Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Mobility Assistance for People with Cognitive Disabilities (MAPCD) program, including the WayFinder 3 assistive smartphone navigation app and training program, addresses barriers to community mobility and provides supports to both individuals with cognitive deficits and their caregivers. We describe the MAPCD program and examine strategies that facilitated the adoption of the WayFinder 3 app designed to optimize independent community mobility. Primary Author and Speaker: Sarah E. Anderson Additional Authors and Speakers: Lisa Juckett Contributing Authors: Carmen DiGiovine, Sandra A. Metzler, Ashley Stojkov, Bethany Frick, Kaetlyn E. Culter, and Elizabeth Mance

Date Presented 04/8/21 People with developmental disabilities (DD) often face transportation challenges that impede community participation. The purpose of this study was to examine the impact of a comprehensive intervention program on the travel skills of individuals with DD to increase community mobility. Primary Author and Speaker: Elizabeth Pfeiffer Contributing Authors: Allison Smith

Date Presented 04/13/21 The MAPCD project uses the WayFinder3 GPS app and comprehensive trainings to improve community mobility for individuals with cognitive disabilities and their caregivers. Participants used the app in their daily lives, and preliminary findings demonstrate unique and substantial benefits including increased autonomy and improved quality of life. This research advances the field of OT through the implementation of innovative assistive technology to improve independence in community mobility. Primary Author and Speaker: Kaetlyn E. Culter

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This mixed-methods online survey collected self-report data from 88 older adults on self-restricting driving behaviors. Data identified trends in various factors, including overall driving behaviors, community mobility, use of alternative transportation, and age of older adults independently living in urban and suburban California. Increased self-restricted driving behaviors were reported with the increased age of respondents. This change in driving results in diminished occupational participation. Primary Author and Speaker: Winifred Schultz-Krohn Additional Authors and Speakers: Elisa Chan, Alyson Bothman, Lisa Bullard, Nicholas Chambers, and Derek Colvin Contributing Authors: Chiao-Ju Fang

Importance: Driving is one of the most important instrumental activities of daily living. As adults age, many face challenges with maintaining independent driving, leading to risk for decreased occupational engagement and quality of life. The extent to which occupational therapy services meet the driver rehabilitation needs of older adults is unknown. Objective: To characterize driver rehabilitation service utilization among a nationally representative sample of community-dwelling older adults. Design: Exploratory, descriptive cross-sectional study using the National Health and Aging Trends Study 2016 wave. Participants: Community-dwelling adults age 65 and older who received rehabilitation services in the past year (N = 1,173). Outcomes and Measures: Sociodemographic information, comorbidities, rehabilitation use, community mobility, and participation restrictions were collected using self-report and performance-based measures. Results: Of this sample of older adults, 63.0% reported driving as their primary mode of transportation, 25.8% reported limitations in community participation related to transportation, and 9.2% reported having received rehabilitation focused on driving or other transportation goals in the past year. Findings from this study suggest a discrepancy between utilization of driver rehabilitation and self-reported need. Conclusions and Relevance: Many older adults reported limitations in community participation for transportation-related reasons, yet driver rehabilitation represented only a small proportion of services used. As experts in driver rehabilitation, occupational therapy practitioners should lead the way in advocating for increased utilization of driver rehabilitation and development of innovative, accessible transportation options to promote community mobility and participation among older adults. What This Article Adds: The results of this study illustrate an important discrepancy between self-reported need for and utilization of driver rehabilitation services. Occupational therapy practitioners can play an important role in meeting older adults’ driving and transportation needs to enable them to fully participate in their community and daily routines.

OBJECTIVE. Community participation is integral to wellness. This study examined the outcomes of Let’s Go, a program designed to facilitate community participation of urban-dwelling, low-income older adults. METHOD. Fifty-two older adults participated in a mixed-methods, single-group pretest–posttest study. The Impact on Participation and Autonomy Questionnaire, participant surveys, and semistructured interviews were used to evaluate self-reported participation in community-based occupations, confidence, isolation, frequency of community trips, autonomy outdoors, and satisfaction with social life and relationships. RESULTS. Significant improvement was found in participation, confidence, frequency of community trips, autonomy outdoors, and satisfaction with social life and relationships at 4 wk and 6 mo. Qualitative themes were decreased isolation, importance of peer and community support, increased knowledge of mobility options, and a shift from fear to confidence. CONCLUSION. Community mobility programming can facilitate the participation of marginalized older adults in community-based occupations.

