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IMPORTANCE: Although the Assessment of Motor and Process Skills (AMPS) is an excellent tool for evaluating the functional performance of instrumental activities of daily living (IADLs), a limited number of studies have used the AMPS for decisions regarding the IADL of fitness to drive and community mobility. OBJECTIVE: To determine the specificity and sensitivity of the AMPS as a tool for determining a person's fitness to drive. DESIGN: Cross-sectional observational design. SETTING: Three driving rehabilitation programs in three states. PARTICIPANTS: Participants were 388 community-living adults (M age = 68.74 yr, SD = 11.53); 196 adults were recruited before completing a comprehensive driving evaluation, and 192 were recruited in two other studies of older drivers. OUTCOME AND MEASURES: AMPS and results of comprehensive driving evaluation or on-road assessment. RESULTS: Using a logistical regression, AMPS Motor and Process Skills scores yielded a sensitivity of 84.6% and a specificity of 88.8%. The odds ratio of the AMPS Motor Skills score was .347; for the AMPS Process Skills score, it was .014. Using cross-validations, the model with AMPS Motor and Process scores produced a cross-validation area under the curve of .918, with sensitivity and specificity of 84.6% and 88.4%, respectively, and a probability greater than .334 was used for predicting a fail or drive-with-restriction evaluation. CONCLUSIONS AND RELEVANCE: The AMPS Motor and Process Skills scores revealed significant differences between those who failed or had driving restrictions and with those who passed the driving evaluation, which supported the AMPS as an effective tool for predicting fitness to drive. Plain-Language Summary: This study demonstrates how the Assessment of Motor and Process Skills (AMPS), as a top-down occupational therapy assessment tool, can be used to differentiate between medically at-risk drivers who are likely to pass a comprehensive driving evaluation and those who are likely to fail or need restrictions. AMPS will assist occupational therapy practitioners in determining who is most appropriate to receive driving rehabilitation services and/or when to refer a person for a comprehensive driving evaluation.

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Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

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Purpose: Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study's objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae. Design: Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a) ≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed. Results: Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p<.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048. Conclusions: CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.

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''Using eye-tracking technology, this study examined hazard detection at night. Using a 2 (younger versus older) x 2 (simulator versus on road) repeated-measures mixed design, 16 older adults and 17 younger adults drove their own vehicle and on a driving simulator under nighttime conditions wearing eye tracking technology. Both driving conditions had three roadway hazards of pedestrians looking at their cell phone while posed to cross the roadway. Pupil glances were recorded using outcome measures of total fixation duration, number of fixations, and time to first fixation. Results showed older adults detected hazards similarly to younger adults, especially during on-road performance. Night hazard detection was similar across driving conditions except for time to first fixation, which was faster on-road for both age groups. Results support potential use of driving simulators as a proxy for on-road with night driving needed for research and practice.

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IMPORTANCE: Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD). OBJECTIVE: To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA. DESIGN: A pretest-posttest design using the same intervention and outcome measures. SETTING: University research setting. PARTICIPANTS: Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female. INTERVENTION: A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM. OUTCOME AND MEASURES: Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey. RESULTS: Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008). CONCLUSIONS AND RELEVANCE: Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM. Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver's license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence.

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This cross-sectional study compared visual-motor processing speed and reaction times between medically-at-risk drivers and normal controls to determine if the time in seconds distinguished between drivers who pass, fail, or need restrictions based on a road test. The medically-at-risk drivers' data (N = 35, 28-89 years) were collected as part of a comprehensive driving evaluation and coded by diagnosis (e.g., cognitive, neurological, medical) and driving outcome. The healthy control (N = 121, 21-79 years) data were collected in previous studies. The Vision Coach™ Full Field 60 task was used to collect reaction times in seconds between the two groups. Independent t-tests showed a significant difference (p < .001) in trial times between healthy controls and medically-at-risk adults. No significant difference (p = .141) was found between the three diagnoses groups. The resulting scores from the Vision Coach™ demonstrated a significant different (p < .001) between those who were determined fit to drive without restrictions and those who were determined not fit to drive after a comprehensive driving evaluation, showing the potential to be used as a screening tool for determining driving risk.

