Trouble Getting In and Out of Vehicles?

How hard is it for you to get in and out of your vehicle? If you are having trouble, have you discussed this problem with your primary provider? Your primary provider can help by completing assessments, providing you with some resources, maybe even ordering Physical Therapy to conduct an evaluation, which includes transfer ability in and out of your vehicle. Being able to get in and out of your vehicle, drive and get around, safely, is part of your independence.

For adults 65 and older, primary providers complete an annual assessment to see how well older adults can live on their own. The tool commonly used for this assessment is called the Instrumental Activities of Daily Living (IADL). These activities are self-care tasks that require more complex planning and thinking beyond basic activities of daily living, such as bathing, dressing/undressing, and toileting. Examples of IADL’s include using the phone, shopping for groceries, managing medicines, and getting around independently (Guo & Sapra, 2021). These skills require you to get around on your own, including use of a car, taxi or public transportation. To manage the transportation system requires functional mobility skills to transfers in and out of cars, vans, trucks, and / or buses.

Risk of Falls Getting In and Out of Vehicles

The risks of older adults getting in and out of vehicles has been a safety concern for years. Back in 2008, Dellinger, et al., published the results of their study to examine injuries experienced by older adults boarding (i.e., entering) and alighting (i.e., exiting) motor vehicles, with a special emphasis on falls. Analyzing data to their specific interest, 2001-2003, these researchers analyzed a representative sample, 37,000 annual boarding and alighting injuries required emergency care, 41.3% being due to falls. These falls were higher for women than men, and, hospitalizations were 10 times higher for older adults than those younger than 65yo. Injuries were more common when alighting (exiting) the vehicle, twice the rate, than boarding. These findings are compelling to address strategies to prevent falls while getting in and out of motor vehicles.

I have not found updated information about older adults’ injuries getting in and out of vehicles, but CDC’s Transportation Safety Program does collect and report data about vehicle crash among older adults, as the risk of being injured or killed in a traffic crash increases as people age (CDC, 2021). Risks vary by age, gender, and functional abilities (i.e., vision, cognition, mobility). Other conditions, such as stiff joints and muscles, back, hip and/or knee pain, weakness, make getting in and out of vehicle more difficult, especially if the vehicle seats are too low. But, I did find resources for you to review, strategies to possibly integrate into your safe mobility practices.

Resources to Improve Safety

CDC provides resources to help older adults stay safe on the road. As I explored these resources, I found strategies that also are relevant to increasing your safety getting in and out of vehicle. I hope you will explore these, maybe share them with your family, friends, and neighbors.

CDC’s Older Driver’s Stay Safe Behind the Wheel (here) resource suggests talking with your primary provider about stopping or changing medications that cause blurry vision, dizziness, sleepiness , confusion, fatigue and/or loss of consciousness with your doctor or pharmacist that increase driving risks. Of course, this guidance also includes wearing glasses and corrective lenses as directed. These risks will also impact your safety getting in and out of vehicles, along with hearing problems and slower reaction / reflex times.

CDC’s MyMobility Plan (here) is designed to guide older adults to stay safe, mobile and independent in your home and neighborhood, knowing that changes in mobility will make it harder to get around with aging. I have patients that I have been treated in my Falls Clinic that experienced near misses and falls, with minor or major injurious falls, associated with getting in and out of a motor vehicle. I imagine that you too may know of individuals who have had such experiences, or yourself had such an experience.

New York’s Be Care Ready, Feet Steady: Tips on Safety Getting in and out of Car. (pdf)

Their main message is: Don’t fall getting in or out of your car! They developed a great document that you can download and share
The two key strategies are to get in safely are:

  • Backside in first: Stand with your back to the car and lower yourself carefully so you don’t hit your head. Hold on for balance.
  • Rotate and slide in your feet. If you have weaker legs, you many need to lift your legs and feet into the vehicle.
Three strategies are suggested to safely get out of your car:
  • Don’t rush. Rotate and slide feet out. Check that your seat belt is clear of your arm and your head is clear of the doorway.
  • Plant your feet for balance, with your feet shoulder width apart.
  • Raise yourself up. If you are grabbing onto an object to help get yourself out of the car, make sure it is not going to move.
Other safety tips that are musts to always remember include (…. Please read more):
  • Look for hazards before your move…
  • Make room to move………
  • Secure walkers, canes and similar items……
  • Hold on………

(New York, 2015, June, https://www.health.ny.gov/publications/6514/index.htm )
Alberta, CA’s Learning About Getting in and out of a Car Safely. (here)

This tool’s strategies are similar with the steps outline by the NY resource. However, they have suggestions for older adults who do have problems with mobility and balance, offering step-by-step mobility actions to get into and out of the car, offering products to make it safer and easier to get in and out of the vehicle. The products presented are a grab bar, a car door strap to hold onto, a swivel seat to help you turn on the seat as you lift your legs in or out of the car, and a seat belt extender to make it easier to reach and connect or disconnect your seat belt.

Ladies and Gentlemen, I hope these resources are useful to you, your family and friends, to reduce your fall risks getting in and out of your vehicles. I encourage you to be safe, careful, open, and willing to discuss any concerns about your safety with your primary care provider. Even more resources are available to you. As part of rehabilitation practices, Physical Therapists evaluate and train individuals on mobility and transfer skills that includes vehicles as well as driving skills.

Always know that your entire Harmony Team is dedicated to reducing your risks for falls. I look forward to hearing from you.

Thank you for reading this message and in advance for sharing these resources with others. Your Harmony Team is here for you!

Pat Quigley
04/08/22

References

CDC. (2021, Nov. 17). Transportation Safety. Older Adult Drivers. Available here

CDC. (2021, Nov. 17). Transportation Safety. Older Adult Drivers. CDC Resources. Older drivers: Stay safe behind the wheel. Available here

Dellinger, A.M., Naumann, R., & Haileyesus, T. (2008). Fall injuries in older adults from an unusual source: Entering and exiting a vehicle. Journal of the American Geriatrics Society, 56(4): 609-14. DOI:10.1111/j.1532-5415.2008.01638.x

Guo, H.J., & Sapra, A. (2021). Instrumental activity of daily living. StatPearls. Bookshelf ID: NBK553126PMID: 31985920 Available: https://www.ncbi.nlm.nih.gov/books/NBK553126/

Healthwise Staff. (2020, Nov. 16). Learning about instrumental activities of daily living. My Health Alberta, CA. Accessed 040722. Available here.

New York State. Department of Health. (2015, June). Fall Injury Prevention. Be Car Ready, Feet Steady: Tips on Safely Getting In and Out of Your Car. Available here.