This systematic review presents research on the effectiveness of occupation- and activity-based interventions to improve everyday activities and areas of occupation and social participation for people with traumatic brain injury (TBI). Nineteen studies identified through a comprehensive database search were reviewed and synthesized into five themes: (1) multidisciplinary and interdisciplinary treatment approaches, (2) community-based rehabilitation programs, (3) treatment approaches using client-centered goals and relevant contexts, (4) social skills training and peer mentoring interventions, and (5) community mobility interventions. Evidence supports the use of multidisciplinary and interdisciplinary approaches across a variety of settings, with no single treatment approach or setting clearly superior to another. The specific contributions of occupational therapy practitioners and the nature of occupational therapy interventions have not been well studied, making it difficult to determine the extent to which occupation- and activity-based interventions provided by occupational therapy practitioners improve occupational performance and social participation after TBI.

Difficulty in driving after deployment has emerged as an impediment for servicemembers returning from Operation Iraqi Freedom and Operation Enduring Freedom (OIF–OEF). This study explored postdeployment driving stress and related occupational limitations using two self-report instruments: the Driver’s Stress Profile and the Driving and Occupational Limitations questionnaire. Data gathered from 103 OIF–OEF returnees confirmed that driving and related occupational issues occur postdeployment. Significant low to moderate correlations were found between postdeployment driving stress and limitations in community mobility, leisure, and social participation. The returnees who drove off base more frequently during deployment showed significantly higher levels of postdeployment driving stress than the returnees who drove off base less frequently. Moreover, the returnees who demonstrated higher levels of driving stress and occupational limitations required more time to resume normal driving postdeployment. Findings raise awareness about the need to design effective driver rehabilitation and community reintegration programs for this population.

A systematic literature review was conducted to evaluate the effectiveness of interventions within the scope of occupational therapy practice to improve or maintain the driving performance and community mobility of older adults with low vision. The results of this review identified a limited number of articles—eight—that met the inclusion criteria. Identified intervention strategies included the use of bioptics or prisms, multidisciplinary vision rehabilitation for community mobility, driving simulator training, driver education programs, and orientation and mobility training. Evidence is insufficient for the effectiveness of these interventions in improving or maintaining the driving performance or community mobility of older adults with low vision. Key study limitations included heterogeneity of sample characteristics (age, type of vision impairment), lack of standardization of interventions (device type, time, intensity duration), and lack of standardized assessments to measure driving and community mobility. This evidence-based review is informative for discussion of practice, education, and research implications.

A systematic review of literature related to the effects of drivers’ license policies and community mobility programs on older adult participation was completed as a part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. The results revealed that states can achieve a goal of reducing traffic crashes, traffic violations, and traffic-related fatalities through relicensing policies requiring in-person renewal and vision testing as well as driving restrictions. Evidence suggests that failure to consider the continued community mobility needs of older adults can result in increasing fatalities among senior citizens using other modes of community mobility. This evidence-based review is informative for occupational therapy practice; however, it does not reveal the association between policy and community mobility interventions and improved engagement and participation. There is a role for occupational therapy in policy development and community mobility programming to promote engagement in occupation to support participation.

In response to demands of health care and community-based systems, occupational therapy practitioners are eager to provide effective services that are client centered, supported by evidence, and delivered in an efficient and cost-effective manner. Findings from the scientific literature provide a source of legitimacy and authority for informing and guiding practice in all areas, including driving and community mobility with older adults. A systematic review examined studies designed to enhance the driving ability, performance, and safety of older adults. This article presents an overview of the methodology used to develop the focused questions related to the person, vehicle, infrastructure, and policy and community mobility; conduct the literature review; and establish quality control. It includes a summary of the evidence and implications of the review for clinical practice, education, and research to ultimately identify interventions effective in supporting older adult participation and engagement in occupation.