Recommendations for Clients Who Can Continue to be Safe Drivers

General Recommendations

If client has not had medical investigations (e.g., neurologist, geriatrician, optometrist/ophthalmologist) ensure a referral is made
Refer client for a formal driving assessment
Community organizations may provide informal driving evaluations, driver refresher or information sessions that can help the client identify problematic driving manoeuvres and safe driving strategies
Talk to the client and family about safe driving in the future. Help develop a driving retirement plan (e.g., identify and try alternative methods of transportation)

Recommendations when Vision is Affecting Safe Driving

Support the use of any prescribed corrective lenses
Identify with client the driving situations that cause visual challenges
Suggest avoidance of common visually-challenging situations:
- Times of low light (e.g., dusk, dawn or in fog)
- Inclement weather such as rain or snowfall
- Night time driving, particularly in areas where there is high traffic, resulting in glare from headlights of oncoming vehicles

When driving at night and faced with oncoming vehicle, shift gaze to side/edge of the road to reduce influence of glare
Investigate installation of modified mirrors that provide greater coverage of the side and rear of the vehicle. Practice use of these mirrors with the client prior to their use in a driving situation
Adjust the driver’s seat so the client can see comfortably through the windshield and at least 10 feet in front of the vehicle
Keep interior and exterior of vehicle windows clean
Seek assistance from a reliable passenger to assist with visual activities such as reading street signs
Try to drive on well-lit streets if driving at night
If the client has difficulty reading information on the instrument panel, suggest increasing the brightness
Some vehicles have interior lights that mark features such as door locks, interior light controls and other controls. If these aren’t present, use white or reflective tape to mark important controls
If a visual field deficit is present, but is not limiting the ability to continue to be a safe driver, teach the client organized scanning techniques. Encourage them to rotate their head to look over their shoulder to check their blind spot when making a lane change
Reinforce the importance of taking frequent breaks to prevent fatigue while driving

Recommendations when Cognition is Affecting Safe Driving

1) Client has an identified cognitive impairment but can drive safely in some situations. A diagnosis of mild cognitive impairment or early stages of dementia does not necessarily mean the client must stop driving. While many drivers voluntarily limit their driving in unfavourable conditions, clients and their families will still benefit from a discussion of strategies to enhance safe driving.

Plan for driving trips, even within familiar areas. Plan time of day, where possible, and route
Identify those situations that present particular challenges for the client while driving
Identify personal aspects that may affect the ability to drive safely
- Excessive fatigue
- Feelings of stress, frustration or anger
- Feeling generally unwell
- Feeling rushed or under pressure

Some common safe driving strategies include:
- Allow more travel time to/from a destination
- Avoid driving during rush hour or during times when the roadways are more congested
- Avoid driving in poor weather conditions
- Avoid driving on limited access highways
- If conditions, either environmental (e.g., weather) or personal (e.g., fatigue) are not favourable to safe driving, postpone a trip, when possible, or ask someone else to drive

Limit the need to engage in simultaneous activities while driving:
- Preset controls (e.g., temperature, radio) before engaging the vehicle to avoid the need to manipulate them while driving
- Adjust the mirrors, interior lights, seat and steering wheel position before turning on the vehicle
- Program a navigation system before turning on the vehicle
- Limit other distractions when in a situation that requires a high level of concentration, such as when in an unfamiliar area or in dense traffic. In these situations, turn off the radio (or have someone turn it off for you) and ask passengers not to speak
- If use of a cell phone is necessary, ensure that the vehicle is safely parked before using it. Ensure that you are familiar with the laws regulating the use of cell phones for your local jurisdiction

If taking medication, including over the counter medications, ask the doctor/pharmacist about potential side effects that can affect cognition
A passenger can act as a co-pilot to assist with navigation. The co-pilot can be ‘another pair of eyes’ to spot up-coming traffic situations, stop lights or stop signs, or assist with safe lane changes. It is important to remember that when the co-pilot alerts the driver to an up-coming traffic situation etc., it takes some time for the driver to process and respond to the communication. Where possible, the co-pilot should give sufficient advance notice to give the driver time to react. While many couples do assist each other while driving (BV), it is also important to discuss signs with them that the driver is no longer able to benefit from the co-pilot’s assistance.
Have a cell phone available for emergency situations
Use an alternative driver if available