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Occupational therapists are in a unique position to screen and evaluate fitness to drive with both visual-motor processing speed and reaction time being important factors to consider when determining fitness to drive. This study uses the Vision CoachTM to investigate the differences in visual-motor processing speed and reaction time across age and sex of healthy adults. It also explores whether the position of sitting or standing made any difference. The results showed no difference between male/female or standing/sitting positions. However, there was a statistically significant difference between age groups, with older adults demonstrating slower visual-motor processing speed and reaction times. These findings can be used for future studies to explore the impact of injury or disease on visual-motor processing speed and reaction times and its relation to fitness to drive.

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This study explored the effect of music on the driving performance of experienced young adult drivers with and without autism spectrum disorder (ASD) using an interactive driving simulator with two types of scenarios. A 2 (Group: autism/neurotypical) × 2 (Music: music/no music) × 2 (Scenario: hazards/wayfinding) factorial design was used with the order of scenarios and music conditions counterbalanced. Participants were 34 neurotypical drivers and 5 drivers with ASD, all with at least 3 years of driving experience. Paired sample t-tests demonstrated no effect of music for any condition. Overall, the drivers with ASD had higher performance means than the neurotypical group with significant differences in the wayfinding scenario and the category for following regulations. Neurotypical drivers had better performance on the wayfinding scenario than the hazard scenario in maneuvers and being attentive to the environment. Although this study had a low number of drivers with ASD, it suggests drivers with ASD can perform better than neurotypical drivers, possibly because they follow road rule guidelines more consistently than neurotypical peers. In addition, this is the first study to examine wayfinding skills in teens/young adults with and without ASD.

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This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.

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Community mobility is important for social participation and quality of life. Thus, it is important to sustain older adults in their communities by supporting their ability to drive as long as possible. Use of global positioning system (GPS) technology may provide such support. This descriptive study examined 89 healthy community older adults' perspective on using and programming a GPS after using it for wayfinding to unfamiliar destinations. Participants were equally divided between two age groups (60s, 70s) and familiarity with GPS (familiar, unfamiliar). The results showed age differences in problems following GPS directions and those who were familiar found it significantly easier to use. The majority of the unfamiliar group indicated an increased interest in using GPS and were significantly more interested in training to use a GPS. Preference for learning how to use a GPS included in-person delivery and practice with troubleshooting, using the menus and changing routes as topics critical for training. The implications of these results are discussed.

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BACKGROUND AND OBJECTIVES: New technologies are being implemented in motor vehicles. One key technology is the electronic navigation system (ENS) that assists the driver in wayfinding, or actually guides the vehicle in higher level automation vehicles. It is unclear how older adults interact with ENSs and the best approach to train older adults to use the devices. The objectives of this study were to explore how older drivers interacted with an ENS while driving on live roadways and how various training approaches impacted older drivers' ability to accurately enter destinations into the ENS. RESEARCH DESIGN AND METHODS: In Experiment 1, 80 older drivers navigated unfamiliar routes using an ENS or paper directions and completed a series of ENS destination entry tasks. In Experiment 2, 60 older drivers completed one of three training conditions (ENS video only, ENS video with hands-on training, placebo) to examine the impacts of training on destination entry performance. RESULTS AND DISCUSSION: Driving performance was aided by the use of the ENS, but many older drivers had difficulty entering destinations into the device (Experiment 1). The combined video with hands-on ENS training resulted in the best overall destination entry performance (Experiment 2). Practical applications: The results suggest older drivers may experience problems entering destinations into ENSs, but training can improve performance. These performance issues may be especially important as more vehicle features require interaction with computer systems to select destinations or other automation related features. Further research is needed to determine how to prepare the next generation of older drivers who will interact with technologies aimed at increasing mobility.

