CarFit: A Potential Framework for Addressing Driving in Your Older Adult Patients

By Jamie Stark, OTR/L, AOTA FWE, LSVT

Occupational Therapist

We have all been there. You’re completing an initial evaluation and learn a patient is driving. Based on the findings of your evaluation, patient comments, and family concerns, this sparks some unease for you. You’ve heard it all before: “I only drive to the doctor,” “I stay within a couple of miles of my home,” and, many times, “My kids don’t want me driving anymore.” My own grandfather used to tell me, “I don’t need to be able to see faces when I drive.”

There is so much that goes into driving to make an individual safe, confident, and comfortable, but driving is even more complex than that. Driving is part of our patients’ identities; it allows them the autonomy to get out into the community, participate socially, access their doctors regularly, grocery shop, and do simple errands people tend to take for granted like going to the convenience store or the bank. I often find that my patients who have had to stop driving seem to have lost a part of themselves and feel debased, which makes it a difficult topic to address.  Some of your patients may have been hospitalized with a long road to recovery ahead. They may have not resumed driving due to pressure from family or a lack of confidence in their own abilities. Especially in those instances, you can play such a vital role in their educated decision to resume or quit driving altogether.

Where do you begin? Being able to drive is more than just vision, coordination, and getting to and from the car. Personally, I felt that I had a pretty good handle on addressing driving—until I took a long, hard look at my CarFit materials from graduate school. I realized that I could be doing a lot more to ensure the safety and comfort of my patients. Discussing driving does not have to be uncomfortable for anybody!

What is CarFit and why is it important?

CarFit is a free education program created by the American Society of Aging in collaboration with AAA, AARP, and the American Occupational Therapy Association (AOTA). CarFit focuses on improving the safety and comfort of older adult drivers and ensuring their proper fit between individuals and vehicles.  The program also provides information and materials on available community resources and adaptive equipment to improve the ease and safety of the entire occupation of driving.

People over the age of 65 are the fastest-growing population in the United States. By 2030, there will be 58.9 million people age 65 and older and many of those individuals will still be driving. Community mobility is critical to having access to social participation and the community, and it supports healthy aging. The National Center for Statistics and Analysis data shows that older drivers have a tendency to be safer in regard to wearing their seat belts and obeying laws related to driving. However, they are also more likely to be injured or killed when a crash does occur.  It is extremely important that older adult’s cars are properly adjusted and fitted for them which can increase both the safety of the older adults we serve as well as the safety of other drivers on the road.

The CarFit check itself is a 12-point check performed by a trained team usually consisting of technicians and often occupational therapists. The occupational therapist adds value to the team as they are able to provide great additional training, adaptive equipment recommendations, and resources specific to community mobility. Occupational therapists are uniquely positioned to address and identify the needs of older adult drivers and appropriateness for a referral to address potentially negative findings (i.e., referral to driver rehabilitation programs, a visit to their eye doctor, addressing limitations in strength or range of motion).

What is included in the CarFit check?

This 20-minute check includes the following:

1. How to re-adjust the car if there is more than one driver.
2. Seat belt check/use: should be located low on the pelvis, not over stomach/soft tissue.
3. Steering wheel tilt, distance from the airbag, head restraint: specific measurements are recommended to improve control of the vehicle and ensure proper line-of-sight and access to dashboard controls.
4. Distance from chest to the steering wheel: adjustments allow the airbag to properly and safely deploy.
5. Line-of-sight over wheel: adjustment improves vision and decreases interference from the steering wheel.
6. Position to gas pedal: adjustment decreases fatigue in leg and foot muscles and ensures control.
7. Position to brake pedal: assessed to ensure proper coordination, range of motion, and muscle strength to move between gas and brake and depress the brake pedal.
8. Mirror adjustments: completed to decrease blind spots and improve visibility to make merging and lane changing safer.
9. Neck mobility: to ensure proper cervical range of motion for a blind spot check.
10. Ignition key and system: ensure the ability to insert and turn with ease.
11. Operation of vehicle controls: signals, headlights, flashers, windshield wipers, ability to turn the steering wheel from far left to far right.
12. Vehicle walk-around: This aspect is performed by the OT. The OT completes the walk-around with the driver, which allows the therapist to observe the driver’s balance and mobility. This also provides an opportunity to discuss any questions and any red flags noted by the technician during the CarFit check (i.e., neck mobility, difficulty reaching pedals, or turning key, noting damage to the car indicating the need for more detailed assessment). The OT discusses beneficial resources and adaptive equipment and makes appropriate recommendations.

How can you get CarFit certified?

A half-day training is all it takes to become a trained CarFit technician. Anyone can become trained to be a CarFit technician, so find information for a training near you. After becoming a trained technician, you can take your involvement to a higher level by becoming an event coordinator by attending a two-hour training. Following that certification, you can organize and host CarFit events. Yearly at the AOTA Conference a CarFit training is typically held, which is a great use of your time at the conference! 2  The resources that you keep from the course are informative, concise and very helpful in everyday practice to ensure you are addressing all the vital areas of driving with your patients.

What does CarFit training add to your practice?

You serve older adults in their natural environment and build great rapport with our patients and their families and as a result, they come to trust us and our professional opinion on many topics, and it is important they all know that driving is one of them! Who to better address this than their FOX clinician? Also, if we don’t address their positioning and individual aspects of operating their car, who will?  Many of our patients are still driving; however, I have found that in my practice many of them are not only ill-fitted for their vehicle, which causes them to be less safe while driving but also creates discomfort due to improper positioning. Many older adults are not educated on how to adjust the various parts of their vehicle to optimize fit and this is especially true in those newer vehicles.

By utilizing the information learned in the CarFit training, you will feel confident and well-equipped to team up your skills as a clinician and CarFit technician to address driving with your older adult patients. A short 15-20 minutes is all it takes to provide education and the changes needed to improve the safety and comfort of our patients and others on the road during our treatment session!