2) For clients who remain safe to drive, but have limited confidence in their driving ability, some recommendations include:

Participation in some form of driver evaluation, formal or informal, can help drivers in this category gain a better appreciation of their driving skill
Discuss problematic situations with this client to identify what contributes to their lack of confidence when driving
Identify personal aspects that may affect the ability to drive safely
- Excessive fatigue
- Feelings of stress, frustration or anger
- Feeling generally unwell
- Feeling rushed or under pressure
Some common safe driving strategies include:
- Allow more travel time to/from a destination
- Avoid driving during rush hour or during times when the roadways are more congested
- Avoid driving in poor weather conditions
- Avoid driving on limited access highways
- If conditions, either environmental (e.g., weather) or personal (e.g., fatigue) are not favourable to safe driving, postpone a trip, when possible, or ask someone else to drive
Client should plan the trip in advance to determine which routes will be followed
Suggest that the client have a cell phone available for emergency situations. If use of a cell phone is necessary, ensure that the vehicle is safely parked before using it. Ensure that client is familiar with the laws regulating the use of cell phones for the local jurisdiction

Recommendations for Clients when Physical Ability is Affecting Safe Driving

1. Limited Range of Motion

Limited Neck Flexibility:

Investigate installation of modified mirrors that provide greater coverage of the side and rear of the vehicle. Practice use of these mirrors with the client prior to their use in a driving situation
Encourage client to rotate upper body to ensure they check their blind spot prior to making a lane change
If not already being seen by a physiotherapist, recommend referral for a program to improve neck flexibility

Limited Left-Knee Flexion

Teach client how to properly transfer into and out of the vehicle
Assist client to adjust their seat for optimal comfort, while still maintaining the ability to access the pedals with their right foot

Limited Right-Knee Flexion and Extension

Teach client how to properly transfer into and out of the vehicle
Recommend a vehicle with telescoping steering wheel or one with adjustable positions to facilitate transfers and position in the driver’s seat
Assist client to adjust their seat to an optimal distance from the foot pedals
If not sure that client can safely use the pedals because of limited knee ROM, refer to a driver rehabilitation specialist for evaluation and recommendation of vehicle modifications

Limited Trunk and Shoulder Movements

If not sure that client can safely drive because of limited trunk and shoulder ROM, refer to a driver rehabilitation specialist for evaluation and recommendation of vehicle modifications
Investigate installation of modified mirrors that provide greater coverage of the side and rear of the vehicle. Practice use of these mirrors with the client prior to their use in a driving situation

2. Endurance

Identify with client when they have the most energy during the day and help them plan driving trips to coincide with those times
Discuss energy conservation concepts with the client and encourage them to take frequent breaks when driving to prevent fatigue
Suggest the client choose to drive during less busy times of the day to decrease the amount of energy required to sustain attention
Recommend that the client engage in a community fitness program to increase their endurance, within the limits of any medical condition that affects endurance
If the client intends to purchase a new/used vehicle, recommend that they check the weight of the doors and the force necessary to adjust the seats

3. Balance

Recommend that the client engage in a community fitness program to increase their balance and core strength, within the limits of any medical condition that affects balance
Practice sitting in a parked car with the client and reaching for various controls as well as checking blind spots encouraging maintenance of proper body alignment
If the client intends to purchase a new/used vehicle, recommend that they check the weight of the doors to determine if they are able to reach them easily in order to shut the door after entering the vehicle

4. Strength

Encourage client to take frequent breaks when driving to avoid becoming over fatigued due to effort required to control vehicle
If client cannot do up seatbelt independently, teach alternate strategies (e.g., use of whole hand to push clip into lock) to ensure they are able to use this safety device
Reduce effort steering or electronic gas and brake may be needed
Recommend that the client engage in a community fitness program to increase their strength and core strength, within the limits of any medical condition that affects strength
If not sure that client can safely drive because of reduced strength, refer to a driver rehabilitation specialist for evaluation and recommendation of vehicle modifications