Older adults who are fond of driving and have become accustomed to it throughout the majority of their adult lives may experience difficulty with driving at an older age. This difficulty may impair their mobility and independence, as well as their ability to reach various destinations. Consequently, it can disrupt their occupational, social, and familial routines. In the current era, people work even after their official retirement age. Therefore, impeding driving can also result in financial damage.

Changes in medical conditions, including alterations in vision, cognitive changes, physical impairments, mental disabilities, and the natural aging process, affect mobility in general and driving in particular. Various disabilities and impairments negatively affecting driving ability that have not been identified or treated, may pose a significant hazard to both the drivers and those in their vicinity, including other drivers and pedestrians.

The driving rehabilitation process involves diagnosing the underlying problem, with an emphasis on identifying the source of the difficulty to drive safely (for instance, motor function, vision impairment, behavioral, cognitive, or perceptual problems). It also involves finding solutions and performing various adjustments to be able to continue driving safely. For example, adjustments related to seating position while driving, optimizing the visual arrangement of the driving environment, and implementing learning strategies to enhance attention and concentration during driving.

It is important to note that the issue of assessing and addressing mobility issues within the community through occupational therapy, as well as driving rehabilitation, has been advancing globally and in Israel. This progress is an integral part of therapeutic and rehabilitative endeavours aimed at restoring individuals to active participation in the community at large and facilitating independent living.

Who requires driving assessment and rehabilitation

• Drivers suffering from medical or functional conditions, acquired, hereditary, or permanent, or such that have worsened over the years, that may hinder their ability to drive
• Drivers who have undergone physical or brain injuries that may affect their ability to drive, such as cerebrovascular accident (stroke), head injuries, spinal cord injuries, and amputations (due to diabetes)
• Drivers suffering from diseases that have worsened over the years and with aging, such as Parkinson’s disease, multiple sclerosis, and arthritis
• Drivers suffering from dementia
• Drivers who are in good health or their family members who are concerned about their driving ability because of their age seek to evaluate their skills when they recognize a specific issue and are uncertain about its potential impact on driving.

The process of assessment and rehabilitation is performed with the utmost sensitivity because, occasionally, the drivers themselves are not aware of the problem affecting their driving. It is important to keep in mind that they are usually people who have driven most of their adult lives and find it difficult to imagine their lives without a vehicle assisting them to manage their daily routine. Therefore, if you, as family members or people in their immediate vicinity, observe a decline in their driving abilities that could potentially result in unsafe driving, you can get help from the family doctor and other professionals who can assist you in effectively communicating with the driver about their declining driving abilities and the implications it may have.

The obligation to report and determining driving fitness

In Israel, according to paragraph 12b of the Transportation Ordinance, any change in a person's medical condition that could potentially impact their driving ability must be reported to the relevant authorities. In Israel, the obligation to report any changes in the physical, visual, cognitive, or mental condition of a driver that could affect their driving ability lies with the drivers themselves rather than with their family doctors, who may observe such changes.
During the driving fitness test, the driver’s license is not revoked, but they may not drive until the end of the test.

At the end of the assessment process, the overall driving fitness ability will be determined. According to the findings, the Medical Institute for Road Safety will determine whether the driver is fit for driving or not. If required, they will recommend certain physical and technical adjustments (including adjusting devices for the car).

If you have decided to undergo an examination at the occupational therapy clinic specializing in driving, the occupational therapists will write down their decision and forward it to the referring factor. It is important to note that the family doctor, upon receiving the assessment summary from the occupational therapist, is obliged to report the driver’s lack of driving fitness to the Medical Institute for Road Safety, which serves as a professional, statutory authority.

Filing an appeal on the driving fitness test

If a decision has been made regarding a driver’s lack of driving fitness in the Medical Institute for Road Safety, leading to a license revocation, it is possible to file an appeal. In certain cases, there are instances of changing medical conditions where a driver has recovered from a specific injury that initially resulted in a decision on lack of driving fitness. In such situations, the appeal process allows for a re-evaluation of the updated condition.

Get to know the Medical Institute for Road Safety (Marvad)

The Medical Institute for Road Safety serves as the authorized body, according to the law in Israel, to determine a person’s fitness to drive.

The Marvad forwards recommendations to the Ministry of Transportation and the Licensing Department regarding a driver’s medical condition and its implications for driving. The Medical Institute will provide recommendations for the necessary medical examinations to assess driving fitness, including assessments related to vision, neurology, and psychiatry. Psychologists are also employed by the Medical Institute to assess the cognitive aspects, as well as the neurological and personality factors that impact driving fitness or lack thereof.

Part of the examinations take place at the Marvad branches in Tel Aviv or Haifa. However, due to the high demand for the institute, certain drivers are referred to external providers to undergo the assessment of driving fitness.

Within the Marvad, a committee is responsible for assessing vehicle size, providing recommendations on the appropriate type of vehicle for the driver, and determining the necessary adaptations such as steering wheel, pedals, and other devices.

The process of assessing driving fitness

The overall process of assessing driving fitness is performed by an occupational therapist who leads the diagnostic processes in the clinic, and also supervise the process of diagnosis and assessment of driving itself (performed by a driving instructor as well).

In recent years, there have been courses for diagnosis and rehabilitation in the broader field of mobility, specifically focusing on driving abilities. These courses are offered as part of continuing education and graduate studies in occupational therapy, providing an opportunity for specialization in this domain. There are medical centers with clinics dedicated to the diagnosis and rehabilitation of driving abilities. These clinics provide treatment to patients who seek assistance voluntarily, at the request of their family members, or upon referral from medical professionals such as doctors. The services provided in these clinics entails payment.

Nevertheless, it is essential for every occupational therapist to recognize the significance of mobility and the driving domain as integral aspects of professional intervention. This recognition stems from the understanding that these domains are fundamental to an individual's active participation in the community, family, and daily routines.
Therefore, when you refer to a driving diagnosis and assessment, make sure the specific occupational therapist has undergone appropriate training and has explicit knowledge of the issue of driving.

The process of driving skills rehabilitation

After analysing the underlying problem that has led to a disruption or deterioration in driving skills, if the examinee has been found to have a potential to resume driving, they will be referred to begin a driving skills rehabilitation program, including interventions targeting all stages of driving. The process is led by certified occupational therapists. The process includes:

• Occupational therapy which focuses on enhancing aspects that can be improved, including reaction time, visual concentration, divided attention, and balance enhancement
• Driving simulator training, as a function which includes driving
• Driving training with a driving instructor: The occupational therapist will emphasize to the driving instructors the various issues that the driver should encounter during driving lessons and provide guidance to both the teaching instructor and the driver regarding further independent training
  • Adjusting the type of car, aid devices and car environment (for instance, the required parking space) for the driver’s needs.

Driving alternatives

If the professional assessment concludes that the driver is unfit to drive, they will receive consultation and guidance regarding alternative options for transportation instead of relying on their familiar and convenient car.

• Public transportation: Receiving guidance, training, and gaining experience in using accessible and safe public transportation
• Electric scooter: An alternative to driving is the use of an electric scooter, which can be considered feasible after assessing the driving environment and estimating the driver's cognitive ability to operate it safely
• A driver: This can be either a caregiver, a hired driver, or occasionally, a family member who joins in the effort
• Transportation services: Various associations operate transportation services, for a nominal fee or voluntarily. Contact the welfare departments in your place of residence to obtain specific details
• Safe mobility in the community: Personal consultation of an occupational therapist, involving a combination of guidance, training, and practical experience in road-crossing and safe walking along roads. This may involve the use of simulators as well as real-life practice in community settings.