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Introduction

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"I think the only way we can grow and get on in this world is to accept the fact we're not perfect and live accordingly."

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—Ray Bradbury, The Illustrated Man

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LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

  1. Identify the implications of driving cessation for the older adult.

  2. Explore alternative methods of community mobility recommended for the older adult.

  3. Identify assessment and intervention options for the geriatric practitioner to support community mobility for the individual client as well as the community and population.

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Clinical Vignette

Mrs. Conchita Sanchez is a 69-year-old retired teacher who is experiencing vision and functional difficulties secondary to her progressing macular degeneration. She has remained active in her retirement as a volunteer in the local elementary school and as a story reader in the children's section of the local library. In addition to being independent in self-care and driving throughout her adult life, Mrs. Sanchez serves as the primary caregiver to her husband who has Parkinson's disease. She has been the sole driver in her household for more than 5 years and has been responsible for all shopping, transport to medical appointments for both herself and her husband, and has assisted her daughter with afterschool pickup of the grandchildren 2 days per week at school. Now, however, her vision has deteriorated to the point that she can no longer drive.

  1. On the basis of the brief occupational profile of Mrs. Sanchez, what areas of occupational engagement will be most influenced by her inability to drive?

  2. What suggestions might you have for facilitating continued occupational engagement and fulfillment of her roles as volunteer, spouse, caregiver, and grandparent?

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Losing the Ability to Drive: A Psychosocial Perspective

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In Western industrialized society, the ability to drive and hold a driver's license is very important both psychologically and functionally because it is equated with freedom, choice, identity, independence and autonomy, and status (Portegijs, Rantakokko, Mikkola, Viljanen, & Rantanen, 2014). Functionally, having a driver's license means you can go shopping, visit a friend, keep appointments, go to your place of worship, or just take a drive whenever and wherever you choose. Community mobility is recognized as an occupation in the Occupational Therapy Practice Framework (3rd ed.; American Occupational Therapy Association [AOTA], 2014), defined as "planning and moving around in the community and using public or private transportation, such as driving, walking, bicycling, or accessing and riding in buses, taxi cabs, or other transportation systems" (p. S19). In addition to being an occupation, community mobility is an "occupation enabler" because mobility in the community serves as a conduit to engagement in many other occupations including work, leisure, and instrumental activities of daily living (Stav, 2015). Due to the occupation and occupation enabler status of community mobility, one's ability to access and be mobile in the community has significant implications for the ...

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