therapists should lead the way in advocating for increased utilization of driver rehabilitation services and development of innovative, accessible community transportation options to improve participation and late life function among community-dwelling older adults.
References
Jones, J., Dickerson, A., Flaten, H. K., Belmashkan, S., & Betz, M. E. (2016). Driving Rehabilitation Specialists’ Perspectives on Older Driver Evaluations. American Journal of Occupational Therapy, 70(2), 7002270010p1. doi:10.5014/ajot.2016.016915
Mielenz, T. J., Durbin, L. L., Cisewski, J. A., Guralnik, J. M., & Li, G. (2017). Select physical performance measures and driving outcomes in older adults. Injury Epidemiology, 4(1). doi:10.1186/s40621-017-0110-2