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Objective: Considerable evidence indicates that medical conditions prevalent among older individuals lead to impairments in visual, cognitive, or psychomotor functions needed to drive safely. The purpose of this study was to explore the factors determining driving difficulties as seen from the viewpoint of 30 older drivers with mild cognitive impairment (MCI) and 30 age-matched controls without cognitive impairment. Methods: Perceptions of driving difficulties from both groups were examined using data from an extensive questionnaire. Samples of drivers diagnosed with MCI and age-matched controls were asked to report the frequency with which they experienced driving difficulties due to functional deficits and knowledge of new traffic rules and traffic signs. Results: The analysis revealed that 2 factors underlie MCI perceptions of driving difficulties, representing (1) difficulties associated with late detection combined with slowed response to relevant targets in the peripheral field of view and (2) difficulties associated with divided attention between tasks requiring switching from automatic to conscious processing particularly of long duration. The analysis for healthy controls revealed 3 factors representing (1) difficulties in estimating speed and distance of approaching vehicles in complex (attention-dividing) high-information-load conditions; (2) difficulties in moving head, neck, and feet; and (3) difficulties in switching from automatic responses to needing to use cognitive processing in new or unexpected situations. Conclusions: Though both group analyses show difficulties with switching from automatic to decision making, the difficulties are different. For the control group, the difficulty in switching involves switching in new or unexpected situations associated with high-information-load conditions, whereas this switching difficulty for the MCI group is associated with divided attention between easier tasks requiring switching. These findings underline the ability of older drivers (with MCI and without cognitive impairment) to indicate probable impairments in various driving skills. The patterns of difficulties perceived by the MCI group and the age-matched healthy control group are indicative of demanding driving situations that may merit special attention for road designers and road safety engineers. They may also be considered in the design of older drivers' fitness to drive evaluations, training programs, and/or vehicle technologies that provide for older driver assistance.

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BACKGROUND.: Route navigation is a high-level skill and requires intact executive functioning to successfully find one's way while driving in unfamiliar environments. PURPOSE.: Driving performances were compared while navigating using electronic devices and printed directions on unfamiliar driving routes as well as in an interactive driving simulator. METHOD.: Twenty-four participants drove two on-road routes using GPS and printed directions, and navigated using printed directions in the simulator, using a point system to evaluate performance. The two unfamiliar routes, order of simulator and on-road driving, and use of GPS and printed directions were counterbalanced. Paired t test were used to compare both GPS versus printed directions and performance between on-road driving and the simulator. FINDINGS.: Participants' performance using GPS on the road was significantly better than with printed directions. There was no significant difference between performance in the simulator and on the road. IMPLICATIONS.: Using GPS may be an effective strategy for improving safety. Using a driving simulator may be an efficient means of evaluating the strategic level of driving, executive function, and readiness to drive.

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This article discusses what is currently known about three important topics related to older driver safety and mobility: screening and evaluation, education and training interventions, and in-vehicle technology. Progress is being made to improve the safe mobility of older adults in these key areas; however, significant research gaps remain. This article advances the state of knowledge by identifying these gaps, and proposing further research topics will improve the lives of older adults. In addition, we discuss several themes that emerged from the review, including the need for multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education/training for both older adults themselves and the variety of stakeholders involved in older adult transportation; and programs and interventions that are flexible and responsive to individual needs and differences.

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Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences.

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Driving is a highly valued instrumental activity of daily living on which many older adults depend for access to their community. The demand to address driving is changing as older adults experience increasing longevity while facing medical conditions that often affect their fitness to drive. As one of the most complex of daily tasks, driving is a multifaceted issue that involves the older driver, family members, state licensing and health care practitioners. This commentary discusses potential options and strategies for making evidence-based fitness to drive decisions by differentiating between driving skills and driving capacities, and how these differences are manifested on the road. Typical service options are described using an algorithm format that suggests decision points with options and referrals for service based on the individual's experiences and/or needs.